FrancophonIA/ELRC3.0 huggingface dataset:
English: Since the systemic exposure observed for Linoladiol N is much higher than those reported for other estradiol-containing products available for intravaginal use, restricting the duration of treatment to four weeks is considered an adequate risk minimisation measure given the existing safety concerns and the surrounding uncertainties regarding the systemic estradiol exposure related with this product in the target population of post-menopausal women.
Slovenian: Ker je sistemska izpostavljenost, opažena pri zdravilu Linoladiol N, precej večja kot sistemska izpostavljenost, o kateri so poročali pri zdravilih za intravaginalno uporabo, ki vsebujejo estradiol, je omejitev trajanja zdravljenja na štiri tedne ustrezen ukrep za zmanjševanje tveganja z ozirom na obstoječe varnostne težave in z njimi povezane negotovosti glede sistemske izpostavljenosti estradiolu, povezane s tem zdravilom, v ciljni populaciji postmenopavzalnih žensk.
English: In addition for further minimisation of any potential safety risk, the MAHs have been requested to provide a detailed plan including precise short timelines on the adaptation of the lower pack size (25 g) to add an applicator in the package and the withdrawal of the 35 g and 50 g pack sizes, in all EU member states where they are currently authorised.
Slovenian: Poleg dodatnega zmanjšanja kakršnega koli morebitnega varnostnega tveganja so od imetnika dovoljenja za promet z zdravilom zahtevali, naj predloži podroben načrt, vključno z natančnim kratkim odmerjanjem ob prehodu na manjše pakiranje (25 g), ki se bo dodalo aplikatorju v pakiranju, in umiku velikosti pakiranja po 35 g ter 50 g v vseh državah članicah EU, kjer so ta zdravila trenutno odobrena.
English: In addition, the contraindications and warnings have been updated to take into consideration the international guidelines and current clinical knowledge on safety of systemic HRT especially regarding thromboembolism and breast and endometrial cancer, and also the known lack of sensitivity of spontaneous adverse event reporting.
Slovenian: Poleg tega so se kontraindikacije in opozorila posodobila tako, da upoštevajo mednarodne smernice, trenutno klinično znanje o varnosti sistemskega hormonskega nadomestnega zdravljenja, predvsem glede tromembolije in raka dojke ter endometrija, znano pomanjkanje občutljivosti pri spontanem poročanju neželenih učinkov;
English: In addition to endometrial safety concerns, known risks for systemic oestrogen-containing products for HRT are breast cancer, ovarian cancer, venous thromboembolism, ischaemic stroke.
Slovenian: Poleg pomislekov glede varnosti za endometrij so znana tveganja sistemskih zdravil, ki vsebujejo estrogene in so namenjena hormonskemu nadomestnemu zdravljenju, rak dojke, rak jajčnika, venska trombembolija in ishemična kap.
English: In addition, the CHMP considered that the maximum duration of treatment should continue to be restricted to four weeks, and clear information that treatment beyond four weeks is not recommended should be reflected in the posology section.
Slovenian: Odbor CHMP je menil, da mora biti najdaljše trajanje zdravljenja še naprej omejeno na štiri tedne, v poglavje o odmerjanju pa je treba dodati jasne informacije, da zdravljenje, daljše od štirih tednov, ni priporočljivo.
English: No clinical studies investigating PK/absorption of estradiol and prednisolone, dosefinding and the efficacy of Linoladiol HN in the therapeutic indications approved have been submitted.
Slovenian: Predložene niso bile nobene študije, ki bi proučevale farmakokinetiko/absorpcijo estradiola ter prednizolona, določanje odmerka in učinkovitost zdravila Linoladiol HN pri terapevtskih indikacijah.
English: In addition the restriction to 4 weeks use of these products is justified by the clinical data currently available.
Slovenian: Poleg tega trenutno razpoložljivi klinični podatki utemeljujejo omejitev uporabe teh zdravil na 4 tedne.
English: The CHMP noted that the maintenance dose recommended for Linoladiol N is about 8 times higher than the maintenance dose of estradiol 25 mcg vaginal tablets and estradiol vaginal ring and 20 times higher than the maintenance dose of estradiol 10 mcg vaginal tablets.
Slovenian: Odbor CHMP je ugotovil, da je vzdrževalni odmerek, priporočen za zdravilo Linoladiol N, približno 8-krat večji kot vzdrževalni odmerek vaginalnih tablet s 25 µg estradiola in vaginalnega obročka z estradiolom ter 20-krat večji kot vzdrževalni odmerek vaginalnih tablet z 10 µg estradiola.
English: Systemic exposure is neither required nor advised for topical therapy and raises known safety concerns recognized for systemic HRT.
Slovenian: Sistemska izpostavljenost pri topičnem zdravljenju ni potrebna in ni priporočena ter predstavlja znano varnostno težavo, značilno za sistemsko hormonsko nadomestno zdravljenje.
English: The Committee therefore agreed that the indication could be “Treatment of vaginal atrophy due to oestrogen deficiency in postmenopausal women”, according to the MAH grounds, provided that a restriction on the duration of use of these medicinal products to 4 weeks only (not repeated use), as mentioned above.
Slovenian: Odbor se je zato strinjal, da je lahko na podlagi razlogov, ki jih je navedel imetnik dovoljenja za promet z zdravilom, indikacija: „Zdravljenje atropije nožnice zaradi pomanjkanja estrogena pri postmenopavzalnih ženskah“, če se trajanje uporabe teh zdravil omeji samo na 4 tedne (brez ponavljajoče se uporabe), kot je omenjeno zgoraj.
English: • For the 0.005 % w/w estradiol with 0.4 % w/w prednisolone containing medicinal products for topical use the Committee considered that in view of the currently available safety data these products should be used for the initial short-term external treatment of acute, mild inflammatory skin diseases of the external genital area in postmenopausal women for which weak acting corticosteroids and estradiol are indicated.
Slovenian: • za zdravila za topično uporabo, ki vsebujejo 0,005 % m/m estradiola in 0,4 % m/m prednizolona, je odbor menil, da je treba te izdelke skladno s trenutno razpoložljivimi varnostnimi podatki uporabljati za začetno kratkotrajno zunanje zdravljenje akutnih, blagih vnetnih kožnih bolezni zunanjih spolovil pri postmenopavzalnih ženskah, pri katerih so indicirani šibki kortikosteroidi in estradiol.
English: For that reason the CHMP recommended to restrict the use of these medicinal products to 4 weeks only (no repeated use), and advised that if symptoms of vaginal atrophy re-appear alternative therapies, either non-hormonal or lower-dose estradiol containing topical products, should be considered.
Slovenian: To je bil razlog, da je odbor CHMP priporočil omejitev uporabe teh zdravil na samo 4 tedne (brez ponavljajoče se uporabe) in svetoval, naj se pretehta uporaba drugih oblik zdravljenja, tj. nehormonskih zdravil za topično uporabo ali zdravil za topično uporabo, ki vsebujejo estradiol, če se simptomi vaginalne atrofije ponovno pojavijo.
English: • The Committee considered the procedure under Article 31 of Directive 2001/83/EC of the 0.01% w/w estradiol containing medicinal products for topical use as well as fixed dose combination products containing 0.005 % w/w estradiol with 0.4 % w/w prednisolone for topical use.
Slovenian: • odbor CHMP je obravnaval postopek v skladu s členom 31 Direktive 2001/83/ES za zdravila za topično uporabo, ki vsebujejo 0,01 % m/m estradiola, ter kombiniranih zdravil za topično uporabo s fiksnim odmerkom, ki vsebujejo 0,005 % m/m estradiola in 0,4 % m/m prednizolona;
English: In terms of the PK data, systemic levels of estradiol are of interest due to well-known safety concerns.
Slovenian: Pri farmakokinetičnih podatkih je treba upoštevati sistemske ravni estradiola, da so varnostne težave dobro znane.
English: Study SCO 5174, a randomised, double-blind, placebo-controlled parallel group post-authorisation study investigating the efficacy and safety of Linoladiol N in the treatment of 48 postmenopausal women with vaginal atrophy, the primary test parameter was the vaginal maturation index (VMI).
Slovenian: Študija SCO 5174, randomizirana, dvojno slepa, s placebom nadzorovana študija z vzporednimi skupinami, opravljena v obdobju trženja, je proučevala učinkovitost in varnost zdravila Linoladiol N pri zdravljenju 48 postmenopavzalnih žensk z nožnično atrofijo, pri čemer je bil primarni testni parameter maturacijski indeks (MI).
English: Current treatment guidelines for vaginal atrophy recommend the use of low-dose local vaginal oestrogens, along with non-hormonal lubricants or moisturisers.
Slovenian: Trenutne smernice za zdravljenje nožnične atrofije priporočajo uporabo lokalnih nožničnih estrogenov z nizkim odmerkom v kombinaciji z nehormonskimi lubrikanti ali vlažilnimi sredstvi.
English: However, no conclusions regarding endometrial safety can be drawn based on post-marketing data, due to the low number of total reported cases for Linoladiol N and the confounded cases reporting endometrial events.
Slovenian: podatkov iz obdobja trženja ni mogoče sklepati glede varnosti za endometrij, saj je število skupnih poročanih primerov za zdravilo Linoladiol N majhno, primeri poročanja endometrialnih dogodkov pa nedosledni.
English: In addition, the MAHs have been requested to provide a detailed plan including precise short timelines on the adaptation of the lower pack size (25 g) and the withdrawal of the 35 g and 50 g pack sizes, in all EU member states where they are currently authorised.
Slovenian: Poleg tega so od imetnika dovoljenja za promet z zdravilom zahtevali, naj predloži podroben načrt, vključno z natančnim kratkim odmerjanjem ob prehodu na manjše pakiranje (25 g) in umiku velikosti pakiranja po 35 g ter 50 g v vseh državah članicah EU, kjer so ta zdravila trenutno odobrena;
English: The pharmacokinetics of the dosing regimen of Linoladiol N administered on the skin of the vulva was not investigated and therefore the CHMP considered that the indication should be restricted to only vaginal treatment (and not on the skin of vulva) after a lower oestrogen treatment has failed, and the treatment duration limited to four weeks.
Slovenian: Farmkokinetike režima odmerjanja zdravila Linoladiol N pri nanosu na kožo vulve niso preučevali, zato je odbor CHMP menil, da je treba indikacijo omejiti samo na nožnično zdravljenje (in izključiti kožo zunanjih spolovil), če zdravljenje z manjšimi odmerki estrogenov ni bilo uspešno, trajanje zdravljenja pa omejiti na štiri tedne.
English: Based on the provided comparison of the Cmax and Caverage values for Linoladiol N, it appears that the systemic exposure to estradiol at steady state (twice weekly) is about 2.5-3 fold higher compared to 10mcg tablets and about 25% higher for Linoladiol N cream than for the 25 mcg tablets.
Slovenian: Na podlagi predložene primerjave vrednosti Cmax in Cpovprečje za zdravilo Linoladiol N je videti, da je sistemska izpostavljenost v stanju dinamičnega ravnovesja (dvakrat na teden) približno od 2,5- do 3-krat večja v primerjavi z 10 µg tabletami in približno za 25 % večja pri kremi zdravila Linoladiol N kot pri 25 µg tabletah.
English: Clinical monitoring is expected and caution should be used in e.g. patients with a history of malignant oestrogen-dependent tumours or tumours of the womb.
Slovenian: Pričakujeta se klinično spremljanje in previdnost, npr. pri bolnicah z malignimi, od estrogenov odvisnimi tumorji ali tumorji maternice v anamnezi.
English: The CHMP considered that Linoladiol HN could continue to be used in the initial short-term external treatment of acute, mild, inflamed, burning and itching skin diseases of the external female genital area, for which weak-acting corticosteroids and low-dose estradiol are indicated.
Slovenian: Odbor CHMP je menil, da se lahko zdravilo Linoladiol HN še naprej uporablja za začetno kratkotrajno zunanje zdravljenje akutnih, blagih, vnetnih, pekočih in srbečih kožnih bolezni ženskih zunanjih spolovil, pri katerih so indicirani šibki kortikosteroidi in majhni odmerki estradiola.
English: Secondly, the MAH disagreed with the CHMP assessment of the overall profile of the Linoladiol N product.
Slovenian: Kot drugo se imetnik dovoljenja za promet z zdravilom ni strinjal z oceno splošnega profila zdravila Linoladiol N, ki jo je izvedel odbor CHMP.
English: Of the three comparators (vaginal tablets 10 and 25 mcg and vaginal ring) discussed estradiol vaginal tablets 25 mcg is associated with the highest systemic exposure to estradiol and was compared to Linoladiol N. After a single dose of estradiol vaginal tablets 25 mcg, Cmax without baseline correction was 206 pmol/l, while Caverage without baseline correction during the first 24 h was 86 pmol/l based on the studies by Notelovitz (2002) and Nilsson and Heimer (1992).
Slovenian: Od treh obravnavanih primerjalnih zdravil (vaginalne tablete 10 ter 25 µg in vaginalni obroček) so vaginalne tablete s 25 µg estradiola povezane z največjo sistemsko izpostavljenostjo estradiolu, zato se je to zdravilo primerjalo z zdravilom Linoladiol N. Po enkratnem odmerku vaginalnih tablet s 25 µg estradiola je bila vrednost Cmax (brez prilagajanja glede na izhodišče) 206 pmol/l, medtem ko je bila vrednost Cpovprečje (brez prilagajanja glede na izhodišče) v prvih 24 urah 86 pmol/l, kar je temeljilo na študijah, ki so jih opravili Notelovitz (2002) in Nilsson ter Heimer (1992).
English: Estradiol serum concentrations were determined with the following main results: baseline-adjusted AUCδ0-36 900.8 pg/ml h, baseline-adjusted Cδmax 92.2 pg/ml.
Slovenian: Določili so koncentracije estradiola v serumu z naslednjimi glavnimi rezultati: glede na izhodišče prilagojena vrednost AUCδ0-36 900,8 pg/ml h, glede na izhodišče prilagojena vrednost Cδmax 92,2 pg/ml.
English: Despite any limitations of historical comparisons with other locally applied medicinal products, it can be concluded that exposure to estradiol after administration of Linoladiol N is considerably higher than after administration of other lower dosed estradiol products for topical intravaginal therapy.
Slovenian: Kljub omejitvam zgodovinskih primerjav z drugimi lokalnimi zdravili je mogoče sklepati, da je izpostavljenost estradiolu po uporabil zdravila Linoladiol N znatno večja kot po uporabi drugih zdravil z majhnim odmerkom estradiola za topično intravaginalno zdravljenje.
English: 0.01 % w/w estradiol containing medicinal products for topical use (Linoladiol N) The CHMP took into account all available data on pharmacokinetics (PK), dose-finding, efficacy and safety, including endometrial safety, of products for intravaginal administration and/or administration on the skin of the vulva containing estradiol, and also the well-known risks of systemic hormonal replacement therapy (HRT) in the approved therapeutic indication.
Slovenian: Odbor CHMP je upošteval vse razpoložljive podatke o farmakokinetiki (FK), določanju odmerka, učinkovitosti in varnosti, vključno z varnostjo za endometrij, za zdravila za intravaginalno uporabo in/ali uporabo na koži vulve, ki vsebujejo estradiol, ter o dobro znanih tveganjih sistemskega hormonskega nadomestnega zdravljenja (HNZ) pri odobreni terapevtski indikaciji.
English: Two group of products represented by Linoladiol N (cream, 0.01% w/w estradiol), and Linoladiol HN (cream, 0.005% w/w estradiol and 0.4%w/w prednisolone) were assessed in this procedure.
Slovenian: V tem postopku so ocenili dve skupini zdravil, ki sta jih predstavljali zdravili Linoladiol N (krema, 0,01 % m/m estradiola) in Linoladiol HN (krema, 0,005 % m/m estradiola ter 0,4 % m/m prednizolona).
English: Vaginal oestrogen therapy has been shown to provide improvement in the signs and symptoms of vaginal atrophy.
Slovenian: Pokazali so, da nožnično estrogensko zdravljenje izboljša znake in simptome nožnične atrofije.
English: The MAH agreed to limit the maximum duration of treatment to four weeks and to restrict the route of administration to intravaginal administration only which addresses the concerns regarding long term exposure data and missing study data in question of treatment of skin of the vulva.
Slovenian: Imetnik dovoljenja za promet z zdravilom se je strinjal z omejitvijo trajanja zdravljenja na štiri tedne in omejitvijo načina uporabe samo na intravaginalno uporabo, kar je naslovilo pomisleke glede podatkov o dolgotrajni izpostavljenosti in manjkajočih podatkov iz študij, povezanih z zdravljenjem kože zunanjih spolovil.
English: Clinical guidelines2,3 propose the use of topical oestrogens after lack of/inadequate response to nonhormonal vaginal lubricants / moisturisers, and other non-hormonal interventions.
Slovenian: Klinične smernice23 predlagajo uporabo topičnih estrogenov, kadar je odziv na nehormonske nožnične lubrikante/vlažilna sredstva in druge nehormonske intervencije odsoten/nezadosten.
English: In comparison, after a single dose of Linoladiol N, Cmax without baseline correction was 393 pmol/l, Caverage without baseline correction during the first 24 h was 178 pmol/l (Lauritzen, 1992; Göres, 1995 and Mazur, 2003).
Slovenian: V primerjavi s tem je bila vrednost Cmax ob enkratnem odmerku zdravila Linoladiol N (brez prilagajanja glede na izhodišče) 393 pmol/l, Cpovprečje (brez prilagajanja glede na izhodišče) v prvih 24 urah pa 178 pmol/l (Lauritzen 1992, Göres 1995 in Mazur 2003).
English: The available pharmacokinetic data demonstrate that estradiol is systemically absorbed after intravaginal application of Linoladiol N. PK data from study SCO 5174 indicate that estradiol concentrations after 6h of administration (Cmax 92.2 pg/ml) peak well above recommended postmenopausal levels and had not returned back to baseline levels after 36h of administration (likely reflecting trough levels).
Slovenian: Razpoložljivi farmakokinetični podatki kažejo, da se estradiol sistemsko absorbira po intravaginalni uporabi zdravila Linoladiol N. Farmakokinetični podatki iz študije SCO 5174 prav tako kažejo, da so koncentracije estradiola 6 ur po uporabi (Cmax 92,2 pg/ml) precej večje od priporočenih postmenopavzalnih ravni in se v 36 urah po uporabi niso vrnile na izhodiščno raven.
English: Taking into account baseline corrected values, Cmax and Caverage in the 24 h interval after drug administration were 175 pmol/l and 55 pmol/l, respectively, regarding estradiol vaginal tablets 25 mcg, and 331 pmol/l and 120 pmol/l, respectively, regarding Linoladiol N.
Slovenian: Upoštevajoč glede na izhodišče prilagojene vrednosti sta bili vrednosti Cmax in Cpovprečje v 24 urah po uporabi zdravila 175 pmol/l oziroma 55 pmol/l pri vaginalnih tabletah s 25 µg estradiola in 331 pmol/l oziroma 120 pmol/l pri zdravilu Linoladiol N.
English: As vaginal atrophy due to oestrogen deficiency in post-menopausal women is a chronic condition, recurrence of signs and symptoms is expected when topical oestrogen therapy is withdrawn.
Slovenian: Ker je atrofija nožnice zaradi pomanjkanja estrogena pri postmenopavzalnih ženskah kronično stanje, je ponoven pojav znakov in simptomov po prekinitvi zdravljenja z estrogeni pričakovan.
English: Primarily the MAH disagreed with the recommended restriction of indication for Linoladiol N of “Treatment of vaginal atrophy due to oestrogen deficiency in postmenopausal women when at least one lower dose topical oestrogen treatment has failed”.
Slovenian: Primarno se imetnik dovoljenja za promet z zdravilom ni strinjal s priporočeno omejitvijo indikacije za zdravilo Linoladiol N „Zdravljenje atrofije nožnice zaradi pomanjkanja estrogena pri postmenopavzalnih ženskah, kadar je bilo topično zdravljenje z vsaj enim estrogenom v manjšem odmerku neuspešno“.
English: No studies were submitted on the cutaneous use of Linoladiol N in the external genital area.
Slovenian: Študije o kožni uporabi zdravila Linoladiol N na zunanjih spolovilih niso bile predložene.
English: • The Committee is of the opinion that the benefit does not outweigh the risk in the indication of lichen sclerosus genitalis for the 0.005 % w/w estradiol with 0.4 % w/w prednisolone containing medicinal products, in line with current clinical knowledge and therefore this indication should be deleted.
Slovenian: • odbor je menil, da pri indikaciji za lichen sclerosus genitalis korist zdravil, ki vsebujejo 0,005 % m/m estradiola in 0,4 % m/m prednizolona, ni večja od tveganja, kar je skladno s trenutnim kliničnim znanjem, zato je treba to indikacijo izbrisati;
English: During the referral procedure a comparison of Linoladiol N available PK data with other locally applied medicinal products was made.
Slovenian: Med napotitvenim postopkom se je opravila primerjava farmakokinetičnih podatkov, razpoložljivih za zdravilo Linoladiol N, in drugih lokalnih zdravil.
English: Based on the higher dose and substantial systemic estradiol exposure this product is more comparable to systemic HRT products from a safety point of view.
Slovenian: Zaradi velikega odmerka in pomembne sistemske izpostavljenosti estradiolu je to zdravilo z vidika varnosti bolj primerljivo z zdravili za sistemsko hormonsko nadomestno zdravljenje.
English: • For the 0.01% w/w estradiol containing medicinal products for topical use the Committee considered that in view of the currently available data, the benefit-risk balance is favourable in the currently authorised indication, subject to restrictions, warnings and other changes to the product information, as well as further risk minimisation measures agreed.
Slovenian: • odbor je za zdravila, ki vsebujejo 0,01 % m/m estradiola, menil, da je na podlagi trenutno razpoložljivih podatkov razmerje med tveganji in koristmi za trenutno odobreno indikacijo pozitivno, če se upoštevajo dogovorjene omejitve, opozorila in druge spremembe informacij o zdravilu ter nadaljnji dogovorjeni ukrepi za zmanjševanje tveganja.
English: The MAH favoured the initial indication of “Treatment of vaginal atrophy due to oestrogen deficiency in postmenopausal women”.
Slovenian: Imetnik dovoljenja za promet z zdravilom je zagovarjal prvotno indikacijo „Zdravljenje atrofije nožnice zaradi pomanjkanja estrogena pri postmenopavzalnih ženskah“.
English: In this study, mean estradiol serum concentrations at baseline and at day 31 (i.e. about 36 h after administration of study medication on day 29) were 6.4 pg/ml and 15.1 pg/ml, respectively, in the Linoladiol N group and 4.4 pg/ml and 6.2 pg/ml, respectively, in the placebo group.
Slovenian: V tej študiji so bile povprečne koncentracije estradiola v serumu v skupini z zdravilom Linoladiol N 6,4 pg/ml ob izhodišču in 15,1 pg/ml na 31. dan (tj. 36 ur po uporabi preiskovanega zdravila na 29. dan), v skupini s placebom pa 4,4 pg/ml oziroma 6,2 pg/ml.
English: Secondary test parameters included symptoms of vaginal atrophy and vaginal pH. With regard to the VMI, Linoladiol N was statistically significantly superior to placebo (mean VMI Linoladiol N group: at baseline 24.47%, on day 31, 64.23%; placebo group: baseline 32.01%, day 31 37.17%).
Slovenian: Pri maturacijskem indeksu je bilo zdravilo Linoladiol N statistično pomembno boljše v primerjavi s placebom (povprečni MI v skupini z zdravilom Linoladiol N: ob izhodišču 24,47 %, 31. dan 64,23 %; v skupini s placebom: izhodišče 32,01 %, 31. dan 37,17 %).
English: The CHMP agreed with the MAH that not only dose, but also absorption and systemic concentrations of topically administered estradiol are of interest.
Slovenian: Odbor CHMP se je strinjal z imetnikom dovoljenja za promet z zdravilom, da je treba poleg odmerka obravnavati tudi absorpcijo in sistemske koncentracije topičnega estradiola.
English: The authors state that in postmenopausal women reporting vaginal symptoms as their only complaint, these symptoms can be safely and effectively managed with low-dose oestrogen therapy, which reduces the risks associated with long-term systemic hormone therapy.
Slovenian: težavi, ti simptomi varno in učinkovito obvladujejo z zdravljenjem z majhnimi odmerki estrogena, kar zmanjša tveganje, povezano z dolgotrajnim sistemskim hormonskim zdravljenjem.