AimType 1 diabetes mellitus is widely recognized as a chronic autoimmune disease characterized by the pathogenic destruction of beta cells, resulting in the loss of endogenous insulin production. Insulin administration remains the primary therapy for symptomatic treatment. Recent studies showed that disease‐modifying agents, such as anti‐CD3 monoclonal antibodies, have shown promising outcomes in improving the management of the disease. In late 2022, teplizumab received approval from the US Food and Drug Administration (FDA) as the first disease‐modifying agent for the treatment of type 1 diabetes. This review aims to evaluate the clinical evidence regarding the efficacy of anti‐CD3 monoclonal antibodies in the prevention and treatment of type 1 diabetes.MethodsA comprehensive search of PubMed, Google Scholar, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) was conducted up to December 2022 to identify relevant randomized controlled trials. Meta‐analysis was performed using a random‐effects model, and odds ratios with 95% confidence intervals (CIs) were calculated to quantify the effects. The Cochrane risk of bias tool was employed for quality assessment.ResultsIn total, 11 randomized controlled trials involving 1397 participants (908 participants in the intervention arm, 489 participants in the control arm) were included in this review. The mean age of participants was 15 years, and the mean follow‐up time was 2.04 years. Teplizumab was the most commonly studied intervention. Compared with placebo, anti‐CD3 monoclonal antibody treatment significantly increased the C‐peptide concentration in the area under the curve at shorter timeframes (mean difference = 0.114, 95% CI: 0.069 to 0.159, p = .000). Furthermore, anti‐CD3 monoclonal antibodies significantly reduced the patients' insulin intake across all timeframes (mean difference = −0.123, 95% CI: −0.151 to −0.094, p < .001). However, no significant effect on glycated haemoglobin concentration was observed.ConclusionThe findings of this review suggest that anti‐CD3 monoclonal antibody treatment increases endogenous insulin production and improves the lifestyle of patients by reducing insulin dosage. Future studies should consider the limitations, including sample size, heterogeneity and duration of follow‐up, to validate the generalizability of these findings further.

Madam, the Monkeypox disease is a zoonotic infection caused by the Monkeypox virus of the Orthopoxvirus genus in the Poxviridae family. With a similar clinical presentation as the now eradicated smallpox, which includes fever, rash, and lymphadenopathy [1], the disease has remained endemic in Africa since the first reported case in the Democratic Republic of Congo in 1970. However, the latest news coverage has revealed new outbreaks of Monkeypox in non-endemic regions, which has left us wondering, ‘are we seeing the beginnings of a new Epidemic?’ Since its discovery, the number of reported cases of Monkeypox are on the rise, with the first case reported from outside Africa in 2003, when a Monkeypox outbreak reported from U.S.A following a shipment of Prairie dogs received from Ghana [2]. Between 2010-2019, cases were reported in the United Kingdom, Israel, and Singapore, all of which were associated with a recent travel history to Monkeypox endemic countries. As of 21 May 2022, the WHO reports 92 confirmed and 28 suspected cases of Monkeypox in humans from countries where the disease is non-endemic, with the highest numbers being reported in the UK, Spain, and Portugal. These cases are unique because the individuals involved were all infected locally, most of whom were men who had  sex with men (MSMs) [3] , indicating a sexual mode of transmission that warrants  further investigation. The cases being reported in the U.S.A and the U.K are concerning given the high number of international visitors to these countries, who may then spread the infection to their home countries. We believe that the emerging disease poses serious challenges within Pakistan and abroad. While new therapeutic agents (Tecovirimat) and a vaccine (MVA-BN) have been approved for Monkeypox, their availability remains limited. This issue would further be exacerbated by the challenges faced during the vaccination strategies used against Covid-19 in Pakistan [4]. Moreover, Human-to-human transmissions via sharing of beds and eating utensils has also been identified [5], which is concerning given Pakistan’s high population density and low socioeconomic status. We request that the respective Health authorities act to raise awareness of the disease. This may be accomplished by launching an Awareness Campaign using telecommunications and social media. Furthermore, screening of those with a recent travel history to countries with reported outbreaks should be conducted to curtail the spread of disease. --Continue

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