Low-Dose Anti-Thymocyte Globulin (ATG) Preserves β-Cell Function and Improves HbA in New-Onset Type 1 Diabetes.

Diabetes Care 2018 Sep 16;41(9):1917-1925. Epub 2018 Jul 16.

Objective: A pilot study suggested that combination therapy with low-dose anti-thymocyte globulin (ATG) and pegylated granulocyte colony-stimulating factor (GCSF) preserves C-peptide in established type 1 diabetes (T1D) (duration 4 months to 2 years). We hypothesized that ) low-dose ATG/GCSF or ) low-dose ATG alone would slow the decline of β-cell function in patients with new-onset T1D (duration <100 days).

Research Design And Methods: A three-arm, randomized, double-masked, placebo-controlled trial was performed by the Type 1 Diabetes TrialNet Study Group in 89 subjects: 29 subjects randomized to ATG (2.5 mg/kg intravenously) followed by pegylated GCSF (6 mg subcutaneously every 2 weeks for 6 doses), 29 to ATG alone (2.5 mg/kg), and 31 to placebo. The primary end point was mean area under the curve (AUC) C-peptide during a 2-h mixed-meal tolerance test 1 year after initiation of therapy. Significance was defined as one-sided value < 0.025.

Results: The 1-year mean AUC C-peptide was significantly higher in subjects treated with ATG (0.646 nmol/L) versus placebo (0.406 nmol/L) ( = 0.0003) but not in those treated with ATG/GCSF (0.528 nmol/L) versus placebo ( = 0.031). HbA was significantly reduced at 1 year in subjects treated with ATG and ATG/GCSF, = 0.002 and 0.011, respectively.

Conclusions: Low-dose ATG slowed decline of C-peptide and reduced HbA in new-onset T1D. Addition of GCSF did not enhance C-peptide preservation afforded by low-dose ATG. Future studies should be considered to determine whether low-dose ATG alone or in combination with other agents may prevent or delay the onset of the disease.

Download full-text PDF

Source
http://dx.doi.org/10.2337/dc18-0494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6105329PMC
September 2018
8 Reads

Publication Analysis

Top Keywords

globulin atg
8
type diabetes
8
β-cell function
8
anti-thymocyte globulin
8
t1d duration
8
low-dose anti-thymocyte
8
preserves c-peptide
4
established type
4
diabetes t1d
4
c-peptide established
4
colony-stimulating factor
4
low-dose
4
therapy low-dose
4
pegylated granulocyte
4
granulocyte colony-stimulating
4
factor gcsf
4
gcsf preserves
4
years hypothesized
4
decline β-cell
4
slow decline
4

Similar Publications