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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).

Mycosis Fungoides

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!
 Proposed change #1 

Current sentence: “Mycosis fungoides can be treated in a variety of ways. Common treatments include simple sunlight, ultraviolet light (mainly NB-UVB 312 nm), topical steroids, topical and systemic chemotherapies, local superficial radiotherapy, the histone deacetylase inhibitor vorinostat, total skin electron radiation, photopheresis and systemic therapies (e.g. interferons, retinoids, rexinoids) or biological therapies.”

Replace with: The most commonly recommended first-line treatment for mycosis fungoides is psoralen plus ultraviolet A (PUVA therapy)[14]. PUVA is a photochemotherapy that involves topical or oral administration of the photosensitizing drug psoralen followed by skin exposure to ultraviolet radiation.[15] Although other treatments have been used in combination with PUVA, there is a lack of evidence to support that these combination therapies are effective[14]. Other treatments that have been used include light therapy, ultraviolet light (mainly NB-UVB 312 nm), topical steroids, topical and systemic chemotherapies, local superficial radiotherapy, the histone deacetylase inhibitor vorinostat, total skin electron radiation, photopheresis, systemic therapies (e.g. retinoids, rexinoids), and biological therapies (e.g. interferons).[14]

Rationale for proposed change

Currently, the article merely includes a lengthy list of interventions used for mycosis fungoides treatment, without indicating which intervention is the “gold standard” or providing information on which treatments are effective. The article states that these are commonly used interventions, when in fact PUVA is the most common first-line treatment. Indeed, according to a Cochrane systematic review on interventions for mycosis fungoides, many of these treatments are experimental and lack evidence to support that they are effective. As such, we would like to highlight that PUVA is the most common first-line intervention and provide a brief description of what PUVA is to tailor the article to a lay audience. We also want to add that many treatments that have been used in combination with PUVA lack evidence to support their effectiveness. Importantly, we will replace the current source with one that is more recent (2020 versus 2009) and higher up on the evidence hierarchy (Cochrane systematic review versus narrative review). Lastly, interferons are considered a biologic agent, therefore we will edit the article to have interferons listed as an example of biological therapies, rather than for systemic therapies.

Critique of source

The current source ( https://doi.org/10.1182/blood-2009-07-202895 ) is a narrative review that is 12 years old. In contrast, the source that we are replacing it with ( https://doi.org/10.1002/14651858.CD008946.pub3 ) is a recent (2020) Cochrane systematic review, which is higher on the evidence hierarchy. This systematic review discusses the effectiveness and the frequency of use of various interventions for mycosis fungoides, allowing us to enhance the article by adding information on which treatment is regarded as the first-line intervention and which treatments lack evidence to support their effectiveness. Importantly, this is a secondary source and the conflicts of interest of the contributors are listed. Although one contributor received travel expenses and accommodation from UCB Pharma, this company is not involved in the development of therapeutics for mycosis fungoides. Another contributor acted as a consultant for Lilly and Sanofi and received institutional grants for investigator‐initiated trials from Novartis, Sanofi, ALK, and Pfizer. However, the funded work was outside of the scope of this review. As such, we decided that this source is still appropriate to use. The data is presented in a seemingly unbiased manner and the selection criteria for the included studies are explicitly stated.

 Proposed change #2 

Current sentence: “The US FDA approved the drug mogamulizumab (trade name Poteligeo) in August 2018 for treatment of relapsed or refractory mycosis fungoides and Sézary disease.”

Replace with: “Systemic treatments of mycosis fungoides often lead to resistance; as such, additional treatment options are often necessary in advanced disease. Mogamulizumab is a CCR4 monoclonal antibody which has been shown to improve progression-free survival. It was approved by the US FDA in 2018 for use in people with relapsed or refractory mycosis fungoides or Sézary disease.”

Rationale for proposed change

As it stands, the article cites a press release about the FDA approval of mogamulizumab, without background information on the drug (particularly, there is no reference to it being a monoclonal antibody drug, which separates it from the remainder of the drugs listed in the article). Furthermore, there is no discussion of resistance to treatment, and as such, the importance of additional drugs for advanced MF is not made clear. This change will make the article more informative and provide a more robust source of information (​​ https://doi.org/10.2147/DDDT.S185896 ). There is no evident controversy surrounding the use of monoclonal antibodies in treatment of refractory or relapsed MF.

Critique of source

This source is a review article from a peer-reviewed journal which presents information in a seemingly unbiased manner. It is a secondary source, meaning it reviews multiple literature sources. It is a recent article, published in 2020. Contributor conflicts of interest are disclosed. One potential conflict of interest is that one of the authors is noted as being on the review board for the pharma company that manufactures POTELIGEO® (mogamulizumab). We have chosen to move forward with this source because the majority of the information taken from the article is independent of the drug itself - simply facts on relapse in MF. The data on improved outcomes is from multiple independent studies, and other review articles share similar findings.

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