Teplizumab

Teplizumab

Monoclonal antibody
Type	Whole antibody
Source	Humanized (from mouse)
Target	CD3
Clinical data
Trade names	Tzield
Other names	teplizumab-mzwv, PRV-031,[1] MGA031
AHFS/Drugs.com	Monograph
MedlinePlus	a622077
License data	US DailyMed: Teplizumab
Routes of administration	Intravenous
Drug class	Antidiabetic agent
ATC code	A10XX01 (WHO)
Legal status
Legal status	US: ℞-only[2]
Identifiers
CAS Number	876387-05-2^Y
DrugBank	DB06606^Y
ChemSpider	none
UNII	S4M959U2IJ
KEGG	D09013
Chemical and physical data
Formula	C6462H9938N1738O2022S46
Molar mass	145801.49 g·mol^−1
^NY (what is this?)  (verify)

Teplizumab, sold under the brand name Tzield, is a humanized anti-CD3 monoclonal antibody that is the first approved treatment indicated to delay the onset of stage 3 type 1 diabetes in people with stage 2 type 1 diabetes.^[3][4][5]

The Fc region of this antibody has been engineered to have Fc receptor non-binding (FNB) properties.^[6] The mechanisms of action of teplizumab appear to involve weak agonistic activity on signaling via the T cell receptor-CD3 complex associated with the development of anergy, unresponsiveness, and/or apoptosis, particularly of unwanted activated Teff cells. In addition, regulatory cytokines are released and regulatory T cells are expanded that may lead to the reestablishment of immune tolerance ^[7][8]

Teplizumab was approved for medical use in the United States in November 2022.^[3][9] The US Food and Drug Administration (FDA) considers it to be a first-in-class medication.^[10][11]

Medical uses

Teplizumab is indicated to delay the onset of stage 3 type 1 diabetes in people aged eight years of age and older with stage 2 type 1 diabetes.^[2][3]

History

Teplizumab was developed at the University of Chicago in partnership with Ortho Pharmaceuticals, and was then further developed at MacroGenics, Inc.,^[12][13] including a collaboration with Eli Lilly to conduct the first phase III clinical trial in early-onset type 1 diabetes.^[14] After the initial Phase 3 trial conducted by Macrogenics failed to meet the primary endpoint,^[15] the drug was acquired by Provention Bio, which restarted development based on subset analysis of the original trials.^[16][17]

Research

Teplizumab has been used in clinical trials with the aim of protecting the remaining β-cells in people newly diagnosed with type 1 diabetes.^[18] Immunomodulatory agents such as anti-CD3-antibodies may restore normal glucose control if provided in very early stages of the disease, such as stage 2 T1DM, when there are still enough beta cells to maintain euglycemia.^[19]

Teplizumab has been evaluated for treatment of renal allograft rejection, for induction therapy in islet transplant recipients, and for psoriatic arthritis.^[20]

A phase II study showed that teplizumab could delay the development of diabetes in family members of type 1 diabetics showing signs of progression towards diabetes by about two years after a single treatment, renewing interest in its use as a preventive rather than therapeutic treatment in high-risk patients.^[21]

A systematic review and meta-analysis, published in 2024, found that use of teplizumab is associated with better preservation of circulating C-peptide levels.^[22]

References

1. "Provention Bio Announces PRV-031 (Teplizumab) Granted PRIME Designation by the European Medicines Agency" (Press release). Provention Bio. 24 October 2019. Retrieved 18 November 2022 – via PR Newswire.
2. "Tzield- teplizumab-mzwv injection". DailyMed. 17 November 2022. Retrieved 4 December 2022.
3. "FDA Approves First Drug That Can Delay Onset of Type 1 Diabetes". U.S. Food and Drug Administration (Press release). 17 November 2022. Retrieved 18 November 2022. This article incorporates text from this source, which is in the public domain.
4. American Diabetes Association Professional Practice Committee (1 January 2022). "2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2022". Diabetes Care. 45 (45): S17 – S38. doi:10.2337/dc22-S002. PMID 34964875. S2CID 245451959. Retrieved 17 November 2022.
5. "Tzield (teplizumab-mzwv) approved by FDA as the first and only treatment indicated to delay the onset of Stage 3 type 1 diabetes (T1D) in adult and pediatric patients aged 8 years and older with stage 2 T1D" (Press release).
6. Alegre ML, Tso JY, Sattar HA, Smith J, Desalle F, Cole M, et al. (August 1995). "An anti-murine CD3 monoclonal antibody with a low affinity for Fc gamma receptors suppresses transplantation responses while minimizing acute toxicity and immunogenicity". Journal of Immunology. 155 (3): 1544–55. doi:10.4049/jimmunol.155.3.1544. PMID 7636216. S2CID 38982992.
7. Belghith M, Bluestone JA, Barriot S, Mégret J, Bach JF, Chatenoud L (September 2003). "TGF-beta-dependent mechanisms mediate restoration of self-tolerance induced by antibodies to CD3 in overt autoimmune diabetes". Nature Medicine. 9 (9): 1202–8. doi:10.1038/nm924. PMID 12937416. S2CID 26301557.
8. Bisikirska B, Colgan J, Luban J, Bluestone JA, Herold KC (October 2005). "TCR stimulation with modified anti-CD3 mAb expands CD8+ T cell population and induces CD8+CD25+ Tregs". The Journal of Clinical Investigation. 115 (10): 2904–13. doi:10.1172/JCI23961. PMC 1201661. PMID 16167085.
9. "Drug Approval Package: Tzield". accessdata.fda.gov. 5 January 2023. Retrieved 23 January 2023.
10. "Advancing Health Through Innovation: New Drug Therapy Approvals 2022". U.S. Food and Drug Administration (FDA). 10 January 2023. Retrieved 22 January 2023. This article incorporates text from this source, which is in the public domain.
11. New Drug Therapy Approvals 2022 (PDF). U.S. Food and Drug Administration (FDA) (Report). January 2024. Archived from the original on 14 January 2024. Retrieved 14 January 2024. This article incorporates text from this source, which is in the public domain.
12. Woodle ES, Bluestone JA, Zivin RA, Jolliffe LK, Auger J, Xu D, et al. (June 1998). "Humanized, nonmitogenic OKT3 antibody, huOKT3 gamma(Ala-Ala): initial clinical experience". Transplantation Proceedings. 30 (4): 1369–70. doi:10.1016/S0041-1345(98)00278-4. PMID 9636555.
13. Brown WM (April 2006). "Anti-CD3 antibody MacroGenics Inc". Current Opinion in Investigational Drugs. 7 (4): 381–8. PMID 16625825.
14. Sherry N, Hagopian W, Ludvigsson J, Jain SM, Wahlen J, Ferry RJ, et al. (August 2011). "Teplizumab for treatment of type 1 diabetes (Protégé study): 1-year results from a randomised, placebo-controlled trial". Lancet. 378 (9790): 487–97. doi:10.1016/S0140-6736(11)60931-8. PMC 3191495. PMID 21719095.
15. "MacroGenics, Lilly abandon diabetes drug". Washington Business Journal. 21 October 2010.
16. "MacroGenics sells rights for two autoimmune disorder candidates". The Pharma Letter.
17. Herold KC, Gitelman SE, Ehlers MR, Gottlieb PA, Greenbaum CJ, Hagopian W, et al. (November 2013). "Teplizumab (anti-CD3 mAb) treatment preserves C-peptide responses in patients with new-onset type 1 diabetes in a randomized controlled trial: metabolic and immunologic features at baseline identify a subgroup of responders". Diabetes. 62 (11): 3766–74. doi:10.2337/db13-0345. PMC 3806618. PMID 23835333.
18. Herold KC, Gitelman SE, Masharani U, Hagopian W, Bisikirska B, Donaldson D, et al. (June 2005). "A single course of anti-CD3 monoclonal antibody hOKT3gamma1(Ala-Ala) results in improvement in C-peptide responses and clinical parameters for at least 2 years after onset of type 1 diabetes". Diabetes. 54 (6): 1763–9. doi:10.2337/diabetes.54.6.1763. PMC 5315015. PMID 15919798.
19. Kaufman A, Herold KC (May 2009). "Anti-CD3 mAbs for treatment of type 1 diabetes". Diabetes/Metabolism Research and Reviews. 25 (4): 302–6. doi:10.1002/dmrr.933. PMID 19319985. S2CID 36595661.
20. Chatenoud L, Bluestone JA (August 2007). "CD3-specific antibodies: a portal to the treatment of autoimmunity". Nature Reviews. Immunology. 7 (8): 622–32. doi:10.1038/nri2134. PMID 17641665. S2CID 11868182.
21. Herold KC, Bundy BN, Long SA, Bluestone JA, DiMeglio LA, Dufort MJ, et al. (August 2019). "An Anti-CD3 Antibody, Teplizumab, in Relatives at Risk for Type 1 Diabetes". New England Journal of Medicine. 381 (7): 603–613. doi:10.1056/nejmoa1902226. PMC 6776880. PMID 31180194.
22. Kamrul-Hasan AB, Mondal S, Nagendra L, Yadav A, Aalpona FT, Dutta D (May 2024). "Role of Teplizumab, a Humanized Anti-CD3 Monoclonal Antibody, in Managing Newly Diagnosed Type 1 Diabetes: An Updated Systematic Review and Meta-Analysis". Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 30 (5): 431–440. doi:10.1016/j.eprac.2024.03.006. PMID 38519028.