immunosuppressing drug may help modify the course of the disease," Prof Chantal Mathieu, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium, and colleagues reported.
The MELD-ATG study enrolled participants aged 5 to 25 years who had been diagnosed with type 1 diabetes within the previous 3 to 9 weeks. Conducted across 14 centres in eight European countries, the double-blind, randomized, placebo-controlled trial used an adaptive design to identify the smallest effective dose of ATG.
Participants were stratified by age and randomly assigned to receive either a placebo or varying doses of the drug over two consecutive infusion days. All volunteers had at least one diabetes-related autoantibody and a minimum random C-peptide concentration of 0.2 nmol/L at baseline, a marker of residual beta-cell activity.
The results suggest that antithymocyte globulin—commonly used to prevent organ transplant rejection—may be repurposed at a lower dose to protect remaining pancreatic function soon after type 1 diabetes diagnosis. By preserving the body’s own insulin production for longer, such an approach could reduce dependence on injected insulin and help stabilize blood glucose levels.
Investigators note that the adaptive design allowed efficient dose selection and demonstrated that 0.5 mg/kg provides a balance of efficacy and tolerability.
"Larger and longer-term studies will be needed to confirm whether this lower dose can deliver durable clinical benefits and to refine strategies for integrating ATG into early treatment plans. For now, the findings offer hope for a disease-modifying therapy in a condition where none currently exists," they concluded.
Mathieu, C., et al. (2025). Minimum effective low dose of antithymocyte globulin in people aged 5–25 years with recent-onset stage 3 type 1 diabetes (MELD-ATG): a phase 2, multicentre, double-blind, randomised, placebo-controlled, adaptive dose-ranging trial. The Lancet. doi.org/10.1016/S0140-6736(25)01674-5.
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