Saturday, January 18, 2014

Possible Cures for Type-1 in the News (mid January)

Data from 2 Year Follow up of Rituximab (anti-CD20)

Rituximab works by suppressing a specific cell in the immune system, which is involved in communicating and organizing the body's autoimmune attack.  (Specifically: it suppresses B-cells with the CD20 marker, which is why it is refered to as an "anti-CD20".  Immune B-cells have nothing to do with pancreatic beta cells, except a similar name.)

My previous blogging on this trial is here:

Here are the most important parts of their results, from my point of view:
The rate of decline of C-peptide was parallel between groups [treated and untreated], but shifted by 8.2 months in Rituximab treated subjects.
In recent-onset T1DM, Rituximab delays the fall in C-peptide, but does not appear to fundamentally alter the underlying pathophysiology of the disease.

From a cure point of view, this is not a great result, and is similar to several other immune drugs, which tend to delay/extend the honeymoon period.  Years ago, I was hopeful that by combining these drugs or maybe by tweaking doses, that we could turn results like these into a cure. However, I'm less optimistic about this now.  Mostly because I have not seen any research into combinations, or any clinical trials that are trying larger, more frequent doses, or anything else that might squeeze better results out of the drugs that are giving these small results.


Vitamin-D Not Associated with Type-1 Diagnosis

Previous studies done on Vitamin-D being associated with type-1 diabetes has been mixed. Some studies show a correlation between low Vitamin-D and type-1, while other studies do not. This study comes down on the side of "no association".

Here is the title of the paper, which makes a good summary, as well:
No Difference in Vitamin D Levels Between Children Newly Diagnosed With Type 1 Diabetes and Their Healthy Siblings: A 13-Year Nationwide Danish Study
Full text:

Previous blogging on Vitamin-D is here:

Teplizumab Commentary

I have previously blogged on Teplizumab, and the following link goes to some commentary on the results that I blogged about in September:

Here is some more commentary on Teplizumab, including some interesting notes on type-1 diabetes in India.  As you read, remember that the author is assoicated with the company that produces Diamyd, which is a direct competitor to Teplizumab:

Factoid: In One Study 1/3 of Type-1s Had Some Retinopathy After 20 Years

In the study below, the researchers were trying to predict which people with type-1 diabetes would have retinopathy (eye-damage) and which would not.  But to me, the more important information was the overall number.  One third of the people who were followed for 20 years, had some level of retinopathy.  For me, that was a surprisingly high number.  But maybe I just wasn't paying attention.  I actually think that the real number might be much higher, because this study required that the patients go to the same doctor for all 20 years, and that they have A1C numbers from that entire time, so that is a very stable group of people.  It may well be that people who visit multiple doctors over the course of 20 years (which is to say, most people) have a higher level of retinopathy.


Joshua Levy
publicjoshualevy at gmail dot com
All the views expressed here are those of Joshua Levy, and nothing here is official JDRF, JDCA, or Tidepool news, views, policies or opinions. My daughter has type-1 diabetes and participates in clinical trials, which might be discussed here. My blog contains a more complete non-conflict of interest statement. Thanks to everyone who helps with the blog.


Mark Moddey said...

Re: "1/3 patients with retinopathy after 20 years". Lets not overlook that this is 20 years gone by already. Patients first were diagnosed between 1988-1990. The link between tight glucose control and retinopathy, among other complications, wasn't fully accepted in the medical community until 1994. Also, Rapid acting insulin did not hit the market until 1996 with lily's humalog. I feel 20 years in the future with modern insulin and pumps these numbers will be far less than 1/3. Oxidave stress also plays an integral role in the development of retinopathy, one would hope that keeping OS at bay with tighter glucose control and antioxidants will change future prognosis for those of us with type 1.

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