Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
J Am Acad Dermatol. 2018 Dec;79(6):1069-1075. doi: 10.1016/j.jaad.2018.06.061. Epub 2018 Jul 10.
Phototoxicity has been attributed to numerous oral drugs over the past 60 years.
Determine the quality of evidence supporting suspected phototoxicity from oral drugs.
The MEDLINE and EMBASE databases were searched for all studies that contain original data for drug-induced phototoxicity and were published between May 1959 and December 2016. Study quality was assessed by using a modified Grading of Recommendations, Assessment, Development and Evaluation scale.
The review included 240 eligible studies with a total of 2466 subjects. There were 1134 cases of suspected phototoxicity associated with 129 drugs. Most associations were supported by either very low-quality or low-quality evidence (89.1% of the studies). Medications supported by stronger evidence were vemurafenib, nonsteroidal anti-inflammatory drugs, and antibiotics, specifically, fluoroquinolones and tetracyclines. The most frequently reported drugs were vemurafenib, voriconazole, doxycycline, hydrochlorothiazide, amiodarone, and chlorpromazine. Photobiologic evaluation was performed in only 56 studies (23.3%), whereas challenge-rechallenge was done in 10% of cases.
Only English-language publications were reviewed. Cases of phototoxicity that had been incorrectly categorized as photoallergy would not have been included.
Most purported associations between oral drugs and phototoxicity are not supported by high-quality evidence. Despite the variable quality of data, clinicians should be aware of the possible consequences of long-term use of culprit drugs.
在过去的 60 年中，已有多种口服药物被认为具有光毒性。
确定支持口服药物光毒性的证据质量。
检索 MEDLINE 和 EMBASE 数据库，以获取所有包含药物诱导光毒性原始数据的研究，检索时间为 1959 年 5 月至 2016 年 12 月。使用改良的推荐评估、制定与评价分级量表评估研究质量。
本综述共纳入 240 项符合条件的研究，共计 2466 例受试者。共有 129 种药物与 1134 例疑似光毒性病例相关。大多数关联的证据质量为极低或低质量（89.1%的研究）。证据更有力的药物包括维莫非尼、非甾体抗炎药和抗生素，尤其是氟喹诺酮类和四环素类。报告最频繁的药物包括维莫非尼、伏立康唑、多西环素、氢氯噻嗪、胺碘酮和氯丙嗪。仅有 56 项研究（23.3%）进行了光生物学评估，而仅有 10%的病例进行了挑战-再挑战。
仅对英文出版物进行了回顾。错误分类为光过敏的光毒性病例将不包括在内。
大多数口服药物与光毒性之间的假定关联没有高质量证据支持。尽管数据质量存在差异，但临床医生应意识到长期使用可疑药物可能产生的后果。
