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CYCLOSPORINE FOR RECENT-ONSET JUVENILE DIABETES.

More and more evidence suggests that juvenile-onset diabetes mellitus is an autoimmune disease mediated by T- cell attack on the pancreas. The attack may begin years before the clinical onset of the disease. Several studies in animals and humans suggest that cyclosporine, which inhibits T-cell function, may retard the development of diabetes, at least in the short term.

In a non-randomized study of 40 children (ages 7 to 15) with recent-onset diabetes, treatment with low-dose cyclosporine allowed 27 of them to discontinue insulin within 7 weeks. The majority of these 27 children remained in remission after 12 months of continuous treatment. Children with remission had begun treatment earlier after the first symptoms of diabetes appeared, when the disease was less severe; the authors speculate that even though the autoimmune attack on the pancreas had been going on for a long time, some damage was still preventable, even after symptoms appeared. The low-dose cyclosporine caused minimal toxicity, even when administered for 12 months.

It remains to be seen whether such good results can be achieved in a randomized trial, whether cyclosporine treatment can be stopped without the disease returning, and whether long-term treatment with low doses of the drug is toxic. Nonetheless, these results are intriguing.

— ALK

Published in Journal Watch General Medicine March 25, 1988

Citation(s):

Herold K C; Rubenstein A H. Immunosuppression for insulin-dependent diabetes. N Engl J Med 1988 Mar 17 318 701-703.

• Medline abstract (Free)

Bougneres P F; Carel J C; Castano L et al. Factors associated with early remission of Type 1 diabetes in children treated with cyclosporine. N Engl J Med 1988 Mar 17 318 663-670.

• Medline abstract (Free)