Clinical Trials Arena lists the top five terms tweeted on immunology in Q4 2021, based on data from GlobalData’s Pharmaceuticals Influencer Platform.

The top trends are the most mentioned terms or concepts among Twitter discussions of more than 150 immunology experts tracked by GlobalData’s Pharmaceuticals Influencer platform during the fourth quarter (Q4) of 2021.

1. Asthma – 504 mentions

UK-based charities forming a partnership to address lung health issues in children, the overlap between asthma and chronic obstructive pulmonary disease (COPD), and the need for core outcome measurements in asthma were some of the popular discussions on asthma in Q4 2021.

Dr Nick Hopkinson, professor of respiratory medicine at Imperial College, shared an article on UK-based charities Asthma UK and British Lung Foundation establishing the Children’s Charter for Lung Health to protect children’s lungs and prevent ill health and disability. The charter is supported by the British Paediatric Respiratory Society, the British Thoracic Society, the Association of Chartered Physiotherapists in Respiratory Care, and the Association of Respiratory Nurse Specialists.

The charter aims to promote and sustain lung health by ensuring parental health and health during pregnancy and identify action areas to enforce regulations that curb pollution, promote indoor air quality, and reduce exposure to passive smoking. It also aims to improve care for children and young people with lung diseases such as asthma and bronchiolitis, and develop policies and research focused on improving lung health, the article detailed.

In another tweet, Frits Franssen, respiratory physician and professor, shared an article on the Asthma-COPD overlap (ACO), a condition wherein patients experience continued airflow limitation with symptoms that support both asthma and COPD. ACO prevalence is estimated to be between 0.9% to 11.1% in the general population. The symptoms experienced by patients with ACO are more severe and frequent compared to those with asthma or COPD. Patients with ACO are usually excluded from therapeutic trials leading to the lack of evidence-based recommendations for treatments beyond first-line inhaler therapies. The article highlighted that extensive research is required to define the biomarkers of ACO and develop evidence-based treatment options for the condition. Existing evidence including biomarker profiling and genetic data indicate that ACO is a heterogeneous condition, but with definable characteristics.

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John Weiner, a medical consultant specialising in allergic diseases and asthma, shared an article about the need for core outcome measurements in asthma. Sublingual immunotherapy (SLIT) is used to reduce asthma symptoms by introducing small doses of the allergen that a patient is allergic to, which helps in increasing tolerance towards the allergen. A review performed by international charitable organisation Cochrane of 66 clinical trials involving more than 8,000 children found that the evidence supporting the effectiveness of SLIT in treating asthma is currently insufficient.

Furthermore, SLIT was found to be safe in treating mild-to-moderate well-controlled asthma, although additional research is needed to understand the therapy’s safety in uncontrolled asthma. The findings were inconclusive due to the lack of a consistent set of outcome measures used by the trials, which are relevant for people with asthma. The article highlighted the need for the development of core outcome measurement in future clinical trials of asthma, which will help in determining the benefit or lack of benefit offered by SLIT.

2. Coronavirus Disease 2019 and Covid-19 – 327 mentions

A study finding that highly allergic people can safely take the coronavirus vaccine, Covid-19 vaccine generating weak antibody response in people taking immunosuppressants, and a study finding allergies from m-RNA-based Covid-19 vaccines to be rare were some of the popular discussions in Q4.

Dr. John Cush, a rheumatology specialist, shared an article on a study conducted in Israel on the prevalence of allergic reactions in adults who have received the Pfizer-BioNTech Covid-19 vaccine. The study recruited 8,102 adults with a history of allergy and assessed their risk using an algorithm comprising a detailed questionnaire. A total of 429 people who received the Covid-19 vaccine under medical supervision were identified as highly allergic. The study found that 98% of the highly allergic individuals did not have any allergic reaction, while 1% had mild allergic reactions, 0.7% had anaphylactic reactions. The results of the study indicate that a simple algorithm can be used to immunise people with a history of allergy.

In another tweet, Therese Humphrey, a patient advocate at the International Foundation for Autoimmune & Autoinflammatory Arthritis (AiArthritis), shared an article on how Covid-19 vaccine generates poor antibody response in people taking immunosuppressants. TNF inhibitors used to treat rheumatoid arthritis and other autoimmune diseases, for example, generates lower levels of antibodies against the SARS-CoV-2 virus that causes Covid-19. The findings were discovered in a study conducted by the Washington University School of Medicine. The weak antibody response was most prominent against the Delta variant. The study also found that a third dose of Covid-19 vaccine boosted antibody levels although the duration of protection offered by the third dose remains unknown. The researchers highlighted the need for a booster shot for people taking TNF inhibitors. They are also determining the duration of protection offered by the third dose of Covid-19 vaccine for people taking immunosuppressants.

Another discussion on Covid-19 was mentioned by Henry Ehrlich, co-author of Asthma Allergies Children website focused on treatment for asthma and allergies, when referring to a study that found allergies to mRNA-based Covid-19 vaccines to be rare. Conducted by the Stanford University School of Medicine, the study assessed potential allergic reactions to more than 30,000 doses of Covid-19 vaccines developed by Pfizer and Moderna that were administered to health care providers at Stanford. The study found that majority of the reactions developed by people was from an ingredient that stabilises the Covid-19 vaccines and that there were no allergies to the vaccine components that provide immunity against the SARS-CoV-2 virus.

3. Lupus – 141 mentions

Saphnelo^™’s approval by the US Food and Drug Administration (FDA) for the treatment of systemic lupus erythematosus (SLE), the effectiveness of B-cell depletion therapy in the treatment of lupus, and the ways to improve patient outcomes in SLE were some of the popular discussions in the last quarter.

Jose Luis Andreu, associate professor at the University of Madrid’s Department of Medicine, shared an article on the FDA approval of Saphnelo^™ (anifrolumab-fnia) for the treatment of SLE. The approval marks the availability of a new treatment option for lupus, which is estimated to affect 1.5 million people in the US. Saphnelo^™ is a type I interferon receptor antagonist, a key protein found in 80% of adults diagnosed with lupus. The drug’s approval was based on the results of two phase III clinical trials that demonstrated early and sustained benefits on lupus disease activity, skin lupus and joints for people with moderate to severe systemic lupus erythematosus, the article highlighted.

In another tweet, Dr. John Cush shared an article on a trial named NOBILITY that examined the effectiveness of B-cell depletion therapy along with obinutuzumab in the treatment of lupus nephritis (LN). The trial recruited 125 patients with LN who were randomised to receive either obinutuzumab 1,000mg or placebo. The primary endpoint of the study was complete renal response (CRR) at week 52. The study showed that patients administered with obinutuzumab plus standard therapies had improved renal responses compared to those who received standard therapies alone.

Lupus was also mentioned by Dr Ai Lyn Tan, director of research and innovation at the Leeds Teaching Hospitals NHS Trust, who tweeted about a study that examined the ways in which patient outcomes in SLE can be achieved. The study identified newly diagnosed SLE patients in the UK using data from healthcare administrative databases and Office for National Statistics. A total of 809 patients were identified, a majority of who received less than six months of treatment, indicating a delay in the initiation of treatment. Furthermore, most patients experienced disease flares within two months of diagnosis. The study found that initiating treatment at an early stage may slow or reduce the severity of the first SLE flare as well as slow disease progression, minimise organ damage and improve the quality of life of patients.

4. Rheumatoid Arthritis – 119 mentions

Electrical implants being used for treating rheumatoid arthritis (RA), gut microbiome being used to predict prognosis of RA and low flare rate in patients with RA after taking the BNT162b2 Covid-19 vaccine were some of the popular discussions in Q4.

Therese Humphrey shared an article on research being conducted on the use of electrical implants to treat RA. Several studies have analysed the role of the vagus nerve in communicating with the brain when the body is experiencing inflammation. The vagus nerve can serve as a brake for the immune system by sending signals to reduce the release of inflammatory molecules. A small study was conducted to analyse the effectiveness of a vagus nerve stimulation device for RA. The results of the study indicated that the device helped in reducing the signs and symptoms of RA with no adverse events reported. Australia’s non-profit research organisation Bionics Institute is also working on a vagus nerve stimulation device that can be implanted through key hole surgery into the stomach, the article detailed.

In another tweet, Dr. Lee E. Rubin, a board-certified orthopaedic surgeon, mentioned the term while referring to a study that found that gut microbiome may provide an indication of whether the condition of an RA patient will improve. Conducted at the non-profit academic medical center Mayo Clinic, the study was able to forecast clinical outcomes in RA patients with 90% accuracy using gut microbiome data and artificial intelligence (AI). The article stated that probiotics available in the gut play a key role in controlling the course of the disease. The researchers analysed stool samples from 32 RA patients and found that the microbiome traits were different for patients who showed clinical improvement and for those who did not.

Jose Luis Andreu also discussed the term with reference to a clinical assessment that examined the effect of BNT162b2 (BioNTech-Pfizer) Covid-19 vaccine on RA patients. Initial data on the vaccine’s safety and immunogenicity in people with rheumatic and musculoskeletal diseases (RMDs) has indicated a 5%-7% flare rate after vaccination. The article noted that additional data is required for decision-making regarding vaccines in patients with RMD. The clinical assessment examined flare rates in 77 patients with RA three months before vaccination and evaluated disease activity three months after vaccination. The data indicated a low flare rate after taking the Covid-19 vaccine in patients with RA in remission, the article highlighted.

5. Inflammation – 117 mentions

The effectiveness of aliphatic polyamine Spermidine in reducing inflammation in lung diseases such as cystic fibrosis (CF), and higher levels of inflammation in patients with RA increasing the risk of heart failure were some of the popularly discussed topics in the fourth quarter.

B Ramos-Molina, Miguel Servet researcher at Biomedical Research Institute of Murcia, shared a study which found that spermidine, an aliphatic polyamine, was effective in reducing inflammation in patients with CF by inhibiting the production of Th17 cytokine. The Th17/IL-17 signalling pathway plays a key role in the regulation of immune and inflammatory function. Th17 cells produce the IL-17 family cytokines that bind to IL-17 receptors during the activation of the Th17/IL-17 pathway, thereby increasing the release of other inflammatory cell chemokines. The study found that spermidine targets T cells and downregulates the production of inflammatory cell chemokines and has strong anti-inflammatory effects against lung inflammation.

Another discussion on inflammation was shared by Dr. John Cush on a cohort study which found that RA patients with high levels of inflammation were at an increased risk of heart failure. The study included more than 9,000 RA patients with a median follow-up of 10.7 years. The hazard ratio for heart failure at ten years was 1.46 (95% confidence interval) in patients having high levels of inflammatory markers, the study found. Heart failure was diagnosed in 749 patients during the follow-up period of the study, while heart failure developed in 379 patients within five years of diagnosis of RA. Furthermore, the rate of heart failure increased at five and ten years in patients with high inflammation levels at baseline. The findings provide an opportunity for mitigation of heart failure in RA patients during the early stages of the disease, the article highlighted.