Short steroid treatment may help manage teplizumab CRS without stopping therapy
Key takeaway:
In one adolescent with new-onset type 1 diabetes, short courses of glucocorticoids appeared to control teplizumab-related cytokine release syndrome and allowed both teplizumab courses to be completed.
Study at a glance
What was studied
Steroid treatment for cytokine release syndrome during teplizumab therapy in one adolescent with new-onset type 1 diabetes
Study type
non-randomized clinical trial (non-RCT or NRCT)
duration
Long-Term (> 12 mo)
Intervention
Teplizumab, Systemic steroid therapy
Outcomes
Beta-cell function, HbA1c, Daily insulin dose, Adverse events incidence
Funding
Non-industry sponsored
Main effects
Cytokine release syndrome symptoms ↓ after short glucocorticoid treatment
Teplizumab treatment completion ↑ because both infusion courses were finished
HbA1c ↔ remained fairly low through follow-up in this one patient
Total daily insulin dose ↓ stayed relatively modest during partial remission
Evidence Summary
| Intervention | Outcome | Measured Change | Study Effect |
|---|---|---|---|
 Systemic steroid therapy (Medications) |  Adverse events incidence (Safety) | Decrease | Limited |
Systemic steroid therapy (Medications) |  Beta-cell function (Metabolic Health) | Uncertain | Limited |
Teplizumab (Medications) | Adverse events incidence (Safety) | Increase | Mixed |
Teplizumab (Medications) | Beta-cell function (Metabolic Health) | Uncertain | Limited |
Teplizumab (Medications) |  Daily insulin dose (Glycemic Control) | Decrease | Limited |
Teplizumab (Medications) | HbA1c (Glycemic Control) | Decrease | Limited |
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Evidence Suggest
- Intravenous methylprednisolone and oral prednisone were used during the first CRS episode, and prednisone was used again during the second course.
- The patient completed both 12-day teplizumab courses without interruption after glucocorticoid treatment.
- Reported HbA1c values were 6.3% at 6 months, 6.4% at 15 months, 6.1% at 24 months, and 5.4% at 30 months.
- The authors reported ongoing low-dose basal insulin use and preserved mixed-meal C-peptide trends, which they interpreted as sustained partial remission.
Who this applies to
These findings apply most directly to adolescents or young people with new-onset type 1 diabetes receiving teplizumab who develop clinically significant cytokine release syndrome during treatment. Even then, the report reflects only one patient managed at a single center.
Keep in Mind
This paper mainly addresses adverse-event management, not a definitive test of teplizumab efficacy. The apparent benefit of glucocorticoids was limited to allowing treatment completion and symptom control in one patient. Because there was no formal comparison and many later outcomes reflect the broader effect of teplizumab itself, the case should be viewed as hypothesis-generating rather than practice-changing.
Between the Lines
- This was a single-patient case report.
- There was no direct control comparison for steroid use during CRS management.
- The patient was excluded from the parent trial analysis because glucocorticoids were prohibited.
- The report cannot show whether the same outcome would happen in other patients.
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Journal Reference
Khine A, Sanda S, Torok C, Quandt Z, Gitelman SE. Glucocorticoids to Manage Cytokine Release Syndrome During Teplizumab Therapy for New-Onset Type 1 Diabetes. Diabetes Care. 2026;49(3):e46-e48. doi:10.2337/dc25-2494
Sources
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Key References
Most relevant evidence and guidance related to this research.
ADA Standards of Care in Diabetes—2024
Supporting Evidence
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