Is thymosin alpha 1 effective for treating long COVID (Coronavirus disease 2019)?

Thymosin Alpha 1 for Long COVID: Current Evidence and Recommendations

Thymosin alpha 1 is not recommended for the treatment of long COVID as there is currently insufficient evidence to support its use for this condition. 1

Current Evidence on Thymosin Alpha 1 in COVID-19

Acute COVID-19 Evidence

• The European Alliance of Associations for Rheumatology (EULAR) guidelines specifically state there is insufficient evidence to recommend various immunomodulatory drugs for COVID-19, including interferons and other immunomodulators not specifically listed 1
• Limited studies have shown mixed results for thymosin alpha 1 in acute COVID-19:
  • A small pilot trial showed thymosin alpha 1 increased CD4+ T-cell counts in hospitalized COVID-19 patients with hypoxemia and lymphocytopenia, but clinical recovery differences were not statistically significant 2
  • A retrospective cohort study found thymosin alpha 1 shortened viral RNA shedding duration and hospital stay in non-severe COVID-19 patients but did not prevent disease progression or reduce mortality 3
  • A meta-analysis suggested possible mortality reduction in moderate to critical COVID-19 patients, but with significant heterogeneity among studies 4
  • Another multicenter retrospective study found no association between thymosin alpha 1 use and decreased mortality in critically ill COVID-19 patients 5

Long COVID Evidence

• Only one small ex vivo study has examined thymosin alpha 1 in long COVID (PASC), suggesting it might improve immune response restoration in patients with chronically altered immune responses 6
• This preliminary research is insufficient to recommend clinical use for long COVID

Treatment Recommendations for Long COVID

Current guidelines for long COVID management focus on:

• Symptom-based management for specific manifestations like gastrointestinal symptoms 7:

  • Antihistamine therapy (H1 and H2 blockers) for gastrointestinal symptoms
  • Symptom-specific medications (loperamide for diarrhea, anti-emetics for nausea)
  • Dietary modifications and supplements as adjunctive therapy

• Traditional Chinese Medicine approaches for rehabilitation:

  • TCM decoctions based on syndrome differentiation may help improve pulmonary function in convalescent patients 1
  • Posture management, breathing exercises, and TCM health-preserving exercises like Baduanjin and Tai-chi may assist with pulmonary function recovery 1

Important Considerations

• Lack of high-quality evidence: Most studies on thymosin alpha 1 for COVID-19 are retrospective or small pilot trials with significant limitations
• Regulatory status: Thymosin alpha 1 is not FDA-approved for long COVID treatment
• Potential risks: Immunomodulatory therapies may have unintended consequences in the complex immune dysregulation of long COVID
• Better alternatives exist: Focus on symptom management with evidence-based approaches while research continues

Conclusion

While there is some preliminary research suggesting thymosin alpha 1 might have immunomodulatory effects that could theoretically benefit long COVID patients, the current evidence is insufficient to recommend its use. Management should focus on established symptom-based approaches while awaiting results from ongoing research into targeted therapies for long COVID.