[Journal Club] Baricitinib immune therapy for new onset type 1 diabetes

Type 1 diabetes has a very high treatment burden in terms of direct costs, inconvenience and lost productivity for patients and their carers. Further, all the glucose checking, hormone replacement and consults don’t abolish the vascular complications associated with poor glycaemic control. Only in the last few years has it been possible to pharmacologically alter the course of type 1 diabetes and other auto-immune diseases without generating intolerable side effects.

Teplizumab is an antibody to CD3 which was presented to the world in 2019 as delaying the onset of type 1 diabetes in high-risk individuals thanks to its protective effect on pancreatic β-cells. It has not yet been registered by the Therapeutic Goods Administration but another drug immunomodulatory drug called baricitinib has. Baricitinib is an inhibitor of Janus Kinases indicated for the for the treatment of rheumatoid arthritis, alopecia areata, atopic dermatitis and even COVID-19.
 
In December of last year the results of a Phase 2 trial in patients with new-onset type 1 diabetes were published in the New England Journal of Medicine. After almost a year of taking the oral therapy, patients were found to have better glycaemic control and evoked C-peptide levels than those taking placebo, indicating a preserved ability to secrete insulin. In today’s, Pomegranate’s in-house endocrinologist interviews two of the study authors.   

Key Reference
Baricitinib and β-Cell Function in Patients with New-Onset Type 1 Diabetes [NEJM. 2023. 7;389(23)]

Guests
Prof Jenny Couper FRACP FAHMS (Women's and Children's Hospital, University of Adelaide)
Dr Michelle So FRACP (Royal Melbourne Hospital, Northern Hospital)

Guest Host
Dr Rahul Barmanray FRACP (Royal Melbourne Hospital)

Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Things to Sort out’ and ‘Quiet Waters’ by Walt Adams and ‘The Appalachian Trail’ by Hunter Quinn. Music courtesy of FreeMusic Archive includes ‘I am a Man Who Will Fight For Your Honor’ by Chris Zabriskie. Image produced and copyrighted by RACP.

Editorial feedback kindly provided by RACP physicians Amy Hughes, Stephen Bacchi, Fionnuala Fagan and Aidan Tan.  

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