Teplizumab
Other glucose-lowering drugs
Other glucose-lowering drugs
An anti-CD3 monoclonal antibody given as a short course that delays the onset of clinical (stage 3) type 1 diabetes in people at stage 2.
Also called: teplizumab-mzwv
Quick facts
- Group
- Other glucose-lowering drugs
- Target
- CD3 on T lymphocytes (CD3 epsilon)
- Used for
- To delay the onset
- Key effects
- Transient falls in white cells · Rash · Headache
- Monitor
- Blood counts and liver tests before
- ATC
- A10XX01
No doses: the clinician sets them by the current guideline.
Mechanism of action
Type 1 diabetes is caused by T cells that destroy insulin-making beta cells. Teplizumab is a humanized antibody against CD3, the signalling part of the T-cell receptor, engineered not to bind Fc receptors. It partially blocks and modulates the autoimmune T-cell attack on beta cells, preserving their function for longer and delaying the move from stage 2 (autoantibodies and abnormal glucose tolerance) to stage 3 (clinical diabetes).
- Binds CD3 on T cells
- Modulates the autoreactive T cells attacking beta cells
- Beta-cell function is preserved for longer
- Onset of clinical type 1 diabetes is delayed
Indications
- To delay the onset of stage 3 type 1 diabetes in adults and children aged 8 years and older with stage 2 type 1 diabetes Type 1 diabetes mellitus →
Adverse effects
Common
- Transient falls in white cells and lymphocytes
- Rash
- Headache
Contraindications
- Not started without review in people with active infection or a weakened immune system
Key interactions
- Vaccines
- Vaccinations are brought up to date before treatment; vaccines during or after treatment are discussed with the prescriber.
- Other immunosuppressants
- Additive immunosuppression and infection risk.
What is monitored
- Blood counts and liver tests before and during the course
- Signs of infection
- Fever and symptoms of cytokine release during the infusions
- Glucose and HbA1c over time
Administration and safety
- Given once a day for 14 days by a health professional, after baseline laboratory tests.
- Vaccines are updated before starting; missed appointments are rescheduled promptly.
- Premedication and monitoring are used to reduce cytokine-release symptoms.
Pregnancy and breastfeeding
Not recommended: the immune effects could affect the fetus; breastfeeding is also avoided during and for some weeks after the course.
Nursing care
- Before: blood count, liver tests, vaccination status, signs of infection.
- During: temperature, rash, symptoms of infection or liver injury at each visit.
- Teach to report fever, cough, breathlessness, yellow eyes or dark urine.
- Teach that breastfeeding is avoided during the course and for some weeks after.
Pharmacokinetics
- Onset and duration
- Given once daily as a 14-day course; the benefit is a delay of clinical diabetes measured over months to years (Katzung).
Test yourself
Think of the answer, then tap the question to see it.
Which stage of type 1 diabetes is teplizumab used in, and what does it do?
Stage 2 (autoantibodies with abnormal glucose tolerance); it delays progression to stage 3, clinical diabetes.
What is teplizumab's target?
CD3 on T lymphocytes.
Which blood change is expected and transient during the course?
A fall in white cells, particularly lymphocytes.
Connections
← Back to the class: Other glucose-lowering drugs
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Teplizumab-mzwv injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2022).
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Representative model, for educational purposes only.