Type of publication:
Conference abstract
Author(s):
Beese S.E.; Narendran P.; Price M.J.; Tomlinson C.; Sharma P.; Harris I.M.; Adriano A.; Andrews R.C.; Moore D.J.; Quinn L.; Gada R.; *Horgan T.J.; Maggs F.; Burrows M.
Citation:
Diabetic Medicine. Conference: Diabetes UK Professional Conference 2025. Glasgow . 42(Supplement 1) (no pagination), 2025. Date of Publication: 01 Feb 2025.
Abstract:
Background: Type 1 diabetes is characterised by destruction of pancreatic beta cells. We aimed to determine the effectiveness of immunotherapies for preserving residual beta cell function through c-peptide measurement in newly diagnosed type 1 diabetes. Method(s): A systematic review and network meta-analysis (NMA) was undertaken of RCTs of non-antigen-specific immunotherapies to preserve beta cells in newly diagnosed type 1 diabetes. Searches were carried out in MEDLINE, Embase, Cochrane CENTRAL and trial registries (31 July 2024). Risk of bias was assessed using Cochrane Risk of Bias Tool 1. A frequentist NMA was undertaken in R. The primary outcome was c-peptide and interventions were analysed by class. Result(s): Sixty trials were included (4597 patients, 32 classes) plus 43 ongoing/unpublished studies. Forty-one trials were eligible for the NMA. Eleven interventions demonstrated statistically significantly higher c-peptide at 12 months compared with placebo: MSC; both autologous and Wharton's jelly-derived cells, azathioprine, interferon alpha (5000 IU), dendritic cells, golimumab, low-dose ATG, 3 mg 1-course teplizumab, baricitinib, cyclosporin and 9/11 mg 2-course teplizumab (I2 = 66%). All these interventions, except for 9/11 mg 2-course teplizumab and cyclosporin, demonstrated >60% chance of being ranked first. Infusion of MSC (Wharton's jelly-derived) ranked highest (median rank 1, 95% CI 1-2). Few studies were considered high risk of bias overall. Conclusion(s): Whilst several interventions demonstrated statistically significantly better c-peptide levels at 12 months, the findings should be interpreted with caution. Heterogeneity was evident and some comparisons were based on limited data. However, these findings identify the most promising of therapies that should be studied further in head-to-head and combination RCTs.
DOI: 10.1111/dme.15498
