Immunotherapeutic agents in type 1 diabetes: A systematic review and meta-analysis of randomized trials

Gunjan Y. Gandhi, Mohammad H Murad, David N. Flynn, Mohamed B. Elamin, Patricia J. Erwin, Victor Manuel Montori, Yogish C Kudva

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objective: Although recent trial results of anti-CD3 therapy are promising, there have been conflicting results of various immunotherapeutic agents used in patients with type 1 diabetes. We conducted a systematic review and meta-analysis to determine the efficacy of nonantigen-based immunotherapeutic approaches for preservation of beta-cell function in patients with type 1 diabetes. Methods: We searched MEDLINE, EMBASE, Cochrane CENTRAL, reference lists, and content expert files up to September 2006. Eligible studies were randomized controlled trials (RCTs) of antiproliferative agents (methotrexate, azathioprine), monoclonal antibodies (CD3, CD4), T-cell inhibitors (cyclosporin) and other immunotherapeutic agents (photopheresis, linomide, fusidin, buffy coat, intravenous immunoglobulin, BCG, nicotinamide) in patients with newly diagnosed type 1 diabetes followed for ≥ 6 months. Pairs of reviewers working independently and with adequate reliability assessed the trials' methodological quality, collected data, and conducted random-effects meta-analyses on measures of preservation of beta-cell function (e.g. C-peptide secretion, insulin independence). Results: Of the 299 potentially relevant articles identified after an initial search, 20 trials met selection criteria. Meta-analysis of 20 trials (n = 1187 patients) found a small to moderate improvement in beta-cell function with immunotherapy [vs. placebo, effect size 0.37, 95% confidence interval (CI) 0.14-0.6] but there was moderate inconsistency in results across trials (I2 65%, 95% CI 39-77%). Subgroup analysis suggested a greater effect of cyclosporin and antiproliferative agents on beta-cell function when used for ≥ 6 months (pooled effect size 0.77 vs. -0.11, respectively; P interaction = 0.002). Conclusions: Long-term immunotherapy may preserve beta-cell function in newly diagnosed patients with type 1 diabetes. Patients and clinicians must await the conduct of rigorous trials reporting on diabetes resolution, adverse events, and other patient-important outcomes.

Original languageEnglish (US)
Pages (from-to)244-252
Number of pages9
JournalClinical Endocrinology
Volume69
Issue number2
DOIs
StatePublished - Aug 2008

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Type 1 Diabetes Mellitus
Meta-Analysis
Immunotherapy
Cyclosporine
Photopheresis
Confidence Intervals
Fusidic Acid
Placebo Effect
Niacinamide
C-Peptide
Intravenous Immunoglobulins
Azathioprine
Mycobacterium bovis
Methotrexate
MEDLINE
Patient Selection
Randomized Controlled Trials
Monoclonal Antibodies
Insulin
T-Lymphocytes

ASJC Scopus subject areas

  • Endocrinology

Cite this

Immunotherapeutic agents in type 1 diabetes : A systematic review and meta-analysis of randomized trials. / Gandhi, Gunjan Y.; Murad, Mohammad H; Flynn, David N.; Elamin, Mohamed B.; Erwin, Patricia J.; Montori, Victor Manuel; Kudva, Yogish C.

In: Clinical Endocrinology, Vol. 69, No. 2, 08.2008, p. 244-252.

Research output: Contribution to journalArticle

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abstract = "Objective: Although recent trial results of anti-CD3 therapy are promising, there have been conflicting results of various immunotherapeutic agents used in patients with type 1 diabetes. We conducted a systematic review and meta-analysis to determine the efficacy of nonantigen-based immunotherapeutic approaches for preservation of beta-cell function in patients with type 1 diabetes. Methods: We searched MEDLINE, EMBASE, Cochrane CENTRAL, reference lists, and content expert files up to September 2006. Eligible studies were randomized controlled trials (RCTs) of antiproliferative agents (methotrexate, azathioprine), monoclonal antibodies (CD3, CD4), T-cell inhibitors (cyclosporin) and other immunotherapeutic agents (photopheresis, linomide, fusidin, buffy coat, intravenous immunoglobulin, BCG, nicotinamide) in patients with newly diagnosed type 1 diabetes followed for ≥ 6 months. Pairs of reviewers working independently and with adequate reliability assessed the trials' methodological quality, collected data, and conducted random-effects meta-analyses on measures of preservation of beta-cell function (e.g. C-peptide secretion, insulin independence). Results: Of the 299 potentially relevant articles identified after an initial search, 20 trials met selection criteria. Meta-analysis of 20 trials (n = 1187 patients) found a small to moderate improvement in beta-cell function with immunotherapy [vs. placebo, effect size 0.37, 95{\%} confidence interval (CI) 0.14-0.6] but there was moderate inconsistency in results across trials (I2 65{\%}, 95{\%} CI 39-77{\%}). Subgroup analysis suggested a greater effect of cyclosporin and antiproliferative agents on beta-cell function when used for ≥ 6 months (pooled effect size 0.77 vs. -0.11, respectively; P interaction = 0.002). Conclusions: Long-term immunotherapy may preserve beta-cell function in newly diagnosed patients with type 1 diabetes. Patients and clinicians must await the conduct of rigorous trials reporting on diabetes resolution, adverse events, and other patient-important outcomes.",
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AU - Elamin, Mohamed B.

AU - Erwin, Patricia J.

AU - Montori, Victor Manuel

AU - Kudva, Yogish C

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