Background

Phototoxicity has been attributed to numerous oral drugs over the past 60 years.

Objective

Determine the quality of evidence supporting suspected phototoxicity from oral drugs.

Methods

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.

Results

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.

Limitations

Only English-language publications were reviewed. Cases of phototoxicity that had been incorrectly categorized as photoallergy would not have been included.

Conclusions

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.

中文翻译：

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药物引起的光毒性：系统评价

背景

在过去的60年中，光毒性归因于多种口服药物。

客观的

确定支持口服药物可疑光毒性的证据的质量。

方法

在MEDLINE和EMBASE数据库中搜索所有包含药物诱导的光毒性原始数据的研究，并于1959年5月至2016年12月之间发表。研究质量通过使用建议书，评估，发展和评估量表的修订版进行评估。

结果

审查包括240项合格研究，共2466项主题。有1134例与129种药物有关的可疑光毒性病例。大多数关联得到了非常低质量或低质量证据的支持（占研究的89.1％）。强有力的证据支持的药物是维罗非尼，非甾体类抗炎药和抗生素，尤其是氟喹诺酮类和四环素类。报道最频繁的药物是维罗非尼，伏立康唑，强力霉素，氢氯噻嗪，胺碘酮和氯丙嗪。仅56项研究（23.3％）进行了光生物学评估，而10％的病例进行了挑战-再挑战。

局限性

仅对英语出版物进行了审查。错误分类为光过敏的光毒性病例将不包括在内。

结论

高质量的证据不支持口服药物与光毒性之间的大多数据称关联。尽管数据质量参差不齐，但临床医生应意识到长期使用罪魁祸首药物可能产生的后果。