Global first-in-human trial finds arthritis drug can suppress progression of type 1 diabetes

Researchers at St Vincent’s Medical Research Institute (SVI) in Melbourne have shown that a commonly prescribed drug for rheumatoid arthritis can suppress the progression of type 1 diabetes.

The world’s first human trial, published in the New England Journal of Medicine and led by Professor Thomas Kay of SVI, showed that a drug called baricitinib can safely and effectively preserve the body’s own insulin production and suppress the progression of type 1 diabetes in people who have started a treatment within 100 days of diagnosis.

“When type 1 diabetes is first diagnosed, significant numbers of insulin-producing cells are still present. We wanted to see if we could prevent the subsequent destruction of these cells by the immune system. We showed that the baricitinib is safe and effective in slowing the progression of type 1 diabetes in people who have been newly diagnosed,” Professor Kay said.

This groundbreaking research shows promise as the first disease-modifying treatment of its kind for type 1 diabetes that can be administered in tablet form.

“It’s extremely exciting for us to be the first group in the world to test the effectiveness of baricitinib as a potential treatment for type 1 diabetes,” Professor Kay said.

“Until now, people with type 1 diabetes have relied on insulin given by injection or infusion pump. Our trial showed that if started early enough after diagnosis, and as long as participants “When taking the drug, their insulin production was maintained. People with type 1 diabetes in the trial who received the drug needed significantly less insulin for their treatment.”

Managing this lifelong autoimmune disease is incredibly burdensome for those diagnosed and their families, requiring meticulous blood sugar monitoring and day and night insulin administration to stay alive.

Until the discovery of insulin more than 100 years ago, type 1 diabetes was a fatal disease. Despite insulin’s life-saving role, the treatment itself is potentially dangerous if too much or too little insulin is given, and the disease is still accompanied by long-term complications, including heart attack and stroke. , visual impairment, kidney disease and nerve damage.

“We are very optimistic about the clinical availability of this treatment. This would represent a step change in the way type 1 diabetes is managed and we believe it shows promise as a fundamental improvement in ability to control type 1 diabetes,” the professor said. Helen Thomas, preclinical lead for the trial.

The randomized, double-blind, placebo-controlled human trial of the drug baricitinib monitored the blood sugar and insulin production of 91 participants over the course of a year. Of these, 60 received baricitinib and 31 a placebo. All trial participants were aged 10 to 30 and began the trial within 100 days of being diagnosed with type 1 diabetes.

Participants continued their prescribed insulin therapy for the duration of the study. The researchers monitored the participants’ total daily insulin dose, the amount of insulin produced endogenously (by their own pancreas), their blood sugar, and their HbA1C levels. HbA1c, or glycated hemoglobin, is a measure of average blood glucose (sugar) levels over the past two to three months.

Baricitinib blocks an enzyme that normally helps transmit signals that regulate the immune system and inflammation. The drug is currently prescribed for the treatment of rheumatoid arthritis, another autoimmune disease. The drug is also thought to dampen the immune response that develops against insulin-producing cells in people with newly diagnosed type 1 diabetes, thereby delaying the onset of symptoms of the disease, improving blood sugar control and reducing the potential for adverse effects. longer-term health effects.