The top tweeted terms are the trending industry discussions happening on Twitter by key individuals (influencers) as tracked by the platform.

1. Asthma – 501 mentions

The effect of permanent night shifts on asthma, failure of AstraZeneca’s promising asthma drug, and use of hormonal contraceptives for reducing asthma in women were popularly discussed topics in Q4 2020. Juan C Ivancevich, associate professor of immunology at the University of Salvador, shared an article on how people working in permanent night shifts are at an increased risk of moderate to severe asthma compared with people working in normal office hours.

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The findings were from a study published in the medical journal, Thorax, which noted that permanent night shifts misaligns the circadian rhythm of an individual with the external cycle of dark and light. The misalignment elevates the risk of various metabolic and cardiovascular diseases, and cancer in an individual, the article added.

Carlos Andres Celis-Preciado, a pulmonologist at the Hospital Universitario San Ignacio, further discussed the term with respect to failure of AstraZeneca’s asthma drug, tezepelumab, in meeting the primary endpoint in a late-stage clinical trial. Tezepelumab did not demonstrate efficacy in significantly reducing the dependence of asthma patients on oral corticosteroids maintenance drugs, without loss of asthma control.

Asthma also trended in discussions shared by Michael Blaiss, executive medical director of the American College of Allergy, Asthma, and Immunology, on the beneficial effects of hormonal contraceptives (not including progestogen-only contraceptives) in reducing severe asthma exacerbations in women.

He shared an article on a 17-year follow-up study conducted in 83,084 women aged between 16 and 45 years with asthma, which showed that hormonal contraceptives use had a small beneficial effect on asthma exacerbation. The article added that these findings were needed to be confirmed in additional studies.

2. Arthritis – 298 mentions

Racial health disparities in arthritis treatment, the importance of total joint replacement in arthritis patients and novel options in knee osteoarthritis treatment were the popular topics of discussion in Q4. Creaky Joints, a community of people suffering with arthritis, shared an article on a research study that highlighted how rheumatoid arthritis patients of the black community were more likely to be prescribed glucocorticoids than targeted biologic treatments when compared to white patients. The findings were based on analysis of health record data from 1,831 rheumatoid arthritis patients between 2010 and 2018 at an academic centre in Pennsylvania.

The data revealed that 74% of white patients were prescribed a biologic drug compared to 67% of black patients and the frequency of emergency hospital visits of black patients were significantly higher during the eight years. Glucocorticoids have a risk of several severe long-term adverse events such as high blood pressure, diabetes, and osteoporosis, the article added.

Lee E Rubin, an orthopaedic surgeon at the Yale University, further tweeted that joint replacement surgeries such as total hip arthroplasty (THA) or total knee arthroplasty (TKA) should not be considered as merely elective surgeries. He noted that these surgeries have a life-changing impact on arthritis patients who are living in a worse than death health state due to hip or knee pain.

Rubin shared a study published in the Bone and Joint Journal in which a total of 2,073 patients undergoing THAs and 2,168 patients undergoing TKAs were analysed. The study found that 19% of patients waiting for THA and 12% awaiting TKA for their degenerative joint disease were in worse than death state.

Another discussion related to arthritis was shared by Dr John Cush, a rheumatologist at the UT Southwestern Medical Centre, on a study that compared the efficacy of intra-articular steroid injections with intra-articular lidocaine alone in symptomatic knee osteoarthritis. The study was conducted in a small group of 27 patients with knee osteoarthritis who were administered intra-articular methylprednisolone acetate with lidocaine and lidocaine alone. Intra-articular steroid injections were found to be more effective than just intra-articular lidocaine in the study.

3. Lupus – 83 mentions

Biologic therapies for lupus and the success of hydroxychloroquine in the treatment of lupus were popularly discussed in the fourth quarter. Juan Ovalles, a rheumatologist at the Hospital La Milagrosa at Vithas, shared an article on how researchers are working to repeat the success of the biologic therapies for arthritis for the treatment of systemic lupus erythematosus for the last two decades.

He shared a study published in the Current Opinion in Rheumatology, a medical journal, on the recent promising results from open clinical studies of monoclonal antibodies that block interferon and fully humanised anti-CD20 offering a new prospective in the treatment of lupus.

Dr Ai Lyn Tan, a rheumatologist, further shared an article on how nailfold capillary (NFC) abnormalities in lupus patients improved with hydroxychloroquine monotherapy. The data was published in Rheumatology Advances in Practice, the official journal of the British Society for Rheumatology. The NFC abnormalities are caused due to enlarged or ramified capillaries, old or new haemorrhages, and avascular areas, the article added.

Lupus was also discussed by Creaky Joints on how hydroxychloroquine was found to be safe for women with lupus during pregnancy. The drug helped lupus patients have healthier pregnancies with lower rates of flares and premature deliveries compared to those not taking the medication.

4. Immunotherapy – 64 mentions

Immunotherapy for the treatment of allergic rhinitis, the role of immunotherapy in asthma treatment, and advancements in allergen immunotherapy were widely discussed topics in Q4 2020. Dr Dave Stukus, an immunologist at the Food Allergy Centre, shared an article on how subcutaneous and sublingual immunotherapy tablets were found to be effective for allergic rhinitis and may prevent or support allergic asthma. He added that acupuncture and herbal medications have not been backed by sufficient clinical studies to be recommended as the treatment of allergic rhinitis.

George du Toit, professor in paediatric allergy at the King’s College London, discussed how immunotherapy supported asthma patients in reducing their dependence on long-term control medications. He shared an article on how subcutaneous immunotherapy improved asthma patients’ ability to exhale and their overall quality of life.

Another discussion around immunotherapy was shared by Juan C Ivancevich on how allergen immunotherapy is a viable treatment to control allergen asthma. However, the available data related to the allergies from pollen, moulds and pets, as well as other severe allergic conditions is not sufficient to establish the impact of allergen immunotherapy on allergic asthma subtypes.

5. Atopic Dermatitis – 55 mentions

The efficiency of tapinarof topical cream in psoriasis, effect of disparities on atopic dermatitis patients, and encouraging results of Pfizer’s dermatitis drug were popularly discussed in Q4. Dominique du Crest, a dermatology curator, shared an article about the effectiveness of Dermavant Sciences’ topical tapinarof cream for the treatment of plaque psoriasis in a phase III late-stage clinical trial. Tapinarof is the first non-steroidal topical treatment option for psoriasis and atopic dermatitis. Out of 1,025 randomised patients with plaque psoriasis in the study, 35.4% of the patients treated with tapinarof once-daily achieved total skin clearance at week 12, the article noted.

Dr Dave Stukus further tweeted on how atopic dermatitis impacts patients with different skin colours and allergies. Atopic dermatitis patients with different skin colour show different manifestation of conditions such as erythema, follicular eczema, pigment masking and post-inflammatory pigmentary alteration (PIPA).

Atopic dermatitis also trended in discussions shared by Michael Blaiss to highlight the positive results of a late-stage clinical study of Pfizer’s abrocitinib for the treatment of moderate to severe atopic dermatitis. Approximately 64.7% of the enrolled patients in the study showed a positive response to the drug during an initial 12-week period. The approval of the drug can help patients reduce the rate of troublesome flare-ups, the article added.