红细胞生成性原卟啉(EPP)和X-连锁原卟啉(XLP)的特征在于由原卟啉IX的积累引起的皮肤光敏性。我们旨在回顾EPP或XLP患者皮肤光敏性治疗的有效性和安全性的临床证据。我们系统地搜索了MEDLINE,Embase,Cochrane图书馆,和ClinicalTrials.gov.共纳入40项研究,其中包含18种治疗方式的数据。综合治疗安全性数据来自欧洲药品管理局和美国食品和药物管理局。研究使用不同的结果测量来评估敏感性,而没有普遍接受的方法来评估对皮肤光敏性的治疗效果。在纳入的研究中,13项为对照试验。聚集,试验表明,无机防晒霜的应用和阿非美拉诺肽的皮下植入具有中等的积极效果,而有机防晒霜的应用没有效果,或者用β-胡萝卜素口服治疗,半胱氨酸,N-乙酰半胱氨酸,维生素C,或者华法林.没有对照组的研究表明粉底霜的治疗效果,二羟基丙酮/lawsone乳膏,窄带紫外线B光疗,红细胞输血,体外红细胞光动力疗法,或口服硫酸锌,特非那定,西咪替丁,或者角黄素,但是真正的效果是不确定的。评估EPP或XLP患者对光敏性的治疗效果具有很高的偏倚风险,因为经历过的光敏性随天气条件而变化。曝光模式,和色素沉着。有希望的治疗选择的对照试验很重要,尽管在这个小患者群体中具有挑战性。
Erythropoietic protoporphyria (EPP) and X-linked protoporphyria (XLP) are characterized by skin
photosensitivity caused by accumulation of protoporphyrin IX. We aimed to
review the clinical evidence of efficacy and safety of skin
photosensitivity treatments in individuals with EPP or XLP. We systematically searched MEDLINE, Embase, the Cochrane Library, and ClinicalTrials.gov. A total of 40 studies with data on 18 treatment modalities were included. Comprehensive treatment safety data were obtained from the European Medicines Agency and the United States Food and Drug Administration. The studies used different outcome measures to evaluate the sensitivity without a generally accepted method to assess treatment effect on skin
photosensitivity. Of the included studies, 13 were controlled trials. Gathered, the trials showed moderate positive effect of inorganic sunscreen application and subcutaneous implant of afamelanotide and no effect of organic sunscreen application, or oral treatment with beta-carotene, cysteine, N-acetylcysteine, vitamin C, or warfarin. Studies without control groups suggested treatment effect of foundation cream, dihydroxyacetone/lawsone cream, narrow-band ultraviolet B phototherapy, erythrocyte transfusion, extracorporeal erythrocyte photodynamic therapy, or oral treatment with zinc sulphate, terfenadine, cimetidine, or canthaxanthin, but the real effect is uncertain. Assessment of treatment effect on
photosensitivity in patients with EPP or XLP carries a high risk of bias since experienced
photosensitivity varies with both weather conditions, exposure pattern, and pigmentation. Controlled trials of promising treatment options are important although challenging in this small patient population.