Abstract
Six children aged 8-16 years who had clinical IDD for less than 3 weeks, islet cell autoantibodies (ICA) and DR3 and/or DR4 alleles in their HLA phenotype were given immunotherapy, consisting of 4 alternate day I-V boluses of methylpredisolone (30 mg/kg), predisone (2 mg/kg) for 2 months and azathioprine or Imuran (2-3 mg/kg/day) for at least 1 year. Five children were matched to be non treatment controls. Diabetic control was monitored by optimal insulin requirement in U/Kg/day, plasma HbAlc values, and C-peptide responses to oral Sustacal. Immunotherapy significantly improved the parameters over that of controls. One 9 year old boy was able to discontinue insulin therapy by 4 months of immunotherapy, and has had normal HbAlc and C-peptide levels 11 months later. One 17 year old girl could be maintained in excellent control 15 months after diagnosis with only 0.2 u/kg of insulin per day. One 14 year old girl was maintained on 0.1 u/kg insulin/day at 6 months of therapy but had increasing insulin requirements beyond 9 months despite continued administration of Imuran. One 8 year old girl who showed a good initial response to therapy by 4 months, had to have Imuran discontinued because of toxicity. Two children who initially presented in diabetic ketoacidosis showed no response to immunosuppression. These results suggest that conventional steroid/azothioprine immuncsuppression may provide a less toxic alternative to Cyclosporin in the specific therapy of IDD.
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Silverstein, J., Riley, W., Spillar, R. et al. 88 PREDNISONE/AZATHIOPRINE IMMUNOSUPPRESSIVE THERAPY FOR INSULIN DEPENDENT DIABETES (IDD). Pediatr Res 19, 618 (1985). https://doi.org/10.1203/00006450-198506000-00108
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DOI: https://doi.org/10.1203/00006450-198506000-00108