Immunotherapie voor diabetes mellitus type 1

Stand van zaken
Cornelis R. van der Torren en Bart O. Roep

Immunotherapy for type 1 diabetes mellitus (DM1)

Conflict of interest: none declared. Financial support: B. Roep was consulted by Lilly, GlaxoSmithKline, TolerX, Diamyd en Andromeda Biotech.

  • Treatment of type 1 diabetes mellitus (DM1) has greatly improved but remains limited to combating the consequences of the disease.

  • Target values for glucose regulation are achieved in only 20% of patients.

  • Immunosuppression can slow disease progression, but does not cure DM1. Immunotherapy attempts to protect remaining insulin-producing β cells and β cell function.

  • Promising results of immunotherapy in phase 2 studies in patients with DM1 could not be reproduced in phase 3 studies. These studies showed heterogeneity played a role in patient populations and between ethnic groups.

  • In future studies better endpoints of efficacy, biomarkers of disease progression and response to therapy are essential.

  • Vaccination with β-cell specific antigens to stimulate tolerance and vaccination combined with immunotherapy (biologicals) are options for future therapy.

  • Discussion on the acceptability of the side effects of immunotherapy is desirable.