Delaying the Onset of Type 1 Diabetes with Teplizumab: A Narrative Review of Autoantibody Screening and Who Would Actually Be Treated
DOI:
https://doi.org/10.5281/zenodo.22238844Keywords:
Type 1 diabetes, Teplizumab, Islet autoantibodies, Population screening, Disease stagingAbstract
Type 1 diabetes has an asymptomatic phase that can be detected years before insulin is required, and a single 14-day course of an
anti-CD3 antibody has been shown to postpone the clinical diagnosis. In a randomised trial of 76 relatives of people with type 1
diabetes, all of whom had two or more islet autoantibodies and dysglycaemia, 43 per cent of those given teplizumab progressed to
clinical diabetes against 72 per cent given placebo, and the median delay in diagnosis was two years. At the close of the trial 57
per cent of the treated group remained free of diabetes against 28 per cent of the placebo group. The result is genuine and was
sufficient for regulatory approval, but two problems sit alongside it. Published correspondence noted that the survival curves
converge after the first year, so a median delay of two years does not describe a uniform two-year postponement for everyone
treated. And the drug can only be given to people identified in the asymptomatic phase, which requires autoantibody screening of
populations in whom the great majority screened will never be eligible. This review sets out what the trial established, what it did
not, and what the screening requirement implies.
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