FrancophonIA/ELRC3.0 huggingface dataset:
English: Following a national pharmacovigilance review held in 2011 new spontaneous notifications reported with some of those products identified serious cases of fibrosis and ergotism and France considered that this safety concern is not outweighed by the limited evidence of efficacy.
Croatian: Nakon nacionalnog farmakovigilancijskog pregleda koji je proveden 2011., u novim spontanim prijavama podnesenim za neke od ovih lijekova navode se ozbiljni slučajevi fibroze i ergotizma, te je Francuska smatrala da ovo sigurnosno pitanje nije nadmašeno ograničenim dokazima o djelotvornosti.
English: Dementia and dementia related indications, as well as the acute treatment of migraine, are outside the scope of this referral procedure.
Croatian: Demencija i indikacije povezane s demencijom kao i akutno liječenje migrene nisu predmetom ovog postupka upućivanja.
English: The CHMP reiterated that the studies presented in support of the efficacy of dihydroergotoxine were published in the seventies and eighties, with the consequent risk for publication bias, and have several limitations.
Croatian: CHMP je ponovio da su ispitivanja dostavljena u prilog djelotvornosti dihidroergotoksina bila objavljena u sedamdesetim i osamdesetim godinama, te da postoji rizik od pristranosti publikacija i da ispitivanja imaju nekoliko ograničenja.
English: Although some of the proposed measures could help identify patients with preexisting fibrosis, relevant concomitant medication and increased risk, the Committee pointed out that they are insufficient to avoid that some patients develop fibrosis and ergotism during treatment.
Croatian: Iako neke od predloženih mjera mogu pomoći u identifikaciji bolesnika s prethodno postojećom fibrozom, relevantnih konkomitantnih lijekova i povećanog rizika, Povjerenstvo je istaknulo da ove mjere nisu dostatne kako bi se u pojedinih bolesnika izbjegao razvoj fibroze i ergotizma tijekom liječenja.
English: Overall, the SAG disagreed with the indication and the target population definitions proposed by the MAH.
Croatian: Općenito, SAG nije suglasan s definicijama indikacije i ciljne populacije predloženima od nositelja odobrenja.
English: Overall, the CHMP was of the opinion that no situation could justify exposing a patient to risk of fibrosis and ergotism considering the very limited data on efficacy.
Croatian: Ukupno gledano, CHMP je smatrao da nijedna situacija ne može opravdati izlaganje bolesnika riziku od fibroze i ergotizma uzimajući u obzir vrlo ograničene podatke o djelotvornosti.
English: In general, a drug investigated in the prodromal stages of dementia would need to demonstrate improvement in cognitive function, and additionally, delay of progression to dementia.
Croatian: Općenito, lijekovi ispitani u prodromalnoj fazi demencije morali bi demonstrirati poboljšanje u kognitivnoj funkciji, te, dodatno,
English: • The Committee considered that a potential causal association between fibrotic reactions or ergotism and dihydroergotoxine cannot be excluded.
Croatian: • Povjerenstvo smatra da se moguća uzročna veza između fibrotičkih reakcija ili ergotizma i dihidroergotoksina ne može isključiti.
English: The group highlighted that the claimed indication is not used anymore in the clinical practice and that from a clinical viewpoint there is no evidence at present that there is a therapeutic need for this active substance in the treatment of cognitive and neurosensorial impairment in the elderly.
Croatian: Skupina je istaknula da se tražena indikacija više ne upotrebljava u kliničkoj praksi, te da s kliničkog stajališta nema aktualnog dokaza da postoji terapijska potreba za ovu djelatnu tvar u liječenju kognitivnog i neurosenzorskog oštećenja u starijih osoba.
English: In such cases, administration of dihydroergotoxine may delay the administration of an appropriate treatment for dementia.
Croatian: U ovim slučajevima, primjena dihidroergotoksina može odgoditi primjenu odgovarajućeg liječenja demencije.
English: No data were submitted in support of the indication “symptomatic treatment of veno-lymphatic insufficiency” and consequently no conclusion on efficacy could be drawn by the CHMP.
Croatian: Nisu dostavljeni podaci u potporu indikacije „simptomatsko liječenje venolimfatičke insuficijencije” te stoga CHMP nije mogao donijeti zaključke o djelotvornosti.
English: Therefore, the group was of the opinion that there is not a clearly defined population, which unsatisfactorily responds to standard migraine prophylaxis treatment, where there is a therapeutic need for this substance as alternative/last line treatment.
Croatian: Stoga, mišljenje je skupine da ne postoji jasno definirana populacija koja na nezadovoljavajući način odgovara na standardnu profilaksu migrene u slučaju kada postoji terapijska potreba za ovom tvari kao alternativnom/posljednjom linijom liječenja.
English: No reports of ergotism were stated, however, the CHMP questioned the appropriateness of the data collection method (i.e. non exhaustive and thus inconclusive).
Croatian: Nisu navedene prijave ergotizma, no CHMP smatra upitnom primjerenost metode prikupljanja podataka (primjerice metoda nije iscrpna te je stoga neuvjerljiva).
English: Scientific conclusions and grounds for variation to the terms of the marketing authorisations or suspension of the marketing authorisations, as applicable, taking into consideration the approved indications for each product
Croatian: Znanstveni zaključci i razlozi za izmjenu uvjeta odobrenja za stavljanje lijeka u promet ili suspenziju odobrenja za stavljanje lijeka u promet, ako je primjenjivo, uzimajući u obzir odobrene indikacije za svaki proizvod
English: In the 19 clinical studies that are argued to be supportive of this restricted indication, and which included heterogeneous populations, some did not show significant effects of dihydroergotoxine.
Croatian: U pojedinim ispitivanjima od 19 kliničkih ispitivanja, za koje se tvrdilo da podržavaju ovu ograničenu indikaciju, a koja su obuhvatila heterogene populacije, nisu dokazani značajni učinci dihidroergotoksina.
English: The CHMP highlighted that “chronic cognitive impairment excluding Alzheimer's disease and other dementia” is not considered a generally accepted definition of a pathological condition aimed to benefit from treatment.
Croatian: CHMP je istaknuo da se „kronično kognitivno oštećenja, isključujući Alzheimerovu bolest i druge demencije” ne smatra opće prihvaćenom definicijom patološkog stanja koje bi trebalo imati korist od liječenja.
English: Overall, the varying affinity for serotoninergic receptors with the different ergot derivatives and the therapeutic doses used may explain the differences observed for notification rates for the fibrotic reactions.
Croatian: Ukupno gledano, promjenjivi afinitet za serotoninergične receptore s različitim derivatima ergota i korištenim terapijskim dozama može objasniti razlike uočene u razinama prijava fibrotičkih reakcija.
English: Agonism to 5-HT2B receptors induces a proliferative response and mitogenicity of the cells expressing this receptor leading to fibrogenesis.
Croatian: Agonizam na receptore 5-HT2B inducira proliferativni odgovor i mitogeničnost stanica koje eksprimiraju ovaj receptor što uzrokuje fibrogenezu.
English: • Ancillary treatment of intermittent claudication in symptomatic peripheral arterial occlusive disease
Croatian: • pomoćno liječenje intermitentne klaudikacije u simptomatskoj perifernoj bolesti okluzije arterija
English: On 18 January 2012, France triggered a referral under Article 31 of Directive 2001/83/EC for the following ergot derivatives containing medicinal products: dihydroergocryptine/caffeine, dihydroergocristine, dihydroergotamine, dihydroergotoxine and nicergoline.
Croatian: Francuska je pokrenula postupak upućivanja u skladu sa člankom 31. Direktive 2001/83/EZ za sljedeće lijekove koji sadrže derivate ergota: dihidroergokriptin/kofein, dihidroergokristin, dihidrergotamin, dihidriergotoksin i nikergolin.
English: The CHMP was therefore requested to give its opinion on whether the marketing authorisations for ergot derivatives containing medicinal products should be maintained, varied, suspended or withdrawn in relation to the below mentioned indications:
Croatian: Od CHMP-a se stoga zahtijevalo da iznese svoje mišljenje o tome treba li zadržati odobrenje za stavljanje u promet lijekova koji sadrže derivate ergota, promijeniti ga ili suspendirati, a povezano s indikacijama navedenim u nastavku:
English: In addition, a scientific advisory group (SAG) was convened in December 2012 at the request of the CHMP during which the experts discussed, based on their clinical experience, whether this substance plays a role in the prophylaxis of migraine headache.
Croatian: Nadalje, u prosincu 2012. na zahtjev CHMP-a sazvana je znanstvena savjetodavna skupina (SAG) u okviru koje su stručnjaci, na temelju svog kliničkog iskustva, raspravljali o ulozi ove tvari u profilaksi migrenske glavobolje.
English: These included changing the prescription status, limiting treatment duration in certain conditions, contraindicating the product in patients with pre-existing fibrosis or in association with other drugs, the issuing of a DHPC highlighting the risk, a checklist for prescribers, and a pharmacological in vitro study for 5-HT subclass receptors affinity to the product.
Croatian: Oni uključuju promjenu statusa propisivanja, ograničeno trajanje liječenja u određenim uvjetima, što kontraindicira lijek u bolesnika s prethodno postojećom fibrozom ili u vezi s drugim lijekovima, izdavanje pisma liječnicima u kojem se ističe rizik, lista provjere za propisivače te farmakološka i in vitro ispitivanja afiniteta lijeka prema podklasi receptora 5-HT.
English: • The Committee is of the opinion that the evidence for clinically significant efficacy of dihydroergotoxine in the currently assessed indications as well as in the indication proposed by the MAH in the re-examination is very limited, and therefore the potential benefit for patients in these indications is outweighed by the above identified risk.
Croatian: • Mišljenje je Povjerenstva da su dokazi značajne kliničke djelotvornosti dihidroergotoksina u trenutno procijenjenim indikacijama kao i u indikacijama predloženima od nositelja odobrenja u ponovnom pregledu vrlo ograničeni, te da je stoga moguća dobrobit za bolesnike u ovim indikacijama nadmašena prethodno utvrđenim rizikom.
English: Therefore, even if it is highly pharmacologically plausible that ergot derivatives acting as 5HT2B receptor agonists may induce "serotonergic" valve disease similar to that induced by carcinoid tumours or fibrotic lesions of other tissues, it must be remembered that some ergot derivatives are not 5-HT2B receptor agonists.
Croatian: Stoga čak i ako je uvelike farmakološki vjerojatno da derivati ergota koji djeluju kao agonisti receptora 5-HT2B mogu potaknuti „serotoninergičnu” bolest zalistaka sličnu onoj izazvanoj karcinoidnim tumorima ili fibrotičkim lezijama drugih tkiva, ne smije se zaboraviti da neki derivati ergota nisu agonisti receptora 5-HT2B.
English: The CHMP has considered the totality of the available data on the safety and efficacy of dihydroergotoxine.
Croatian: CHMP je uzeo u obzir ukupne dostupne podatke o sigurnosti i djelotvornosti dihidroergotoksina.
English: The marketing authorisation holders (MAHs) submitted all available efficacy data from clinical trials and observational studies, including data that became available since the granting of the initial marketing authorisation.
Croatian: Nositelji odobrenja za stavljanje lijeka u promet predali su sve dostupne podatke o djelotvornosti iz kliničkih i opservacijskih ispitivanja uključujući podatke koji su postali dostupni nakon davanja početnog odobrenja za stavljanje lijeka u promet.
English: The CHMP noted that patients included in studies presented various symptoms or putative diagnosis, effect was mainly assessed with subjective scores, symptoms observed were very heterogeneous and results were not consistent across studies and long-term data are not in favour of an effect of dihydroergotoxine as compared to placebo.
Croatian: CHMP je napomenuo da su bolesnici obuhvaćeni ispitivanjima imali različite simptome ili navodne dijagnoze, da je učinak uglavnom procijenjen na temelju subjektivnih rezultata, da su uočeni simptomi bili vrlo heterogeni, a rezultati nisu bili konzistentni u svim ispitivanjima i podaci nisu bili u korist djelovanja dihidroergotoksina u usporedbi s placebom.
English: Ergot derivatives are recognised as being capable of inducing fibrosis, in particular heart valve fibrosis.
Croatian: Uočeno je da su derivati ergota u stanju izazvati fibrozu, posebice fibrozu srčanog zaliska.
English: In addition, dihydroergotoxine is composed of dihydroergocryptine and dihydroergocristine which are also considered to be associated with the induction of fibrotic reactions.
Croatian: Nadalje, dihidroergotoksin se sastoji od dihidroergokriptina i dihidroergokristina, za koje se također smatra da su povezani s izazivanjem fibrotičkih reakcija.
English: In the view of the SAG, it is not excluded a priori that the drug might be efficacious in a subgroup of well- defined patients according to current criteria, but this cannot be determined based on the information provided, which includes highly heterogeneous patient population and study outcome parameters.
Croatian: Prema mišljenju SAG-a, a priori se ne isključuje da prema aktualnim kriterijima lijek može biti djelotvoran u podgrupi dobro definiranih bolesnika, no to se ne može utvrditi na temelju dostavljenih informacija, koje uključuju izrazito heterogenu populaciju bolesnika i parametre ishoda ispitivanja.
English: In spite of the fact that propranolol and flunarizine are recognized in migraine prophylaxis, the absence of a placebo group does not allow to conclude on the efficacy of dihydroergotoxine in the prophylaxis of migraine.
Croatian: Usprkos činjenici da su propranolol i flunarizin priznati za profilaksu migrene, izostanak placebo grupe ne dopušta donošenje zaključka o djelotvornosti dihidroergotoksina u indikaciji profilakse migrene.
English: The CHMP considered that these studies did not provide robust evidence supporting the efficacy of dihydroergotoxine in the proposed target population.
Croatian: CHMP je zaključio da ova ispitivanja nisu osigurala čvrste dokaze koji podupiru djelotvornost dihidroergotoksina u predložene ciljne populacije.
English: • Acute retinopathies of vascular origin
Croatian: • akutne retinopatije vaskularnog podrijetla
English: Dihydroergotoxine mesilate is an ergot alkaloid, known also as codergocrine mesilate and ergoloid mesilate, which is composed of equal parts of mesilates of dihydroergocornine, dihydroergocristine, and dihydroergocryptine.
Croatian: Dihidroergotoksin mezilat je ergot alkaloid, poznat pod nazivom kodergokrin mezilat i ergoloid mezilat, koji se sastoji od jednakih udjela mezilata dihidroergokornina, dihidroergokristina i dihidroergokriptina.
English: In view of the above, the CHMP was of the opinion that the studies submitted could not demonstrate that dihydroergotoxine has a clinically relevant effect on patients with cognitive impairment.
Croatian: U svjetlu prethodno navedenog, mišljenje je CHMP-a da dostavljena ispitivanja nisu mogla pokazati da dihidroergotoksin ima klinički značajan učinak na bolesnike s kognitivnim oštećenjem.
English: The risk minimisation measures proposed were not considered by the Committee to effectively reduce the risk for the two highlighted reactions (fibrosis and ergotism) in the broad indication proposed by the MAH.
Croatian: Povjerenstvo je smatralo predložene mjere smanjivanja rizika neučinkovitima za smanjivanje rizika za dvije istaknute reakcije (fibrozu i ergotizam) u širokoj indikaciji predloženoj od nositelja odobrenja.
English: In view of the above, the Committee considered that there is a risk for rare but severe fibrotic reactions and ergotism associated with dihydroergotoxine treatment.
Croatian: U svjetlu prethodno navedenog, Povjerenstvo je zaključilo da postoji rizik od rijetke, no ozbiljne fibrotičke reakcije i ergotizma povezanih s liječenjem dihidroergotoksinom.
English: The MAHs also submitted their own overviews and critical summaries of all spontaneous reports of fibrotic reactions (cardiac with or without pulmonary arterial hypertension, pulmonary, pleural, peritoneal, retroperitoneal, etc) and ergotism with their ergot derivatives-containing medicinal products.
Croatian: Nositelji odobrenja predali su također vlastite preglede i kritičke sažetke svih spontanih izvješća o fibrotičkim reakcijama (srčana s hipertenzijom plućne arterije ili bez nje, pulmonalna, pleuralna, peritonealna, retroperitonealna itd.) i ergotizmu za svoje lijekove koji sadrže derivate ergota.
English: Fibrotic reactions have been associated to chronic use of ergot derivatives and although the reporting rate for dihydroergotoxine is low, the risk is sufficiently serious not to be dismissed particularly when considering its potential use in long-term treatment in a broad patient population.
Croatian: Fibrotičke reakcije povezane su s kroničnom primjenom derivata ergota te, iako je broj prijava za dihidroergotoksin mali, rizik je dovoljno ozbiljan da se ne odbacuje posebice ako se uzme u obzir potencijalna primjena u dugotrajnom liječenju u široke populacije bolesnika.
English: From the approved indications of the dihydroergotoxine containing medicinal products the ones that are in the scope of this referral procedure and are approved in at least one Member State are the following (specific wording of the indication may vary from product to product):
Croatian: Iz odobrenih indikacija za lijekove koji sadrže dihidroergokriptin, sljedeći su lijekovi obuhvaćeni ovom procjenom te su odobreni u barem jednoj državi članici (specifične formulacije za indikaciju mogu varirati od lijeka do lijeka):
English: • The variation to the terms of the marketing authorisation for dihydroergotoxine containing medicinal products referred to in Annex I, to delete the below indications from the Product Information (specific wording of the indication may vary from product to product and from country to country) as well as any relevant reference to these indications, when there are other therapeutic indications approved as part of their marketing authorisation:
Croatian: • izmjenu uvjeta odobrenja za stavljanje u promet lijekova koji sadrže dihidroergotoksin, a koji su navedeni u Dodatku I, brisanje u nastavku navedenih indikacija iz Informacija o lijeku (specifične formulacije mogu varirati od lijeka do lijeka i od zemlje do zemlje) kao i svih relevantnih referenci za ove indikacije u Informacijama o lijeku kada postoje druge terapijske indikacije odobrene kao dio njihova odobrenja za stavljanje lijeka u promet:
English: • The Committee maintained its opinion that the benefit-risk balance of dihydroergotoxine containing products:
Croatian: • Povjerenstvo je zadržalo svoje mišljenje da omjer koristi i rizika za lijekove koji sadrže dihidroergotoksin:
English: Based on the clinical experience the group considered that no special population exists that could benefit from the treatment with this active substance in the prophylaxis of migraine headache.
Croatian: Na temelju kliničkog iskustva, skupina je zaključila da ne postoji posebna populacija za koju bi liječenje ovom djelatnom tvari u profilaksi migrenske glavobolje imalo posebne koristi.
English: More specifically, the CHMP stated that apart from “ergotism” other preferred terms are also related to symptoms of ergotism (i.e paraesthesia, formication, tingling, intestinal/cerebrovascular/peripheral/tongue ischaemia, angina pectoris, coronaropathy, thoracic pain, nausea, vomiting, diarrhoea, abdominal pain, cold sensation, thrombosis, stroke, gangrene, necrosis, vasoconstriction/vasospasm, cyanosis, myalgia, muscular cramps, pain in extremities, vertigo, hypoaesthesia, numbness, headache, confusion, hallucinations).
Croatian: Konkretnije, CHMP je naveo da su osim „ergotizma” drugi preferirani uvjeti također povezani sa simptomima ergotizma (primjerice parestezijom, formikacijom, zujanjem u ušima, intestinalnom/cerebrovaskularnom/perifernom ishemijom/ishemijom jezika, anginom pektoris, koronaropatijom, boli u prsima, mučninom, povraćanjem, proljevom, abdominalnom bol, osjetom na hladnoću, trombozom, moždanim udarom, gangrenom, nekrozom, vazokonstrikcijom/vazospazmom, cijanozom, mijalgijom, mišićnim grčevima, boli u ekstremitetima, vrtoglavicom, hipoestezijom, utrnulošću, glavoboljom, konfuzijom, halucinacijama).
English: Therefore, other mechanisms inducing fibrosis cannot be excluded, which suggests a causal link between fibrosis and agonism of 5-HT2A and 5-HT1B receptors and also plausible effect on serotonin transporter.
Croatian: Stoga se ne mogu isključiti drugi mehanizmi koji uključuju fibrozu što ukazuje na uzročnu vezu između fibroze i agonizma 5-HT2A i 5-HT1B receptora te također vjerojatni učinak na serotoninskog prijenosnika.
English: For the indication “ancillary treatment of Raynaud's syndrome” the CHMP noted that the indication claimed by the MAH is peripheral vascular disease and that in some Members States the ancillary treatment of Raynaud's syndrome is approved for dihydroergotoxine as part of this more general indication (i.e. “peripheral vascular disease”).
Croatian: Za indikaciju „pomoćno liječenje Raynaudova sindroma”, CHMP je napomenuo kako je indikacija za koju je nositelj odobrenja tražio odobrenje periferna vaskularna bolest te da je u pojedinim državama članicama pomoćno liječenje Raynaudova sindroma odobreno za dihidroergotoksin kao dio ove općenitije indikacije (primjerice „periferne vaskularne bolesti”).
English: The data from the reported cases of fibrosis (n=9) are limited in order to draw firm conclusions, however, the capacity of dihydroergotoxine to induce fibrotic reactions, localised in the retroperitoneal, pulmonary and cardiac area cannot be excluded notably based on the absence of any other aetiology for some of the assessed cases and the mechanism of action of ergot derivatives.
Croatian: Podaci iz prijavljenih slučajeva fibroze (n=9) ograničeni su pa se iz njih ne mogu izvući čvrsti zaključci, međutim nije moguće isključiti sposobnost dihidroergotoksina da uzrokuje fibrotičku reakciju, koja je lokalizirana u retroperitonealnom, pulmonalnom i srčanom području na temelju odsustva bilo koje druge etiologije za pojedine procijenjene slučajeve i mehanizme djelovanja derivata ergota.
English: The outcome in the different components included in these assessment tools vary considerably between the studies and no general conclusions can be drawn neither on the size of possible effects nor on the clinical relevance.
Croatian: Ishod u različnim komponentama uključenim u ove alate procjene uvelike varira od ispitivanja do ispitivanja te nije moguće donijeti općenite zaključke o razmjeru djelovanja ni o kliničkom značaju.
English: However, the CHMP also noted that the MAH provided information only for their product (Hydergine) and that underreporting is likely.
Croatian: No, CHMP je također napomenuo da je nositelj odobrenja dostavio informacije samo za svoj lijek (Hydergine), te kako je izgledno da je nositelj odobrenja dostavio premalo prijava.
English: The CHMP reviewed all available data in support of the benefit and safety on dihydroergotoxine and considered the above restricted indication proposed by the MAH.
Croatian: CHMP je pregledao sve dostupne podatke dostavljene u prilog koristi i sigurnosti dihidroergotoksina te je razmotrio prethodno ograničenu indikaciju predloženu od nositelja odobrenja.
English: The SAG further considered that the evidence presented by the MAH was of poor quality.
Croatian: Nadalje, mišljenje je SAG-a da su dokazi koje je dostavio nositelj odobrenja slabe kvalitete.
English: Based on these data and based on the pharmacological plausibility, dihydroergotoxine is considered to be associated with fibrotic reactions.
Croatian: Na temelju ovih podataka i farmakološke vjerojatnosti, smatra se da je dihidroergokriptin povezan s fibrotičkim reakcijama.