User:Jan2020-med2024/sandbox

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Practice Editing Here (Nov 23rd in-class Wiki session work)

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

Assignment # 3
Wikipedia Article Title: Amyloidosis
 * Note: You will be emailing your assignment # 3 directly to your tutor, however, please paste a version here that excludes your personal information. This will allow us to support your efforts on Wikipedia prior to editing "live" in the article.

1.     Proposed Changes

Add to the end of ‘Research’ section:

Research into treatments for ATTR amyloidosis have compared liver transplantation, oral drugs that stabilize the misfolding protein (including tafamidis and diflunisal), and newer therapeutic agents still being investigated (including patisiran). Based on available research, liver transplant remains the most effective treatment option for advanced ATTR amyloidosis, protein stabilizing drugs may slow disease progression but were insufficient to justify delay of liver transplant, and newer agents such as patisiran require additional studies.

2.     Rationale for proposed change

The research section of the Wikipedia article mentions the novel RNA silencing drug patisiran as an upcoming therapy for ATTR. However, this information is not provided in the context of other treatments like liver transplant and oral drugs that stabilize the misfolded protein (tafamidis and diflunisal). Liver transplantation remains the most effective treatment because tafamadis and diflunisal did not delay disease progression sufficiently to delay transplant. However, liver transplant is for advanced disease and drugs that can inhibit protein misfolding are important for treatment earlier in the disease. This is why novel RNA silencing drugs like patisiran are promising. So far, patisiran has been studied in a very selective patient population, so the potential of patisiran must be moderated relative to other treatment methods.

3.     Controversy

There may be controversy about tafamadis, one of the oral drugs that stabilizes the misfolded transthyretin protein. Tafamadis is one of the most expensive drugs on the market. The Canadian Agency for Drugs and Technologies in Healthcare (CADTH) found that a price reduction of 92% would be required for tafamadis to be cost effective, especially considering the uncertainty about the long-term efficacy of tafamadis beyond 30 months. The high cost of tafamadis may have affected research, since clinical trials may not have compared new treatments to tafamadis. In contrast, diflunisal is a small fraction of the cost. Given the potential bias that the cost of tafamadis may have induced in the literature, I referred to both protein-stabilizing drugs (tafamadis and diflunisal) as a group and attempt not to overstate their potential as treatments.

4.     Critique of Source

This is a comprehensive review of studies that have evaluated the efficacy and safety of treatments for ATTR. The inclusion criteria may have missed some studies in diverse populations by only selecting English language publications.

To assess the methodological quality of included studies, the authors used quality scales including PRISMA, Jadad, and Oxford quality scale. The majority of clinical trials had low quality scores, and the observational studies were of moderate quality. Due to this overall low quality, the authors provided summaries of the included studies but did not perform any meta-analyses. The low quality of studies is a major limitation, but likely unavoidable due to the relative rarity of this disease and thus limited research.

It may have been helpful if the authors examined the funding sources of included studies. Of the 21 included studies, 11 were about tafamadis. It would be relevant to know if this relative abundance of tafamadis information is funded by one pharmaceutical company.

We propose to add to the section called Signs and Symptoms - Heart. Our proposed paragraph is as follows: Cardiac amyloidosis can present as symptoms of heart failure including shortness of breath, fatigue, and edema. As cardiac amyloidosis progresses, the amyloid deposition can affect the heart’s ability to pump and fill blood as well as its ability to maintain normal rhythm, which leads to worsening heart function and decline in people’s quality of life.

What to post on the Wikipedia article talk page?

 * This will also be covered on Nov 23rd 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 2020/Talk Page Template