オカダ ヨウスケ   Okada Yosuke
  岡田 洋右
   所属   医学部医学科  臨床医学系 第1内科学
   職種   准教授
論文種別 症例報告
言語種別 英語
査読の有無 査読なし
表題 Pancreas-protective effect of rituximab for acute-onset type 1 diabetes in the honeymoon period: a case report.
掲載誌名 正式名:Endocrinology, diabetes & metabolism case reports
略  称:Endocrinol Diabetes Metab Case Rep
ISSNコード:/20520573
掲載区分国外
巻・号・頁 2016,160020頁
著者・共著者 Kurozumi Akira, Okada Yosuke, Arao Tadashi, Miyazaki Yusuke, Yoshikawa Maiko, Torimoto Keiichi, Kubo Satoshi, Nakayamada Shingo, Tanaka Yoshiya
発行年月 2016
概要 UNLABELLED:A randomized controlled study of rituximab demonstrated that the drug protects pancreatic function in patients with acute-onset type 1 diabetes mellitus (AOT1DM). However, the mechanism of this protective effect is poorly understood. We examined the effects of rituximab in two patients with AOT1DM in the honeymoon period and the mechanism of these effects. Case 1 was a 40-year-old man and Case 2 was a 45-year-old man, both diagnosed with AOT1DM. Various tests indicated intact capacity for endogenous insulin secretion and that they were in the honeymoon phase of AOT1DM. Treatment with rituximab protected against pancreatic β-cell damage and maintained somewhat the endogenous insulin secretion. In Case 2, HbA1c level was maintained below 6.5% up to 24 months after treatment. However, in Case 1, the patient showed a gradual increase in HbA1c level starting around 9 months but fell at 12 months to >9.0% and required an insulin dose about twice greater than that of Case 2. High spleen tyrosine kinase (Syk) levels were recorded in the two patients before rituximab administration and after the treatment, the levels were further increased in Case 1, but decreased in Case 2. Both patients require continuous careful follow-up for glycemic control, insulin secretion capacity, and adverse reactions in the future. Although the clinical relevance of high Syk levels in AOT1DM patients remains unclear, the difference in the change in Syk level between the two patients may explain the different clinical courses.LEARNING POINTS:We described the pancreas-protective effect of rituximab in two patients with acute-onset type 1 diabetes mellitus in the honeymoon period and investigated the possible mechanism of action.The present study demonstrated that treatment with rituximab maintained endogenous insulin secretion capacity for 2 years in the two patients.The phosphorylated-spleen tyrosine kinase (p-Syk) data suggest that the differences in HbA1c level and the required insul
DOI 10.1530/EDM-16-0020
PMID 27252867