Talk:Onasemnogene abeparvovec

Zolgensma name
Just to clarify, AVXS-101 is being investigated in two formulations: an intravenous formulation, intended to be used in infants under ~9 kilograms; and an intrathecal formulation, to be used in all other SMA patients. The company has already submitted the dossier (in EU, Japan, and USA) for the intravenous formulation, which if approved will be sold as "Zolgensma". The intrathecal formulation, on the other hand, is still in the clinical trial stage and has no trade name announced. The two will, naturally, be different drugs and it is incorrect to claim that "Zolgensma" will be the trade name for both. Sources: Avexis website; SMA News Today; and others. — kashmīrī  TALK  20:34, 10 January 2019 (UTC)


 * - Oh cool. Thanks. I wasn't aware of the different formulations. I've created a separate page for AveXis BTW. NickCT (talk) 21:03, 10 January 2019 (UTC)

Adverse effects and side effects
Are simple synonyms. A summary should also be in the lead. Doc James (talk · contribs · email) 12:01, 12 November 2019 (UTC)
 * Not really . Onasemnogene abeparvovec has no known side effects, however there have been a number of adverse events observed during the three small clinical trials. They are mentioned on the leaflet, in line with regulatory requirements, but I don't think it makes much sense to list them in the lede unless we know they occur frequently. FYI, the clinical trials of this drug were conducted on a total number of just 68 patients. — kashmīrī  TALK  22:12, 12 November 2019 (UTC)
 * They are listed here https://www.fda.gov/media/126109/download
 * The source says "The most common adverse reactions (incidence ≥ 5%) were elevated aminotransferases and vomiting"
 * Seems fairly clear to me.
 * Yes the terms can be used in different ways but in common use they are synonyms. It is perfectly reasonable to write the lead in common rather than technical English. Doc James  (talk · contribs · email) 12:28, 18 November 2019 (UTC)

Side effects in the lead
I see zero need to add side effects in the lead, for two reasons: As a comparison, there is no point of listing death as a side effect in the lead sections of articles on surgical operations, although death certainly is listed among possible complications. Simply, except for cosmetic surgeries, people usually have no alternative and the decision on the method is taken by the surgeon. So, let's keep lead sections focused on the treatment and not on possible complications and adverse events.
 * These are all adverse events observed in the trials which may or may not be linked to the active substance.
 * This is not an OTC drug and people do not chose it based on side effects - so side effects are not a key information for them.


 * Some of these side effects are key things patients and their health care providers should be watching out for. They are part of a summary of a medication. In fact key side effects are what the prescribing information by the FDA begins with Doc James (talk · contribs · email) 12:37, 18 November 2019 (UTC)
 * Wikipedia is not a guide and the clinicians who will use the specialty drug Zolgensma will know perfectly well what to watch for without checking on Wikipedia. As I wrote, this is not an OTC drug. The leaflet does not use the term "side effects" either. — kashmīrī  TALK  12:46, 18 November 2019 (UTC)
 * Wikipedia is also not a patient handout but is for everyone. Attempting to suppress the black box warning attached to the worlds most expensive medication... You will need consensus. Doc James  (talk · contribs · email) 12:48, 18 November 2019 (UTC)
 * Nobody is suppresing anything. Lead section has a specific structure and purpose - that is to define the term - and you can't singlehandedly stick anything there that is printed in a box by a source. — kashmīrī  TALK  12:52, 18 November 2019 (UTC)
 * Per WP:LEAD the lead is "an introduction to the article and a summary of its most important contents." Doc James  (talk · contribs · email) 12:56, 18 November 2019 (UTC)
 * WP:LEAD is clear on this, therefore agree w/ Doc James--Ozzie10aaaa (talk) 13:50, 18 November 2019 (UTC)
 * Note the word "SUMMARY". It's on purpose. What you did in the lede here was to copy entire sentences from body. Also I disagree that side effects or observed adverse events are one of "most important" articles on drugs (other than OTC drugs where I find it justified to include warnings in prominent place). — kashmīrī  TALK  19:34, 18 November 2019 (UTC)
 * Sure so obviously we disagree. Doc James  (talk · contribs · email) 13:22, 19 November 2019 (UTC)

Obscure names
Such as the one it was developed under "AVXS-101" do not belong in the first sentence of the article. It can go in the infobox and the body of the text. Doc James (talk · contribs · email) 12:41, 18 November 2019 (UTC)
 * Although it may appear strange, there is world out there outside of the US. In that faraway world, trade names are not allowed to be used before drugs receive regulatory approval, and AVXS-101 has traditionally been used there for convenience, being shorter than that onase.... word. — kashmīrī  TALK  12:50, 18 November 2019 (UTC)
 * Basically unpronounceable. Doc James  (talk · contribs · email) 12:53, 18 November 2019 (UTC)
 * agree w/ Doc James--Ozzie10aaaa (talk) 12:57, 18 November 2019 (UTC)
 * Kashmiri you obviously do not have consensus for this. Doc James  (talk · contribs · email) 13:36, 19 November 2019 (UTC)

Not sure what you are getting at with
"OA as a biologic should never be conflated with the medication approved in the US"? Is the claim that the biologic is not the medication? Or the medication is not the biologic?

The medication is now approved so it is "used to treat" not just "developed to treat" Doc James  (talk · contribs · email) 13:24, 19 November 2019 (UTC)
 * agree--Ozzie10aaaa (talk) 15:29, 19 November 2019 (UTC)

WP:MEDMOS

 * We use person rather than patient.
 * We use easier to understand language especially in the lead. Doc James  (talk · contribs · email) 13:30, 19 November 2019 (UTC)
 * Agree on both, although I don't think "intravenous" is such an arcane term as not to be understood by the person who looks up this particular article. We do have an option of wikilinking for a reason. — kashmīrī  TALK  00:49, 20 November 2019 (UTC)
 * "One time injection into a vein" in my opinion follow well and not seeing a need to change... Doc James  (talk · contribs · email) 13:25, 20 November 2019 (UTC)

Edit warring
I'm here from an RFPP request to full-protect this page because of your ongoing content dispute, in which you are clearly reverting each other multiple times over at least the last day. You're both very experienced editors and clearly knowledgeable about the topic, and I see there has been some discussion, so for the time being I am declining the request. But please slow down, discuss your edits, and reach a consensus before you make changes to the article. I would rather not come back and make log entries for this page. Ivanvector (Talk/Edits) 14:40, 19 November 2019 (UTC)
 * Thanks (similarly, I would rather not have to report this to 3RR, so hope it is resolved without further edit warring).  Sandy Georgia  (Talk)  14:46, 19 November 2019 (UTC)
 * Hi, thanks, your lenience is very much appreciated. James and me are currently sorting this out off-wiki (as the discussion covers some non-public information). I am sure we will get there. Timezone difference is not working to our advantage, so things might take a while. Thanks again, — kashmīrī  TALK  00:46, 20 November 2019 (UTC)
 * There are some further issues that need addressing. Doc James  (talk · contribs · email) 14:24, 20 November 2019 (UTC)

Unfortunately our off-wiki discussion did not bring resolution. I am repeating my arguments here: — kashmīrī  TALK  19:39, 1 December 2019 (UTC)
 * OA is still an experimental compound in all the world's countries except one, and in all of them it is known as onasemnogene abeparvovec and AVXS-101. Excising this information from the lead section and supplanting it with US marketing data directly violates WP:GLOBAL. I am strongly against reducing Wikipedia to US commercial market.
 * Doc James clearly confusues side effects, which form the drug's properties, with adverse reactions observed during clinical trials which may or may not be treatment-related. The impact on liver function seems to be universal and is now a black box warning, so it should be mentioned. Otehr "side effects" listed by Doc James in the lead section are mentioned on the drug's prescribing information only as adverse events observed in the three trials.
 * I think it is an honest mistake when Doc James confused drug's effects on humans with effects on lab animals: the drug's prescribing information carries no mention of heart effects in humans; it only mentions heart problems observed in lab mice in a section on animal toxicity. I have now removed the mention of heart defects from the lead.
 * Doc James argues that we should highlight prescribing information for use of "clinicians and healthcare providers". Well, as much as I wholeheartedly support the efforts to improve the quality of medical information on Wikipedia, I am dead against anyone promoting Wikipedia as the source of medical information for clinical practice. Patients should never make treatment choices based on Wikipedia, whilst clinicians should always refer to the drug's prescribing information and/or academic publications. Period. We have WP:NOTAGUIDE for a reason. Consequently, I see a rough overview of pharmacological properties as desirable in the lead but I think fine details should be skipped in order not to blur the picture and confuse the reader hoping to guide them in their choice of treatment. Here, as OA's safety profile has been deemed acceptable by the FDA (although this might change given recent tox reports), whilst SMA type 1 is a potentially fatal disorder, we should take special care that the information on WP is presented to both the patient and their referring clinician in a balanced way, without unnecessarily focusing on either benefits or risks of the treatment.

Heart damage
Yes an elevated trop represents heart damage. Ref says "Transient increases in cardiac troponin‑I levels (up to 0.176 µg/L) were observed following ZOLGENSMA infusion in clinical trials." So no not just lab mice. Doc James (talk · contribs · email) 00:26, 2 December 2019 (UTC)
 * Transient increase in troponin-I levels is NOT equal to heart damage. Don't invent stuff. Increased cardiac troponin‑I is associated with a higher probability of cardiovascular events (e.g., acute heart failure) but itself is not the same as "heart damage". For instance, the increase may stem from an off-target effect on the TNNI3 gene that encodes troponin-I, or there may be other explanations as well that you as a non-researcher have not thought of. So either quote the source exactly as it says or leave out what you don't understand. — kashmīrī  TALK  01:42, 2 December 2019 (UTC)
 * Here is a quote for you: cTn levels can also be elevated in many other conditions, including heart failure.... And then check Figure 1 with a list of such conditions. —  kashmīrī  TALK  01:52, 2 December 2019 (UTC)
 * Yes elevated trops represent heart damage.
 * A trop is elevated in heart failure as there is ongoing heart damage. Doc James  (talk · contribs · email) 02:17, 2 December 2019 (UTC)
 * That may be in your area of work. In biology you can think of many other mechanisms. It may be an effect on TNNI3, it may be a cross-reaction between the active compound and the chemicals used in troponin testing, it may also be caused by the impurities in OA (the manufacturer perhaps does not dislose it, but AO contains a much higher percentage of impurities [miscoded viruses] than a small-molecule GMP drug), and perhaps many others. See, there are more things in biology and medicine than are dreamt of by ER doctors.
 * That's why I insist that you stick to the wording used in the source instead of inventing own stuff, per WP:NOR. — kashmīrī  TALK  14:50, 3 December 2019 (UTC)
 * An increased trop represents damage to the heart. So restored the prior wording. Doc James  (talk · contribs · email) 23:59, 29 March 2020 (UTC)
 * How about "There is also evidence of damage to the heart of unclear significance."? Doc James  (talk · contribs · email) 00:13, 30 March 2020 (UTC)

FDA
It should be stated what FDA stands for, as a European I had to check it on Google. — Preceding unsigned comment added by 178.255.153.164 (talk) 18:05, 27 December 2019 (UTC)
 * Wikipedia can be edited by anyone. Feel free to improve the article. — kashmīrī  TALK  18:37, 27 December 2019 (UTC)
 * ✅. Primefac (talk) 18:42, 27 December 2019 (UTC)

Name should be explained
"Onasemnogene abeparvovec is the international nonproprietary name (INN) and the US adopted name (USAN)." All very well and good, but what does this alphabet soup (even with "xioi" on the end as well) actually mean or derive from? This article doesn't say. 2A00:23C4:7681:8500:81D9:9F21:BC97:368F (talk) 02:48, 8 March 2021 (UTC)