Comparing Beta Cell Preservation Across Clinical Trials in Recent-Onset Type 1 Diabetes

• Published in: Diabetes technology & therapeutics Vol. 22; no. 12; p. 948
• Main Authors: Jacobsen, Laura M, Bundy, Brian N, Greco, Madison N, Schatz, Desmond A, Atkinson, Mark A, Brusko, Todd M, Mathews, Clayton E, Herold, Kevan C, Gitelman, Stephen E, Krischer, Jeffrey P, Haller, Michael J
• Format: Journal Article
• Language: English
• Published: United States 01.12.2020
• Subjects: Intervention; Clinical trial; Type 1 diabetes; Immunotherapy
• ISSN: 1557-8593
• DOI: 10.1089/dia.2020.0305

Several immunotherapies have demonstrated endogenous insulin preservation in recent-onset type 1 diabetes (T1D). We considered the primary results of rituximab, abatacept, teplizumab, alefacept, high-dose antithymocyte globulin (ATG), low-dose ATG, and low-dose ATG ± granulocyte-colony-stimulating factor trials in an attempt to rank the effectiveness of the agents studied. C-peptide 2-h area under the curve means were modeled using analysis of covariance. The experimental treatment group effect for each study, compared with its internal control, was estimated after adjusting for baseline C-peptide and age. Percentage increase in C-peptide over placebo and the absolute difference within study were calculated to compare and contrast effect size among interventions. Low-dose ATG (55% and 103%) and teplizumab (48% and 63%) ranked highest in C-peptide preservation at 1 and 2 years, respectively. Low-dose ATG and teplizumab show the greatest impact on C-peptide preservation among recent new-onset T1D studies; these should be further explored as core immunotherapies in the T1D prevention setting.