Thymosin alpha1 based immunomodulatory therapy for sepsis: a systematic review and meta-analysis

• This meta-analysis strengthened the viewpoint that sepsis patients could benefit from immunomodulatory therapy.
• Thymosin alpha1 based immunomodulatory therapy could significantly reduce the risk of all-cause mortality among septic patients.
• Subgroup analyses showed that both using Thymosin alpha1 alone and combined with ulinastain could bring about lower mortality in patients with sepsis.
• Because of the poor quality of some included trials, these findings should be applied cautiously, and more well designed clinical trials are needed.

ObjectivesThymosin alpha1 (Tα1) is considered a promising immunomodulatory drug. However, it is still unclear whether Tα1 should be recommended for the management of sepsis. Here we conducted a systematic review and meta-analysis to assess the efficacy of Tα1 based immunomodulatory therapy on the clinical outcomes of septic patients.MethodsWe searched for relevant clinical trials published before Dec. 12, 2014 through electronic databases. All articles about Tα1 based immunomodulatory therapy for sepsis were included regardless of language. Two authors independently selected studies, extracted data and assessed the quality of each included study. We polled the data related to all-cause mortality with Review Manager 5.1.ResultsTwelve controlled trials were evaluated in all. Tα1 based immunomodulatory therapy had a significant trend toward lower all-cause mortality among patients with sepsis (pooled risk ratio 0.68, 95%CI 0.59-0.78, p < 0.00001, 12 trials, n = 1480).ConclusionsTα1 based immunomodulatory therapy was associated with a lower mortality in septic patients. Nevertheless, these findings should be interpreted cautiously because of the poor quality and small number of participants of the included trials. More well-designed worldwide multicenter clinical trials are needed to provide a conclusive guideline for clinical practice.