Okada Yosuke
   Department   School of Medicine  Internal Medicine(1), Clinical Medical Sciences
Article types case reports
Language English
Peer review Non peer reviewed
Title Pancreas-protective effect of rituximab for acute-onset type 1 diabetes in the honeymoon period: a case report.
Journal Formal name:Endocrinology, diabetes & metabolism case reports
Abbreviation:Endocrinol Diabetes Metab Case Rep
ISSN code:/20520573
Domestic / ForeginForegin
Volume, Issue, Page 2016,160020頁
Author and coauthor Kurozumi Akira, Okada Yosuke, Arao Tadashi, Miyazaki Yusuke, Yoshikawa Maiko, Torimoto Keiichi, Kubo Satoshi, Nakayamada Shingo, Tanaka Yoshiya
Publication date 2016
Summary 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