GAD vaccine reduces insulin loss in recently diagnosed type 1 diabetes: findings from a Bayesian meta-analysis.

Autor: Beam CA; Division of Epidemiology and Biostatistics, Department of Biomedical Sciences, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI, 49008-8071, USA. craig.beam@med.wmich.edu., MacCallum C; Division of Epidemiology and Biostatistics, Department of Biomedical Sciences, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI, 49008-8071, USA., Herold KC; Departments of Immunobiology and Internal Medicine, Yale University, New Haven, CT, USA., Wherrett DK; Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada., Palmer J; University of Washington and VA Puget Sound Health Care System, Seattle, WA, USA., Ludvigsson J; Divison of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Jazyk: angličtina
Zdroj: Diabetologia [Diabetologia] 2017 Jan; Vol. 60 (1), pp. 43-49. Date of Electronic Publication: 2016 Oct 04.
DOI: 10.1007/s00125-016-4122-1
Abstrakt: Aims/hypothesis: GAD is a major target of the autoimmune response that occurs in type 1 diabetes mellitus. Randomised controlled clinical trials of a GAD + alum vaccine in human participants have so far given conflicting results.
Methods: In this study, we sought to see whether a clearer answer to the question of whether GAD65 has an effect on C-peptide could be reached by combining individual-level data from the randomised controlled trials using Bayesian meta-analysis to estimate the probability of a positive biological effect (a reduction in C-peptide loss compared with placebo approximately 1 year after the GAD vaccine).
Results: We estimate that there is a 98% probability that 20 μg GAD with alum administered twice yields a positive biological effect. The effect is probably a 15-20% reduction in the loss of C-peptide at approximately 1 year after treatment. This translates to an annual expected loss of between -0.250 and -0.235 pmol/ml in treated patients compared with an expected 2 h AUC loss of -0.294 pmol/ml at 1 year for untreated newly diagnosed patients.
Conclusions/interpretation: The biological effect of this vaccination should be developed further in order to reach clinically desirable reductions in insulin loss in patients recently diagnosed with type 1 diabetes.
Databáze: MEDLINE
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