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Both the duloxetine (n?=?3,033) and pregabalin (n?=?4,838) cohorts had a mean initiation age around 49?years, 89% were women. During the postindex year, compared to the pregabalin cohort, the duloxetine cohort had higher totally annual supply days (273.5 vs. 176.6, P??0.05), and lower total medical costs ($16,469.1 vs. $20,552.6, P?find more with fibromyalgia who initiated duloxetine in 2008 had better medication compliance and consumed less inpatient, outpatient, and total medical costs than those who initiated pregabalin. Fibromyalgia is an increasingly recognized chronic pain disorder characterized by widespread musculoskeletal pain, tenderness, general fatigue, and sleep disturbances.[1-6] It often co-occurs with other clinical conditions, such as mood disorder, fatigue, headache, irritable bowel syndrome, and interstitial cystitis. The disorder affects about 4 to 10 million Americans and 3% to 6% people worldwide,[7-19] with the highest prevalence rate in women and those with a family history of the condition.[4-7, 9] Treatments for fibromyalgia are mainly aimed at symptom minimization Casein kinase 2 and general health improvement either through prescription medication, behavioral intervention, exercise, or alternative medicine.[20-28] Although patients with fibromyalgia often use analgesics, antidepressants, anticonvulsants, opioids, and dopamine Trichostatin A agonists to relieve their symptoms, only 3 prescription medications have been approved by the Food and Drug Administration (FDA) for the disorder based on their safety and efficacy evidence demonstrated in randomized control trials.[29-41] These 3 prescription medications are pregabalin (an anticonvulsant approved for fibromyalgia in 2007), duloxetine (a selective serotonin norepinephrine reuptake inhibitor (SNRI) approved in 2008), and milnacipran (another SNRI approved in 2009). Although duloxetine and pregabalin are most frequently prescribed among these 3 fibromyalgia medications, no head-to-head randomized controlled trials have been conducted to compare the efficacy and safety of these 2 drugs in patients with fibromyalgia. Real-world studies of these medications in patients with fibromyalgia started in 2010 with the first publication by Zhao and Sun et?al.[6] In that study, Zhao and Sun reported that initiating duloxetine in patients with fibromyalgia was associated with better medication adherence and lower direct medical costs than pregabalin.