Methimazole Versus Propylthiouracil Inpatients With Hyperthyroidism:a Systematic Review

Objective To evaluate the efficacy and safety of methimazole versuspropylthiouracil for patients with hyperthyroidism.Methods We searched the WanFang database, Qinghua Tongfangdatabase, Chongqing VIP database,Chinese Biomedical Literature Database,PubMed,EMBASE, Cochrane Library databases and other databases, time endedMarch1,2014. Eligible studies were prospective, randomized control trials(RCT)、case-control studies、cohort studies of methimazole comparing withpropylthiouracil in patients with hyperthyroidism. Outcome measures includedthese indicators:①efficacy indicator：return to normal thyroid function of timeand number.②security indicator：the number of the occurrence of adversereactions, including liver dysfunction, neutropenia, agranulocytosis, thyroiddysfunction, skin reactions, ANCA-positive cases and ANCA associatedvasculitis. Finally, calculate the total incidence of adverse reactions in thesestudies. Effect sizes using relative risk (Relative risk, RR) described and the95%confidence intervals (Confidence interval, CI) describe the final result. Bytwo researchers according to pre-established inclusion and exclusion criteria toretrieve documents, screening, extract data，analysis quality of data,consolidate data, analysis heterogeneity and bias, and the analysis of problems arising in thecourse of further study.Conduct a quality assessment and use Stata11.0withMeta Meta-analysis software.Results Twenty-six studies,18studies are randomized control trials,8studies are cohort studies,these studies including2915patients, were identified.Among which1669patients is in methimazole group and1246patients inpropylthiouracil group. Meta-analysis showed that the therapeutic regimenmethimazole comparing with propylthiouracil, within4weeks, the twoantithyroid drugs to treat hyperthyroidism no statistical difference in remissionrates.4weeks to8weeks,8weeks and12weeks, methimazole’shyperthyroidism remission rate higher than propylthiouracil, the combinationeffects are[RR=1.934,95%CI （1.221,3.063）,P=0.005],[RR=1.679,95%CI（1.211,2.327）,P=0.002].12weeks to2years methimazole and propylthiouracilno significant difference in remission rate of hyperthyroidism. But in terms ofthe risk of adverse reactions, methimazole compared to propylthiouracil,methimazole reduce incidents of liver damage occurs,[RR=0.381,95%CI（0.291,0.500）,P＜0.001]; and increase incidents of hypothyroidism [RR=2.679,95%CI (1.688,4.253), P＜0.001]; the incidents of the other adverseevents such as skin reactions, neutropenia and agranulocytosis, methimazolecompared to propylthiouracil have no statistical difference.Conclusions Comparing with methimazole and propylthiouracil inpatients with hyperthyroidism（72.97%of patients with Graves disease,3.88%ofpatients with multinodular toxic goiter）, within4weeks, both antithyroid drugsto treat hyperthyroidism no significant difference in remission rates.4weeks to8weeks and8weeks to12weeks，methimazole in hyperthyroid remission ratehigher than propylthiouracil. More than12weeks to2years, the two antithyroid drugs to treat hyperthyroidism no significant difference in remission rates.In the adverse reactions, compare with propylthiouracil, methimazole havelower incidence of liver damage, and the higher incidence of hypothyroidism.But the adverse reactions such as skin reactions, neutropenia andagranulocytosis, methimazole are no significant difference with propylthiouracil.