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Comment & Response
Less Is More
May 2019

Finding the Magic in Magic Mouthwash—Reply

Author Affiliations
  • 1Department of Internal Medicine, Mount Sinai St Luke’s and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York
  • 2Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
  • 3Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
JAMA Intern Med. 2019;179(5):724-725. doi:10.1001/jamainternmed.2019.0291

In Reply We thank Dr Sherr for his interest in our article1 and agree that it focused more on chemotherapy-induced mucositis than radiation therapy–induced mucositis. Oral mucositis remains an often overlooked and undertreated adverse event of cancer therapy that greatly influences the quality of life of patients.2 In the patient with gastric cancer and capecitabine-induced mucositis described in our article, treatment with magic mouthwash resulted in both physical (loss of taste, oral numbness, and drowsiness) and fiscal (out-of-pocket costs) toxicity. Our concerns over the routine use of magic mouthwash in managing oral mucositis go beyond efficacy alone, which itself has been questionable at best. Other issues include the potential for physical adverse events, financial toxicity, lack of standardization of contents, and unnecessary exposure to steroids and antibiotics.1 Without a fixed “recipe,” the generalizability of studies analyzing the efficacy of magic mouthwash is hindered; perhaps a new standard for magic mouthwash can emerge with the publication of the results of the phase 3 randomized double-blind study3 that Dr Sherr mentions.

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