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Document set current to 30 July 2026
Compound monograph · evidence extract

Thymosin alpha-1 in immune modulation and adjunctive immunotherapy — evidence extract

The Institute's graded assessment of Thymosin alpha-1 for immune modulation and adjunctive immunotherapy, with the contributing trials and the domain-by-domain certainty reasoning.

Document identifier
CEI-MN-040/EV-IMMUNE-SUPPORT
Series
Evidence extract
Version
4.2
Published
23 Jan 2026
Last reviewed
23 Jan 2026
Next review
23 Jan 2028
Identifier
10.71829/cei.mono.40
Certainty
Moderate
Cycle
2026 Q1

§1Evidence extract: Immune modulation and adjunctive immunotherapy

§1.1Question and anchor outcome

Population
Pharmacological modification of innate or adaptive immune function, assessed by cell counts, functional assays and clinical infection or oncological endpoints.
Intervention
Thymosin alpha-1, subcutaneous
Comparator
As used in each contributing trial; reported per trial rather than pooled across comparator types
Anchor outcome
CD4 and CD8 counts

Additional outcomes the Institute extracts for this indication: Response to vaccination; Infection incidence; Tumour response where applicable.

§1.2Contributing trials

Table 1. Trials contributing to the assessment of Thymosin alpha-1 in immune modulation and adjunctive immunotherapy.

TrialPhaseDesignRandomisedDurationYear
TA1-HBV-13Randomised, double-blind, active-controlled52 weeks2001
TA1-HCV-13Randomised, double-blind, active-controlled48 weeks2004
TA1-VACCINE-ELDERLY2Randomised, double-blind, placebo-controlled8 weeks1998
TA1-SEPSIS-CN3Randomised, double-blind, placebo-controlled36128 days2013

§1.3Certainty assessment

Certainty assessment by domainDowngrading decision recorded for each certainty domain.Certainty domainNo concernSeriousVery seriousEffect on ratingRisk of biasno downgradeInconsistencyno downgradeIndirectnessdowngrade one levelImprecisionno downgradePublication biasno downgradeTotal downgrading: 1 levelModerate certainty
Figure 2. Domain-by-domain certainty assessment for Thymosin alpha-1 in immune modulation and adjunctive immunotherapy. The starting rating for a body of randomised evidence is high; each serious concern reduces it by one level and each very serious concern by two.

Table 2. Reasoning recorded against each certainty domain.

DomainRatingReasoning
Risk of biasNo concernNo serious concern identified in this domain.
InconsistencyNo concernNo serious concern identified in this domain.
IndirectnessSeriousThe enrolled population differs materially from the population of the assessment question.
ImprecisionNo concernNo serious concern identified in this domain.
Publication biasNo concernNo serious concern identified in this domain.
Overall rating: Moderate certainty. The true effect is likely to be close to the estimate, but there is a possibility that it is substantially different. Further research is likely to have an important impact on confidence in the estimate.

§1.4What this extract does not establish

References cited on this page

References are numbered in order of first citation in this document. Each superscript in the text links to its entry below.

  1. Garaci E, Pica F, Serafino A, Balestrieri E, Matteucci C, Moroni G, Sorrentino R, Zonfrillo M, Pierimarchi P, Sinibaldi-Vallebona P. Thymosin α1 and cancer: action on immune effector and tumor target cells. Annals of the New York Academy of Sciences 2007;1112:225–234. doi:10.1196/annals.1415.025 · PMID 17567944
  2. D’Hondt M, Bracke N, Taevernier L, Gevaert B, Verbeke F, Wynendaele E, De Spiegeleer B. Related impurities in peptide medicines. Journal of Pharmaceutical and Biomedical Analysis 2014;101:2–30. doi:10.1016/j.jpba.2014.06.012 · PMID 25044089
  3. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi:10.1136/bmj.n71 · PMID 33782057

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