Psoriasis drug successfully treats childhood diabetes, clinical trial finds

A drug typically used for treating psoriasis has been found effective in managing early-stage type-1 diabetes in children and adolescents, according to a new clinical trial led by Cardiff University.

The study revealed that Ustekinumab, an immunotherapy used for psoriasis since 2009, can help preserve the body’s ability to produce insulin in type-1 diabetes. This brings the goal of managing type-1 diabetes without insulin closer to reality.

The research, conducted by Cardiff University, Kings College London, Swansea University, and the University of Calgary, identified specific immune cells (Th17 cells) responsible for type-1 diabetes. It also highlighted the potential of immunotherapies in protecting insulin-producing cells.

In the clinical trial, 72 adolescents aged 12 to 18 with recent-onset type-1 diabetes were treated with Ustekinumab. The findings were published in Nature Medicine.

Type-1 diabetes occurs when the immune system attacks and destroys insulin-producing cells, eventually leading to dependence on insulin injections. Researchers are exploring ways to slow or stop this immune attack. Early intervention, before all insulin-making cells are lost, could reduce or prevent the need for insulin, according to Dr. Danijela Tatovic, Clinical Research Fellow.

Immunotherapy aims to slow the destruction of insulin-producing cells by targeting the immune system. Unlike treatments that adjust insulin levels, immunotherapy addresses the underlying immune process.

Ustekinumab is an injection treatment that patients can administer at home. It is already used to treat over 100,000 patients with severe psoriasis, psoriatic arthritis, severe Crohn’s disease, and severe ulcerative colitis. This study showed that Ustekinumab can also protect vital insulin-producing cells. Researchers identified the specific immune cells responsible for this destruction, enabling more targeted therapies that maximize benefits and minimize side effects.

Professor Tim Tree from King's College London explained, “We have found that Ustekinumab reduces the level of a tiny group of immune cells in the blood called Th17.1 cells. These cells make up only 1 in 1000 of blood immune cells, but they seem to play an important role in destroying insulin-producing cells. This explains why Ustekinumab has so few side-effects. It targets the trouble-making cells while leaving 99% of the immune system intact – a great example of precision medicine.”

The treatment was tested in children and adolescents who already needed insulin. According to Professor Colin Dayan, Clinical Professor, it would be better to treat children at an earlier stage, before they require insulin. Ustekinumab's safety record supports its use in children at this early stage.

After 12 months of using Ustekinumab, the study found that C-peptide levels, indicating insulin production, were 49% higher. This trial provides the first clinical evidence of the role Th17 cells play in type-1 diabetes.

While the trial shows the benefits of using Ustekinumab for type-1 diabetes, more clinical trials are needed to confirm these findings and determine which patients would benefit most from the treatment.

You can now detect children who will develop type-1 diabetes years before they need insulin with a simple finger-prick antibody test. Combining early detection with Ustekinumab treatment appears promising for preventing the need for insulin. Further trials will confirm this, said Peter Taylor, Clinical Senior Lecturer.

The study was funded by a partnership between the National Institute for Health and Care Research and the Medical Research Council.

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