AUTHOR=Liu Jiao , Shen Yanfei , Wen Zhenliang , Xu Qianghong , Wu Zhixiong , Feng Huibin , Li Zhongyi , Dong Xuan , Huang Sisi , Guo Jun , Zhang Lidi , Chen Yizhu , Li Wenzhe , Zhu Wei , Du Hangxiang , Liu Yongan , Wang Tao , Chen Limin , Teboul Jean-Louis , Annane Djillali , Chen Dechang 

TITLE=Efficacy of Thymosin Alpha 1 in the Treatment of COVID-19: A Multicenter Cohort Study

JOURNAL=Frontiers in Immunology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2021.673693

DOI=10.3389/fimmu.2021.673693

ISSN=1664-3224

ABSTRACT=<sec><title>Background</title><p>Thymosin alpha 1 (Tα1) is widely used to treat patients with COVID-19 in China; however, its efficacy remains unclear. This study aimed to explore the efficacy of Tα1 as a COVID-19 therapy.</p></sec><sec><title>Methods</title><p>We performed a multicenter cohort study in five tertiary hospitals in the Hubei province of China between December 2019 and March 2020. The patient non-recovery rate was used as the primary outcome.</p></sec><sec><title>Results</title><p>All crude outcomes, including non-recovery rate (65/306 <italic>vs.</italic> 290/1,976, <italic>p</italic> = 0.003), in-hospital mortality rate (62/306 <italic>vs.</italic> 271/1,976, <italic>p</italic> = 0.003), intubation rate (31/306 <italic>vs.</italic> 106/1,976, <italic>p</italic> = 0.001), acute respiratory distress syndrome (ARDS) incidence (104/306 <italic>vs.</italic> 499/1,976, <italic>p</italic> = 0.001), acute kidney injury (AKI) incidence (26/306 <italic>vs.</italic> 66/1,976, <italic>p</italic> &lt; 0.001), and length of intensive care unit (ICU) stay (14.9 ± 12.7 <italic>vs.</italic> 8.7 ± 8.2 days, <italic>p</italic> &lt; 0.001), were significantly higher in the Tα1 treatment group. After adjusting for confounding factors, Tα1 use was found to be significantly associated with a higher non-recovery rate than non-Tα1 use (OR 1.5, 95% CI 1.1–2.1, <italic>p</italic> = 0.028). An increased risk of non-recovery rate associated with Tα1 use was observed in the patient subgroups with maximum sequential organ failure assessment (SOFA) scores ≥2 (OR 2.0, 95%CI 1.4–2.9, <italic>p</italic> = 0.024), a record of ICU admission (OR 5.4, 95%CI 2.1–14.0, <italic>p</italic> &lt; 0.001), and lower PaO2/FiO2 values (OR 1.9, 95%CI 1.1–3.4, <italic>p</italic> = 0.046). Furthermore, later initiation of Tα1 use was associated with a higher non-recovery rate.</p></sec><sec><title>Conclusion</title><p>Tα1 use in COVID-19 patients was associated with an increased non-recovery rate, especially in those with greater disease severity.</p></sec>