Risk of acute pancreatitis with methimazole use: a systematic review and meta-analysis

Recent pharmacovigilance reports suggested that thionamide compounds can increase the risk of acute pancreatitis (AP). Through this systematic review and meta-analysis, we comprehensively evaluated the association between methimazole use and new-onset AP. PubMed/MEDLINE, Embase, Cochrane Library, and Scopus/Web of Science databases were searched from inception to August 2020. The pooled estimates were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Four observational studies, consisting of 202,800 participants and 15,721 cases of AP, were included in the analysis. Methimazole use increased the odds of new-onset AP by 47% (OR 1.47; 95% CI 0.89–2.43), but this association was not significant (p = 0.134). This suggests that the use of methimazole might slightly increase the risk of AP. Because the evidence for this association is limited, caution is advised for active interventions, and further investigation is warranted.