Pediatric Teplizumab (Tzield) to Delay Type 1 Diabetes

What is teplizumab (Tzield)?

Teplizumab (brand name Tzield) is a medication that can delay the onset of type 1 diabetes in people at high risk of developing the condition.

How does teplizumab work?

In type 1 diabetes, the immune system mistakenly attacks insulin-producing cells in the pancreas called beta cells. This reduces insulin production over time, causing blood sugar levels to rise. Eventually, the patient must take supplemental insulin for life.

Teplizumab works by modifying immune cells called T cells, which slows the destruction of beta cells. This allows the pancreas to continue making insulin longer, delaying the need for insulin therapy. One study showed that teplizumab postponed the need for supplemental insulin by two years on average.

Who is eligible for teplizumab?

The Food and Drug Administration (FDA) has approved teplizumab for patients age 8 and older who are at high risk of developing type 1 diabetes. To be considered high risk, your child must meet the following criteria:

• Have at least two autoantibodies (antibodies that attack normal substances made by the body)
• Show elevated blood sugar levels, such as an A1C test result in the prediabetic range or an abnormal result on an oral glucose tolerance test
• Not yet require insulin therapy

These are the features of stage 2 diabetes. Stage 2 typically progresses to stage 3, when symptoms appear and supplemental insulin is needed.

Teplizumab is not approved for patients already diagnosed with type 1 diabetes.

What should I expect from teplizumab treatment?

First, your child will be screened to determine whether they are eligible based on their autoantibodies and blood sugar levels. The team will order additional blood tests to check that your child's liver and kidneys are working normally and that they don't have any signs of an infectious disease.

If no safety concerns are found, your child will receive teplizumab as a daily intravenous (IV) infusion for 14 consecutive days. These treatments take place in an outpatient infusion center and typically take two to three hours each.