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The effect of thymosin α1 on mortality of critical COVID-19 patients: A multicenter retrospective study
Qin Sun1, Jianfeng Xie1, Ruiqiang Zheng2
1Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, No. 87, Dingjiaqiao Road, Gulou District, Nanjing 210009, PR China.
Insights
Thymosin alpha1 therapy did not reduce mortality in critically ill COVID-19 patients. Further analysis revealed no significant survival benefits across subgroups or patient phenotypes.
Area of Science:
- Immunology
- Infectious Diseases
- Critical Care Medicine
Background:
- Thymosin alpha1 (Tα1) was frequently administered to patients with coronavirus disease 2019 (COVID-19).
- Uncertainty existed regarding Tα1's impact on COVID-19 patient outcomes and identifying potential beneficiaries.
- This study aimed to clarify the efficacy of Tα1 in COVID-19 treatment.
Purpose of the Study:
- To evaluate the association between thymosin alpha1 therapy and 28-day mortality in COVID-19 patients.
- To identify specific patient subgroups or phenotypes that might benefit from thymosin alpha1 treatment.
- To provide evidence-based insights into the clinical utility of thymosin alpha1 for COVID-19.
Main Methods:
- Retrospective cohort study including 771 COVID-19 patients from January 1 to February 29, 2020.
- Propensity score matching (PSM) was employed to control for baseline confounders.
- Subgroup and cluster analyses, along with Cox proportional hazard models, were used to assess treatment effects.
Main Results:
- Initial analysis showed lower 28-day mortality in the Tα1 group (41.3% vs. 60.6%, p < 0.001).
- After PSM, no significant difference in 28-day mortality was observed between Tα1 and control groups (51.0% vs. 52.9%).
- Subgroup analyses indicated a potential benefit only in male patients (HR 0.673), while cluster analysis revealed no mortality differences in identified phenotypes.
Conclusions:
- Thymosin alpha1 therapy was not associated with reduced 28-day mortality in critically ill COVID-19 patients.
- Neither subgroup nor phenotype analyses demonstrated a significant survival benefit from thymosin alpha1 treatment.
- The findings suggest limited efficacy of thymosin alpha1 in improving outcomes for the general COVID-19 patient population studied.
Background:
Thymosin α1 therapy was commonly used in patients with coronavirus disease 2019 (COVID-19), while its impact on outcomes and which patients could benefit from thymosin α1 therapy were uncertain.
Study Design And Methods:
Patients with COVID-19 from 19 designated hospitals between January 1 to February 29, 2020 were included, and the main exposure of interest was administration of thymosin α1. The primary outcome was 28-day mortality. Propensity score matching (PSM) was used to account for baseline confounders, cluster analysis and Cox proportional hazard model was used to account for subgroup analysis.
Results:
A total of 771 patients were included, and 327/771 (42.4%) patients received thymosin α1 therapy. The 28-day mortality in thymosin group was significantly lower than that in control group (41.3% vs. 60.6%, p < 0.001). After PSM 522 patients were included in analysis and the 28-day mortality in thymosin α1 group and control group were 51.0% and 52.9% respectively, with no significant difference. In subgroup analyses, the association between thymosin α1 therapy and 28-day mortality appeared to be stronger among male patients (HR 0.673, 95% CI 0.454-0.998; p = 0.049). There were no benefits of thymosin α1 in 28-day mortality in other subgroups. There were two phenotypes after cluster analysis, but no benefits of thymosin α1 were shown in phenotype 1 (HR 0.823 95% CI 0.581-1.166; p = 0.273) and phenotype 2 (HR 1.148 95% CI 0.710-1.895; p = 0.442).
Conclusion:
There was no association between use of thymosin α1 and decreased mortality in critically ill COVID-19 patients. Subgroups analysis and phenotype analysis also showed no differences on mortality after thymosin α1 therapy.
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