Insulin requirements and residual beta-cell function 12 months after concluding immunotherapy in type I diabetic patients treated with combined azathioprine and thymostimulin administration for one year

Moncada, E; Subirá, María L.; Oleaga, Laura; Goñi, Fernando; Sánchez-Ibarrola, A; Monreal, Marta; Sevilla, M.T.; Goñi, Mabel; Yoldi, Alfredo; Terán, Diego; Llorente, Ignacio

doi:10.1016/s0896-8411(05)80030-7

Cited by 16 publications

(5 citation statements)

References 26 publications

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“…The second trial was a double-blinded RCT of azathioprine alone versus placebo which found no effect on FCP, SCP, HbA1c, nor insulin dose at 1 year [16]. Two small trials using alternating (non-randomized) assignment without placebo found mixed effects [17, 18]. …”

Section: Diabetes-specific Effects Of Rheumatologic Immune Modulatorsmentioning

confidence: 99%

Immune-Modulating Therapy for Rheumatologic Disease: Implications for Patients with Diabetes

et al. 2016

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Immune modulators used to treat rheumatologic disease have diverse endocrine effects in patients with diabetes. Providers should be aware of these effects given that diabetes and rheumatologic disease overlap in prevalence and cardiovascular morbidity. In patients with type 1 diabetes, clinical trials have demonstrated that immune modulators used early in the disease can improve pancreatic function, though their efficacy in adults with longstanding autoimmune diabetes is unknown. In patients with type 2 diabetes, hydroxychloroquine is an effective antihyperglycemic and may be preferred for rheumatologic use in patients with difficult glycemic control. In patients without diabetes, hydroxychloroquine and tumor necrosis factor (TNF) inhibitors have been found to decrease diabetes incidence in observational studies. Additionally, dapsone and sulfasalazine alter erythrocyte survival resulting in inaccurate HbA1c values. These multifaceted effects of immune modulators create a need for coordinated care between providers treating patients with diabetes to individualize medication selection and prevent hypoglycemic events. More research is needed to determine the long-term outcomes of immune modulators in patients with diabetes.

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Section: Diabetes-specific Effects Of Rheumatologic Immune Modulatorsmentioning

confidence: 99%

Immune-Modulating Therapy for Rheumatologic Disease: Implications for Patients with Diabetes

et al. 2016

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“…In this case, a positive result was reported when using MMTT, but a nonsignificant difference was found using glucagon-stimulated values (58). Similarly, there are four studies testing azathioprine with or without other agents (30,37,40,70). Though the trials differed with respect to entry criteria, all had clinical remission as their primary outcome and three-fourths reported positive outcomes.…”

Section: Therapies Used For Interventionmentioning

confidence: 99%

Type 1 Diabetes Intervention Trials: What Have We Learned? A Critical Review of Selected Intervention Trials

Greenbaum

2002

Clinical Immunology

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“…Although a possible synergistic effect of the two intervention strategies was demonstrated, unfortunately, all subjects relapsed after 6 to 15 months. Studies with thymostimulin (Moncada, Subira, Oleaga, Goni, Sanchez-Ibarrola, Monreal, Sevilla, Goni, Yoldi, Teran and Llorente 1990) or thymopoetin (Giordano, Panto, Galluzzo, Amato, DeMaria, Oliva, Pugliese, Cangemi and Galluzzo 1990) were performed in combination with either azathioprine (Moncada et al 1990) or glutathione (Giordano et al 1990). Although small effects were seen concerning insulin requirement and C-peptide secretion, the overall benefit was relatively weak and questionable.…”

Section: Novel Immunological Interventions For Type-i Diabetesmentioning

confidence: 99%

Progress in the Immunointervention of Type-1 Diabetes Mellitus

Schernthaner

1995

Horm Metab Res

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Immunointervention studies with immunosuppressive drugs (Cyclosporin A, Azathioprine) in type-1 diabetic patients after clinical diagnosis demonstrated that improvement of beta-cell function is not sufficient and longlasting. Since 80 - 90 % of the beta-cell mass are already destroyed at onset of type-1 diabetes, intervention studies with nicotinamide and insulin (parenteral or oral) were undertaken in the early phase of type-1 diabetes. However, immunomodulation is restricted to familial cases of type-1 diabetes (only 10% of all cases), since prediction of the disease is not possible in the general population. It cannot be excluded that the described immunintervention may only postpone but not hinder the manifestation of type-1 diabetes. Interventions with tolerance induction by BCG or GAD are promising, but did not yet result in prevention of type-1 diabetes in humans. Finally, the most effective strategy would be primary prevention by vaccination or exposure prophylaxis. Should type-1 diabetes prove to be a disease that is provoked through molecular mimicry, i.e. an immunization by an environmental antigen, then strategies to avoid contact with the environmental trigger (f.e. cow's milk protein) or to vaccinate against it (f.e. Coxsackie virus protein P2-c) could be adopted. If all these interventions are not effective in the long term run, research should be concentrated on molecular approaches after improvement in gene transfer technology.

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Insulin requirements and residual beta-cell function 12 months after concluding immunotherapy in type I diabetic patients treated with combined azathioprine and thymostimulin administration for one year

Cited by 16 publications

References 26 publications

Immune-Modulating Therapy for Rheumatologic Disease: Implications for Patients with Diabetes

Immune-Modulating Therapy for Rheumatologic Disease: Implications for Patients with Diabetes

Type 1 Diabetes Intervention Trials: What Have We Learned? A Critical Review of Selected Intervention Trials

Progress in the Immunointervention of Type-1 Diabetes Mellitus

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