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During the early months of the COVID-19 pandemic, a campaign launched by social media-savvy nephrologists, scientists, and researchers challenged published information about the effects of renin-angiotensin system (RAS) inhibitors in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Using a comprehensive social media strategy, a working group founded by Matthew A. Sparks, MD, a Duke nephrologist, researcher, and expert in medically oriented social media, actively pointed out limitations of the research published on RAS inhibitors early in the pandemic.

A correspondence posted in March in The British Medical Journal followed by a rapid response in The Lancet Respiratory Medicine suggested that the use of RAS inhibitors such as angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors could increase SARS-CoV-2 infectivity and severity.

These articles triggered worldwide interest because of the extensive use of commonly prescribed ARBs and ACE inhibitors. Of the 20 most prescribed drugs in the U.S., two from those classes are near the top: lisinopril ranks third, and losartan ranks 11th.

“These poorly referenced articles attempted to apply the findings of a few papers to an entire population. Researchers cannot cite just a few papers and make those claims,” says Sparks, who specializes in RAS inhibitor research. “It is important to take into account the entire breadth of research.

“There was a lot of anxiety about these references to RAS inhibitors,” he adds. “Nephrologists expressed concerns because the use of RAS inhibitors impacts so many people.”

Sparks is on the board of directors of Nephrology Journal Club (NephJC), a not-for-profit international scientific nephrology resource and study group that uses Twitter to promote research, guidelines, and editorials related to nephrology. NephJC also produces Freely Filtered, a nephrology-focused podcast, and maintains regularly updated pages devoted to COVID-19 research with particular relevance to nephrology. Research updates are catalogued meticulously on the website, increasing the information’s utility.

Matthew Sparks, MD, Duke nephrologist
There was, in fact, no reason to stop ACE inhibitors or ARBs. And we presented some evidence that they may be beneficial. In fact, we reached equipoise. It set the stage for future clinical trials.
Matthew Sparks, MD, Duke nephrologist, and experienced social media user

Science-based Social Media

Sparks was also instrumental in creating a research team examining COVID-19 effects across multiple organ systems. The team included 16 scientists and clinicians who emphasized the need for more data related to the lung’s susceptibility to SARS-CoV-2. All were experienced social media users.

The working group published and promoted an early conclusion: Patients taking ACE inhibitors or ARBs are not advised to change therapies unless advised by a physician. Using Twitter and other social media platforms, the working group highlighted flaws in the initial analysis and rebuked the broad conclusions, encouraging additional research based on larger, randomized controlled clinical trials.

This campaign contributed to the launch of trials and new studies—key factors in reversing the momentum of the initial research. “At the time, there were few experts and no lectures to offer contrasting advice,” Sparks says. “There was a massive proliferation of information that conspired to create a great deal of confusion.”

It was a “perfect storm,” Sparks remembers, as established research and RAS inhibitor expertise collided with science-based social media efforts. “There was, in fact, no reason to stop ACE inhibitors or ARBs,” he says. “And we presented some evidence that they may be beneficial. In fact, we reached equipoise. It set the stage for future clinical trials.”

Speed proved to be a valuable aspect of the social media campaign, Sparks says: “If you wait for a journal to publish a paper, you must wait months. That’s why the frequent posts and updated coronavirus information provided via our NephJC website proved so important.”

Based on his experience with social media, Sparks encourages physicians to incorporate social media training into medical school curricula. To this end, Sparks has worked with several collaborators to create the Nephrology Social Media Collective, an international internship program aimed at helping nephrologists and researchers to develop confidence, knowledge, competence, and professionalism in the use of social media.