Systematic Review and Meta-Analysis

Thymosin α1-Based Immunomodulatory Therapy for Sepsis: A Meta-Analysis with Trial Sequential Analysis of Randomized Controlled Trials

Wan-Jie Gu , Xiao-Ping Gu , Zheng-Liang Ma
Department of Anesthesiology, Nanjing Drum Tower Hospital, Medical College of Nanjing University, Nanjing, China
J Anesth Perioper Med 2018; 5(3): 125- 135 . Published on Feb 25, 2017 . doi:10.24015/JAPM.2017.0017
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Background: Preclinical studies suggest that thymosin α1 has immunoregulatory and anti-inflammatory properties in various septic models. However, whether these effects will transform into improved outcomes in humans with sepsis remains unclear. We performed a meta-analysis to define the role of thymosin α1-based immunomodulatory therapy in sepsis.

Methods: We searched Medline and Embase to identify randomized controlled trials that assessed the effect of thymosin α1-based immunomodulatory therapy compared with standard care for adults with sepsis. We calculated risk ratios (RRs) with 95% confidence intervals (CIs) using a random-effects model. The primary outcome was 28-day mortality.

Results: Nine articles with 10 trials involving 1425 patients were included. Compared with standard care, thymosin α1-based immunomodulatory therapy was associated with a significant 31% relative risk reduction of 28-day mortality (RR 0.69, 95% CI 0.60-0.80, P<0.001), with no statistical heterogeneity (I2=0%). The benefit was confirmed by trial sequential analysis and was consistent across all subgroup analyses. For secondary outcomes, thymosin α1-based immunomodulatory therapy was associated with shorter length of intensive care unit (ICU) stay and duration of mechanical ventilation, increased T lymphocyte subsets (CD3+, CD4+, and CD4+/CD8+), and decreased inflammatory mediators (tumor necrosis factor-α, interleukin-1β, and interleukin-6).

Conclusions: Thymosin α1-based immunomodulatory therapy decreases 28-day mortality in patients with sepsis. The benefit might be attributed to its immunomodulatory and anti-inflammatory effects. However, caution should be used to translate these findings to clinical practice, because current evidence is potentially subject to bias. Hence, high-quality and adequately powered trials are still warranted.



Citation: Wan-Jie Gu, Xiao-Ping Gu, Zheng-Liang Ma. Thymosin α1-based immunomodulatory therapy for sepsis: a meta-analysis with trial sequential analysis of randomized controlled trials. J Anesth Perioper Med 2018; 5: 125-35. doi:10.24015/JAPM.2017.0017

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