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Amyloidosis
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Practice Editing Here (Nov 15th in-class Wiki session work)

 * This is a place to practice clicking the "edit" button and practice adding references (via the citation button).

Task:


 * 1) Find a peer-reviewed journal article on PubMed. Practice inserting your citation in the above space using the "cite" tool
 * 2) Choose one "B-level" medical article on Wikipedia from the following list: https://wp1.openzim.org/#/project/Medicine/articles?quality=B-Class&importance=High-Class
 * 3) Practice editing live on Wikipedia by finding a typo in the text or improving the clarity/readability of a sentence by adjusting a few words in a sentence.

Assignment # 3- please post an anonymous copy here!
Wikipedia Assignment # 3

Wikipedia Article Title: Amyloidosis


 * 1) Proposed Changes (3 marks):

Proposed Change #1

Original Sentence: Chemotherapy and steroids, with melphalan plus dexamethasone, is mainstay treatment in AL people not eligible for transplant.

Updated Sentence: Chemotherapy treatment including cyclophosphamide-bortezomib-dexamethasone is currently the mainstay treatment for people with AL Amyloidosis not eligible for transplant.

Proposed Change #2

Original Sentence: Eprodisate theoretically slowed renal impairment by inhibiting polymerization of amyloid fibrils, however after a negative phase three trial, it seems unlikely to be effective

Updated Sentence: In people who have inflammation caused by AA amyloidosis, tumour necrosis factor (TNF)-alpha inhibitors such as infliximab and etanercept are used for an average duration of 20 months. If TNF-alpha inhibitors are not effective, Interleukin-1 inhibitors (e.g. anakinra, canakinumab, rilonacept) and interleukin-6 inhibitors (e.g. tocilizumab) may be considered.

Proposed Change #3

Original Sentence: In 2018, inotersen was approved by the European Medicines Agency to treat polyneuropathy in adult patients with hereditary transthyretin amyloidosis.

Updated Sentence: In 2018, inotersen was approved by the European Medicines Agency to treat polyneuropathy in adult patients with hereditary transthyretin amyloidosis. It has since been approved for use in Canada, the European Union and in the USA.

2.      Rationale for proposed changes (3 marks):

# 1: Although the current source was also a review, the new source indicates an updated guideline for treatment of AL Amyloidosis with chemotherapy as it is more recent. Specifically, it indicates that the combination of cyclophosphamide, bortezomib, and dexamethasone appears to be the most commonly used regimen as it was correlated with higher rates of survival after 2 years and 5 years.

# 2: Currently, the information in sentence #2 comes from a phase 3 randomized controlled trial and not from a secondary source. As such, I would like to use the clinical guideline article I have found to provide more accurate and holistic information on the treatment modalities that can be used for secondary amyloidosis. Since the clinical guideline article is authored by experts in the field and has summarized the available evidence with respect to secondary amyloidosis treatment, it is a more reliable source for treatment recommendations than the current source in the article.

# 3: The current status of geographical approval of inotersen use for amyloidosis has been expanded beyond Europe and is now approved in Canada and the U.S. Thus, the current sentence requires an updated source reflecting the most recent information available about where inotersen is approved for use.

3.      Areas of controversy (if applicable) (1 mark):

Each of the changes we would like to make are with respect to replacing the current information in the article with more recent published treatment practices recommended by experts in the field of amyloidosis. As such, we do not believe there are controversies or ambiguities highlighted by our proposed changes.

4.      Critique of sources (2 marks):

The secondary sources utilized for the first two proposed changes were selected because of their high status on the hierarchy of evidence (clinical practice guidelines and systematic review). In addition, both of the articles cited for the proposed changes are recent and published in reputable journals (i.e. in “core journals” as defined by Wikipedia). One critique, however, is that the clinical practice guideline cited for the second proposed change is derived from a European health agency (SHARE). Thus, the treatment recommendations in this article may not be as applicable to the population in North America and could be biased towards clinical practices in Europe. Another critique is that the systematic review cited for proposed change #1 bases the conventional chemotherapy treatment on a single phase III clinical trial. This information could be susceptible to bias as we are unsure whether the results of this study can be replicated. However, we are confident that if the authors of the systematic review decided to include this data in their review, then it is of merit. For the third proposed change, a critique that could be made is about the fact that the selected secondary source is not a systematic review, and that there is limited literature available regarding use of inotersen for amyloidosis. However, we have decided to use this source as the information is recent (published in 2019) and it provides an unbiased approach in discussing numerous primary sources about the use of inotersen across phase I-III clinical trials.

5.      Article improvement (1 marks):

Please refer to question 1 for the proposed improvements to the article. These changes have been added to the “Talk” page of the wikipedia page for Amyloidosis as suggestion #1, #8 and #9.

What to post on the Wikipedia article talk page (part of assignment 3)

 * This will also be covered on Nov 15th in class. Your group should use the below template to share an outline of your proposed improvements (including your new wording and citations). Article talk pages are not places to share your assignment answers. The Wikipedia community will be more interested in viewing your exact article improvement suggestions including where you plan to improve the article (which section), what wording you suggest, and the exact citation (Note: all citations must meet WP:MEDRS)
 * You will not be able to paste citations directly from your sandbox to talk pages (unless you are interested in editing/learning Wiki-code in the "source editing" mode). We suggest re-adding your citations on the talk page manually (using the cite button and populating the citation by pasting in the DOI, website, or PMID). You will have to repeat this process yet again when you edit the actual article live.
 * Talk Page Template: CARL Medical Editing Initiative/Fall 2021/Talk Page Template