A drug currently used for the skin condition psoriasis could help treat the early stages of type 1 diabetes in children and young people without the need for insulin, a trial has found.
The injection treatment, known as ustekinumab, targets “trouble-making cells” in the blood, according to researchers, who hailed it as a “great example of precision medicine”.
The trial by Cardiff University, King’s College London, Swansea University and the University of Calgary included 72 patients aged between 12 and 18 with recent-onset type 1 diabetes.
Some 62 patients were analysed for the results, with 41 on ustekinumab and 21 in a placebo group.
After a year, researchers found that C-peptide levels – a sign that the body is producing insulin – were 49% higher in those in the ustekinumab group.
Professor Tim Tree, of King’s College London, said: “We have found that ustekinumab reduces the level of a tiny group of immune cells in the blood called Th17.1 cells.
“These cells make up only one in 1,000 of blood immune cells, but they seem to play an important role in destroying insulin producing cells.
“This explains why ustekinumab has so few side effects. It targets the trouble-making cells, while leaving 99% of the immune system intact – a great example of precision medicine.”
Diabetes UK estimates that more 5.6 million people in the UK have diabetes, with 8 per cent of these being type 1 diabetics.
Type 1 diabetes happens when the body cannot produce insulin, which controls blood glucose levels.
Regular insulin injections are the main treatment for the condition.
Dr Danijela Tatovic, of the Cardiff University School of Medicine, said: “Type 1 diabetes occurs when the body’s immune system attacks and destroys the cells of the body that produce insulin.
“This eventually leaves the person dependent on insulin injections.
“Researchers are now developing ways to slow or halt the immune system attack. If such treatments can be started early, before all the insulin-making cells are lost, this could prevent or reduce the need for insulin.”
Ustekinumab – sold under the brand name Stelara – works by interfering with how the body triggers its inflammatory response by suppressing certain cytokines.
The National Institute for Health and Care Excellence (Nice) recommends ustekinumab for patients aged 12 and over with severe psoriasis that has not responded to other therapies.
It can also be used by adults with severe psoriasis or psoriatic arthritis – a long-term condition that causes joint pain and swelling that is developed by some people with psoriasis as they get older – as well as adults with moderate to severe ulcerative colitis and previously treated moderate to severe Crohn’s disease.
Colin Dayan, clinical professor at Cardiff University’s School of Medicine, said: “We tested this treatment in children and adolescents who already needed insulin treatment.
“It would be better if we could treat them at an earlier stage, while the children are still well, and prevent them needing insulin.
“Thankfully, ustekinumab has a good enough safety record to be considered for use in children at this early stage.”
Researchers said further trials are needed to determine the benefits of using ustekinumab to treat type 1 diabetes.
Dr Peter Taylor, of Cardiff University’s Systems Immunity Research Institute, added: “It is now possible with a simple finger-prick antibody test to detect children who will develop type 1 diabetes years before they need insulin.
“Combining screening in this way with early treatment with ustekinumab seems a very promising approach to preventing the need for insulin. Further trials will be needed to confirm this.”
Dr Jessica Farrow, research communications officer at Diabetes UK, said: “This study suggests ustekinumab is safe and can help preserve insulin-producing beta cells in children and young people newly diagnosed with type 1 diabetes.
“We would now like to see more research carried out in greater numbers of people exploring exactly how treatments like this work to slow or stop type 1, to find and tailor treatments that give each person the best outcome.
“In the future, these carefully targeted treatments for people with type 1 could help them to produce more of their own insulin for longer, reducing their risk of devastating long-term complications, without some of the risks linked to other similar treatments.”
