To write an editorial article in the New England Journal of Medicine (NEJM), one of the world's foremost medical journals, is a rare opportunity for Swedish researchers. Johnny Ludvigsson received the invitation to contribute to the journal in conjunction with the publication of two original articles by other type 1 diabetes researchers in NEJM on December 7.
In the December issue, Johnny Ludvigsson reflects on the progress made and the challenges facing type 1 diabetes research.
"It can be perceived as a recognition of how the world's most prestigious medical scientific journal views my position as a diabetes researcher. In that way, it feels honorable and nice that Linköping University is also visible. Additionally, it feels good to have a say in a very important issue that can influence decision-makers, authorities, healthcare, and researchers", says Johnny.
Beta cells and immune therapy drugs
In the article "Immune Interventions at Onset of Type 1 Diabetes — Finally, a Bit of Hope" Ludvigsson criticizes the dominant focus on blood sugar control and advocates for an increased interest in preserving dying pancreatic beta cells. In simpler terms, beta cells are crucial insulin-producing cells in the pancreas, and their preservation is key to addressing the root cause of type 1 diabetes.
The article discusses a Phase III study led by Eleanor L. Ramos et al, demonstrating the success of teplizumab (an immune therapy drug) – an immune intervention. The randomized, double-blinded, placebo-controlled study included patients aged 8-17 and showed significantly higher stimulated C-peptide levels in those treated with teplizumab, 1.5 years after treatment. C-peptide is a marker of insulin production, and shows the body's ability to produce insulin.
Balancing side effects with treatment success
While acknowledging the discomfort and side effects associated with teplizumab, Ludvigsson emphasizes the importance of preserving beta cells. The editorial notices that the FDA and other regulatory bodies in these studies have accepted the preservation of beta cells as the primary goal, and underlines that it is important that the authorities also in future trials accept this assessment of diabetes interventions.
Ludvigsson delves into other promising treatments like golimumab and baricitinib, discussing their potential to preserve beta cells. The article highlights a Phase II study with baricitinib, a JAK inhibitor, showing significant preservation of C-peptide and suggesting alternative treatment paths. JAK inhibitors are a type of medication that can affect the immune system, and their potential role in preserving beta cells adds a new dimension to the treatment of type 1 diabetes.
Call for early intervention
The article concludes by emphasizing the critical importance of offering treatments at the onset of type 1 diabetes. Ludvigsson acknowledges the challenges these treatments may pose but argues that they hold the promise of partial remission and, ultimately, a cure. The article calls for increased research efforts to improve these interventions, establish optimal combinations, inclusion criteria, treatment duration, and long-term outcomes.
For further details, read the full editorial article by Senior Professor Johnny Ludvigsson in the December 7 issue of the New England Journal of Medicine (NEJM).