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Experimental Therapy Helps Some With Type 1 Diabetes Stop Insulin
· Confirmed
In Short: Eledon Pharmaceuticals' experimental immune therapy, tegoprubart, has shown promise in helping some patients with type 1 diabetes (T1D) stop using insulin, according to a study published by Healthcare Brew.
Eledon Pharmaceuticals' experimental immune therapy, tegoprubart, has shown promise in helping some patients with type 1 diabetes (T1D) stop using insulin, according to a study published by Healthcare Brew.
In a trial involving 12 participants with T1D, 11 were able to stop using insulin after receiving islet cell transplants and tegoprubart treatment.
Dr. Piotr Witkowski, director of the pancreas and islet transplant program at UChicago Medicine, noted that one participant had successfully stopped using insulin after passing a four-week threshold.
The therapy's success hinges on its ability to prevent transplant-related immune toxicity, a common issue following islet transplantation.
Dr. Marlon Pragnell, VP of research and science at the American Diabetes Association, highlighted the potential of tegoprubart to solve transplant-related immune toxicity issues.
The current standard of care often involves drugs like tacrolimus, which can damage islet cells and kidneys, ironically exacerbating diabetes symptoms.
Dr. Kenneth Custer, executive vice president and president of Lilly Cardiometabolic Health, emphasized the importance of innovative treatment options that provide greater flexibility in managing type 2 diabetes.
However, tegoprubart is not yet approved for use in type 1 diabetes due to the risk of severe hypoglycemia, as noted by Eli Lilly.
The Breakthrough T1D organization has updated its disease-modifying therapy research funding strategy to include combination therapy, aiming to delay disease progression and potentially achieve remission.
Dr. Haller, speaking to Medscape, argued that until a therapy can induce immune tolerance, a combination of induction and maintenance therapy will be necessary for treating T1D.
The BANDIT trial, which tested baricitinib in newly diagnosed T1D patients, showed that while the drug could preserve insulin production, its benefits were not sustained once treatment was stopped.
Dr. Laura Young, lead author of the WISDM study, published in JAMA, highlighted the potential of wireless technology to improve diabetes management in seniors.
Background
An experimental immune therapy called tegoprubart, made by Eledon Pharmaceuticals, has allowed some patients with type 1 diabetes to stop using insulin.
What's confirmed
- The FDA has approved the once-weekly injectable basal insulin drug insulin efsitora alfa-gobe (Onswik, Eli Lilly) for use as an adjunct with diet and exercise to help control blood sugar in adults with type 2 diabetes (T2D).
What's still developing
- If the more serious side effects can be prevented, a much larger population of people with T1D could have access to this therapy.
- "It's extremely unusual in a kid who presented like he did at his age, to now at almost 11 years old have such a robust C peptide with low insulin requirement and A1c in the low 5s. I will argue that's because of this combination therapy approach," Haller said.
- Specifically, Haller said, for individuals who still have some residual beta-cell function, one approach may be to use induction therapy with a potent immunomodulator such as teplizumab or the investigational human anti-thymocyte globulin SAB-142.
- "Most of us say that until we have a therapy that truly induces immune tolerance, which would be actually fixing the immune system entirely and permanently, we're going to need this sort of induction and maintenance therapy model. That's how almost all other autoimmune diseases are treated," said Haller.
- He subsequently received two courses of teplizumab infusion, followed by maintenance therapy with baricitinib (Olumiant, Lilly), a JAK inhibitor already approved for rheumatoid arthritis and alopecia areata and previously shown to preserve beta-cell function.
- In 2023, the groundbreaking Australian BANDIT (Baricitinib in New Onset Type 1 Diabetes) trial [1] reported that a daily pill of baricitinib, commonly prescribed for rheumatoid arthritis and alopecia, could safely preserve the body's own insulin production and slow the progression of type 1 diabetes (T1D) in people recently diagnosed with the condition.
- Now the follow-up of the blinded BANDIT trial, being presented at this year's Annual Meeting of The European Association for the Study of Diabetes (EASD), Vienna (15-19 Sept), reveals that once baricitinib treatment was stopped, participants' diabetes progressed-they produced less insulin and had less stable blood sugar levels, that were not significantly different to those on placebo.
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- The FDA approval decision was also informed by phase 3 data in two trials in adults with type 2 diabetes and CKD, FIDELIO-DKD and FIGARO-DKD.
- Two months after the This Is Us alum shared she had begun using a GLP-1—a Type II diabetes medication that can also be prescribed for weight loss—she reflected on the other health benefits she has experienced—namely, the strength to handle a four-month stint in Broadway’s & Juliet, which ended last month.
- The human gut is home to trillions of microorganisms (the microbiome), a vast community that helps shape digestion, immune function and metabolism.