Teplizumab

How it works

It binds the CD3 component of the T-cell receptor complex, modulating autoreactive T cells that destroy pancreatic beta cells and thereby slowing progression of the autoimmune process.

Prescribing in practice

• Cytokine release syndrome can occur, particularly early in the treatment course, and patients should be monitored for and managed accordingly during and after infusions.
• Transient lymphopenia is expected, and serious infections and hypersensitivity reactions can occur, so lymphocyte counts and infection signs should be watched.
• It is given as a defined limited course in carefully selected patients with confirmed early-stage disease rather than as ongoing therapy.

Monitoring

Monitor full blood count including lymphocytes, liver enzymes and for signs of cytokine release syndrome and infection during and after the course.

Counselling the patient

• Expect close monitoring during infusions because of the risk of cytokine release reactions.
• Report fever or signs of infection, as your immune cells are temporarily reduced.
• Live vaccines should be avoided around the treatment course; check timing with your team.

Evidence & guidelines

A landmark randomised trial in at-risk relatives showed teplizumab delays progression to clinical type 1 diabetes, supporting its approved use.