FrancophonIA/ELRC3.0 huggingface dataset:
English: The current approval of omega-3 acid ethyl esters containing products in secondary prevention after myocardial infarction is based on the results of the GISSI-P study performed in 1999.
Croatian: Sadašnje odobrenje za primjenu lijekova koji sadrže etilne estere omega-3 kiselina u sekundarnoj prevenciji nakon infarkta miokarda temelji se na rezultatima ispitivanja GISSI-P provedenog 1999. godine.
English: • Even though the meta-analyses by Aung et al. and the recent Cochrane review includes trials with products, doses and populations not exactly representing the approved secondary prevention indication, all studies include patients with cardiovascular disease and therefore, the results are considered as supportive of lack of efficacy.
Croatian: • Iako metaanaliza koju su proveli Aung et al. i noviji pregled Cochraneove baze podataka uključuju ispitivanja s lijekovima, dozama i populacijama koji nisu točno reprezentativni za odobrenu indikaciju sekundarne prevencije, sva ispitivanja uključuju bolesnike s kardiovaskularnom bolešću i stoga se smatra da rezultati podržavaju nedostatak djelotvornosti.
English: In this study, there was a relative risk reduction for one of the two the co-primary MACE endpoints of 10% with a rather poor precision (upper CI 0.99) with the second co-primary endpoint just failing to show a significant result.
Croatian: U ovom je ispitivanju zabilježeno relativno smanjenje rizika u jednoj od dvije mjere koprimarnog ishoda MACE od 10 % s prilično slabom preciznošću (gornja granica intervala pouzdanosti 0,99), dok druga mjera koprimarnog ishoda nije uspjela pokazati značajan rezultat.
English: Upon request from the CHMP, a SAG CVS meeting was convened on 10 October 2018.
Croatian: Na zahtjev CHMP-a, 10. listopada 2018. održan je sastanak Znanstvene savjetodavne skupine za kardiovaskularna pitanja (SAG CVS).
English: Therefore, at the most about 1/3 of the 11,324 randomized patients received appropriate baseline medication at any time during the first year and not more than 5% over the entire first year.
Croatian: nekom trenutku tijekom prve godine najviše oko 1/3 bolesnika i ne više od 5 % bolesnika tijekom cijele prve godine.
English: The Swedish national competent authority considered that in light of recent clinical trials, the clinical benefit of omega-3 acid ethyl esters containing products in prevention after MI should be re-evaluated.
Croatian: Švedsko nadležno nacionalno tijelo smatralo je da je u svjetlu novijih kliničkih ispitivanja potrebno ponovno procijeniti kliničku korist lijekova koji sadrže etilne estere omega-3 kiselina za prevenciju nakon infarkta miokarda.
English: Upon request from the MAHs, a second SAG CVS meeting was convened on 19 March 2019.
Croatian: Na zahtjev nositelja odobrenja za stavljanje u promet dogovoren je drugi sastanak Znanstvene savjetodavne skupine za kardiovaskularna pitanja (SAG CVS) 19. ožujka 2019.
English: ASCEND: A Study of Cardiovascular Events iN Diabetes: Characteristics of a randomized trial of aspirin and of omega-3 fatty acid supplementation in 15,480 people with diabetes.
Croatian: ASCEND: A Study of Cardiovascular Events iN Diabetes: Characteristics of a randomized trial of aspirin and of omega-3 fatty acid supplementation in 15,480 people with diabetes. https://doi.org/10.1016/j.ahj.2017.12.006.
English: Based on the above, the CHMP reiterates that RCTs conducted in other CV risk populations are relevant in support of the efficacy (GISSI-HF although borderline and inconclusive) or lack of efficacy (ORIGIN and SU.FOL.OM3) of omega-3 fatty acids in secondary prevention of cardiovascular disease.
Croatian: Na temelju navedenog, CHMP ponavlja da su randomizirana klinička ispitivanja provedena u populacijama s drugim kardiovaskularnim rizikom, važna kao potvrda djelotvornosti (ispitivanje GISS-HF, iako granično i ne omogućuje donošenje zaključaka) ili nedostatka djelotvornosti (ispitivanja ORIGIN i SU.FOL.OM3) omega-3 kiselina za sekundarnu prevenciju kardiovaskularne bolesti.
English: These were not rich enough to allow for a full adjustment of differences in risk profiles or to mirror real life post MI situations (e.g. no data regarding smoking history, BMI/obesity, physical exercise were reported in the Macchia study).
Croatian: Za ove retrospektivne analize bio je dostupan samo ograničeni broj parametara, a oni nisu bili dovoljno izdašni da bi omogućili potpuno usklađivanje razlika u profilima rizika ili odrazili stvarni život u situacijama nakon infarkta miokarda (npr. podatci o povijesti pušenja, indeksu tjelesne mase / pretilosti, tjelesnoj aktivnosti nisu zabilježeni u Macchiaovom ispitivanju).
English: Therefore if omega-3 fatty acids are effective in reducing cardiovascular events after an MI, cardiovascular benefits in other CV risk populations (e.g. coronary revascularisation, angina pectoris, ischaemic stroke) can be anticipated.
Croatian: Stoga se, ako omega-3 masne kiseline učinkovito smanjuju kardiovaskularne događaje nakon infarkta miokarda, korisni kardiovaskularni učinci mogu očekivati i u populacijama s drugim kardiovaskularnim rizikom (npr. koronarna revaskularizacija, angina pektoris, ishemijski moždani udar).
English: • The CHMP considered the totality of the data submitted for omega-3 acid ethyl esters medicinal products with regard to their use in secondary prevention after myocardial infarction.
Croatian: • CHMP je razmotrio sve podatke dostavljene za lijekove koji sadrže etilne estere omega-3 kiselina u pogledu njihove primjene u sekundarnoj prevenciji nakon infarkta miokarda.
English: The efficacy of omega-3 fatty acids in the claimed indication has also not been demonstrated by other relevant RCTs conducted in other CV risk populations (e.g. coronary revascularisation, angina pectoris, ischaemic stroke ), including ORIGIN, SU.FOL.OM3, ASCEND, and VITAL.
Croatian: Djelotvornost omega-3 masnih kiselina u spornoj indikaciji nisu dokazala ni druga relevantna randomizirana kontrolirana ispitivanja provedena u populacijama s drugim kardiovaskularnim rizikom (npr. koronarna revaskularizacija, angina pektoris, ishemijski moždani udar), uključujući ispitivanja ORIGIN, SU.FOL.OM3, ASCEND i VITAL.
English: Although CHMP considers that the GISSI-P and the OMEGA trials are the most relevant for evaluating the effect of omega-3 containing products in the secondary prevention after MI, it is also acknowledged that RCTs (GISSI-HF, ORIGIN, SU.FOL.OM3) conducted in other CV risk populations (e.g. coronary revascularisation, angina pectoris, ischaemic stroke) are as well relevant, as CV disease is still considered a continuum.
Croatian: Iako CHMP smatra da su ispitivanja GISSI-P i OMEGA najvažnija za procjenu učinka lijekova koji sadrže omega-3 za sekundarnu prevenciju nakon infarkta miokarda, također je potvrđeno da su važna i randomizirana klinička ispitivanja (GISSI-HF, ORIGIN, SU.FOL.OM3) provedena u populacijama s drugim kardiovaskularnim rizikom (npr. koronarna revaskularizacija, angina pektoris, ishemijski moždani udar) jer se kardiovaskularna bolest i dalje smatra kontinuumom.
English: Despite the lack of statistical power for the specific “sudden cardiac death” endpoint, the lack of substantial benefit can be concluded from this trial in a statistically valid way, as evidenced by the narrow confidence intervals.
Croatian: Iako specifična mjera ishoda „iznenadna srčana smrt” nije imala statističku snagu, iz ovog se ispitivanja na statistički valjani način može zaključiti o nedostatku stvarne dobrobiti, kao što to dokazuju uski intervali pouzdanosti.
English: In view of all the available data, the CHMP considered that the evidence that supported the authorisation of omega-3 in secondary prevention after MI suffered from some methodological limitations and was weak.
Croatian: S obzirom na sve dostupne podatke, CHMP je smatrao da su dokazi koji podupiru odobrenje omega-3 za sekundarnu prevenciju nakon infarkta miokarda imali stanovita metodološka ograničenja i da su bili slabe razine.
English: The MAHs disagreed with the CHMP that the evidence that supported the authorisation of omega-3 in secondary prevention after MI suffered from some methodological limitations and was weak and that the efficacy in this indication was not demonstrated in subsequent and more robust clinical trials.
Croatian: Nositelji odobrenja za stavljanje u promet nisu se složili s CHMP-om da dokaz na koji se oslanja dano odobrenje za primjenu omega-3 u sekundarnoj prevenciji nakon infarkta miokarda ima stanovita metodološka ograničenja, da je dokaz slab i da djelotvornost u toj indikaciji nije dokazana kasnijim robusnijim kliničkim ispitivanjima.
English: The results of the meta-analyses by Aung et al. and the recent Cochrane review, even though they include trials with products, doses and populations not exactly representing the approved secondary prevention indication, are considered relevant as all studies include patients with cardiovascular disease and therefore are supportive of lack of efficacy.
Croatian: Rezultati metaanaliza koje su proveli Aung et al. te pregled novije Cochraneove baze podataka, iako se odnose na ispitivanja u kojima lijekovi, doze i populacije nisu točno reprezentativni za indikaciju sekundarne prevencije, smatraju se važnima jer sva ispitivanja uključuju bolesnike s kardiovaskularnim bolestima i stoga podržavaju nedostatak djelotvornosti.
English: The results of the recently published REDUCE-IT trial are of limited relevance since the daily dose was much higher than the dose of the indication under review (4 g vs. 1 g) and the active substance was icosapent ethyl, a highly purified EPA ethyl ester, instead of a mixture of EPA and DHA.
Croatian: Rezultati nedavno objavljenog ispitivanja REDUCE-IT ograničenog su značaja jer je dnevna doza mnogo viša od one za razmatranu indikaciju (4 g naspram 1 g), a djelatna je tvar bila ikosapent etil, visoko pročišćen EPA etilni ester umjesto mješavine kiselina EPA i DHA.
English: A meta-analysis using individual participant data (IPD), selecting patients with a history of MI and treated with the same dose as for the indication under review (1 g) would have been more appropriate.
Croatian: Bila bi prikladnija metaanaliza podataka pojedinačnih ispitanika izborom bolesnika s infarktom miokarda u povijesti bolesti i liječenih dozom jednakom onoj određenoj za indikaciju koja se razmatra (1 g).
English: The issue is highlighted by the fact that omega-3 acid ethyl esters had little effect when compared to the Vitamin E arm in the same trial.
Croatian: Tome se dodaje i činjenica da je učinak etilnih estera omega-3 kiselina bio mali u usporedbi sa skupinom koja je u istom ispitivanju primala vitamin E.
English: The results of RECUCE-IT study results are of limited relevance since the daily dose was much higher than the dose of the indication under review (4 g vs 1 g) and the active substance was icosapent ethyl, a highly purified EPA ethyl ester, instead of a mixture of EPA and DHA.
Croatian: Rezultati ispitivanja REDUCE-IT ograničene su važnosti jer je dnevna doza bila mnogo viša od one za razmatranu indikaciju (4 g naspram 1 g), a djelatna je tvar bila ikosapent etil, visoko pročišćen EPA etilni ester umjesto mješavine kiselina EPA i DHA.
English: Treatment with icosapent ethyl 4g/day was associated with an increase in hospitalization for atrial fibrillation of flutter in the REDUCE-IT trial.
Croatian: U ispitivanju REDUCE-IT liječenje ikosapent etilom, u dozi od 4 g dnevno, bilo je povezano s većim brojem hospitalizacija zbog fibrilacije atrija ili nepravilnog ritma.
English: The latter concern also applies to post-hoc analyses in patients with or without anti-platelet medicinal products, betablockers or ACE-inhibitors.
Croatian: To pitanje odnosi se i na post hoc analize podataka bolesnika koji su primali ili nisu primali antitrombotike, beta-blokatore ili ACE inhibitore.
English: In addition, in other prospective randomised trials performed after the original approval (GISSI-HF, ORIGIN study and SU.FOL.OM3 performed between 2003 and 2012), as well as in meta-analyses (e.g. by Aung et al. 20184), the results from the GISSI-P study could also not be reproduced.
Croatian: Osim toga, rezultati ispitivanja GISSI-P nisu mogli biti ponovljeni ni drugim prospektivnim randomiziranim ispitivanjima provedenima nakon prvobitnog odobrenja (ispitivanja GISSI-HF, ORIGIN i SU.FOL.OM3 provedena su između 2003. i 2012. godine), kao ni metaanalizama (npr. one koju su proveli Aung et al.
English: The provided meta-analyses showed both positive and negative effects of omega-3 fatty acid treatment on the risk of cardiovascular events.
Croatian: Provedene metaanalize pokazale su da terapija omega-3 masnim kiselinama ima i pozitivne i negativne učinke na rizik od kardiovaskularnih događaja.
English: The key concern of this study is that standard of care for the treatment of MI has evolved since the outcome of the GISSI-P trial in particular statin therapy, beta-blocker therapy and invasive treatment.
Croatian: Ključno sporno pitanje u odnosu na to ispitivanje bio je razvoj standardne skrbi za liječenje infarkta miokarda koji je uslijedio nakon rezultata ispitivanja GISSI-P, posebice terapija statinima, terapija beta-blokatorima i invazivno liječenje.
English: PLoS One.
Croatian: Prilog II.
English: Raitt MH, Connor WE, Morris C, Kron J, Halperin B, Chugh SS, McClelland J, Cook J, MacMurdy K, Swenson R, Connor SL, Gerhard G, Kraemer DF, Oseran D, Marchant C, Calhoun D, Shnider R, McAnulty J. Fish oil supplementation and risk of ventricular tachycardia and ventricular fibrillation in patients with implantable defibrillators: a randomized controlled trial.
Croatian: Raitt MH, Connor WE, Morris C, Kron J, Halperin B, Chugh SS, McClelland J, Cook J, MacMurdy K, Swenson R, Connor SL, Gerhard G, Kraemer DF, Oseran D, Marchant C, Calhoun D, Shnider R, McAnulty J.
English: Grounds for re-examination have been submitted by BASF AF and ALFASIGMA S.p.A, representing eleven MAHs.
Croatian: Razloge za preispitivanje mišljenja dostavile su tvrtke BASF AF i ALFASIGMA
English: This included the responses submitted by the marketing authorisation holders in writing and during an Oral Explanation, as well as the outcome of the consultation with the Cardiovascular Scientific Advisory Group on the 10 of October 2018.
Croatian: To je uključivalo odgovore nositelja odobrenja za stavljanje lijeka u promet, dostavljene u pisanom obliku i iznesene tijekom usmenog obrazloženja, kao i rezultat konzultacija sa Znanstvenom savjetodavnom skupinom za kardiovaskularna pitanja 10. listopada 2018. CHMP je također razmotrio razloge koje su dostavili nositelji odobrenja kao temelj zahtjeva za preispitivanje preporuka CHMP-a kao i mišljenja Znanstvene savjetodavne skupine iznesena na drugom sastanku 19. ožujka 2019.
English: beneficial effect of omega-3 for secondary prevention after myocardial infarction at the dose of 1 g/day is weak.
Croatian: Konačno, dokazi koji proizlaze iz ispitivanja GISSI-P i podržavaju koristan učinak omega-3 za sekundarnu prevenciju nakon infarkta miokarda u dozi od 1 g na dan, slabe su razine.
English: Therefore, these results do not support an effect in secondary prevention after MI.
Croatian: Stoga ti rezultati ne podržavaju učinak u sekundarnoj prevenciji nakon infarkta miokarda.
English: The MAHs have described the results from different RCTs to support the beneficial effect of omega-3 fatty acids in secondary prevention after an MI.
Croatian: Nositelji odobrenja za stavljanje u promet opisali su rezultate različitih randomiziranih kliničkih ispitivanja kako bi potkrijepili koristan učinak omega-3 masnih kiselina u sekundarnoj prevenciji nakon infarkta miokarda.
English: In the MAHs' view, GISSI‐P represented the mainstay of evidence in favour of the use of omega-3 fatty acids in the secondary prevention after MI and it is a valid and robust study.
Croatian: Prema mišljenju nositelja odobrenja, ispitivanje GISSI-P glavno je uporište dokaza u prilog primjene omega-3 masnih kiselina za sekundarnu prevenciju nakon infarkta miokarda, a to je valjano i robusno ispitivanje.
English: In particular the GISSI-P and OMEGA trials, which were considered most relevant, have been extensively discussed by the MAHs.
Croatian: Nositelji odobrenja za stavljanje u promet osobito su opsežno razmatrali ispitivanja GISSI-P i OMEGA, koja su se smatrala najvažnijima.
English: The MAHs proposed, as part of their grounds for re-examination, a modification of the indication for use in high-risk patients, i.e. type 2 diabetes, no acute PCI after MI, impaired systolic function (EF < 50%), known intolerance to one or more guideline recommended cardiovascular medications.
Croatian: Nositelji odobrenja za stavljanje u promet predložili su, u razlozima za preispitivanje mišljenja, promjenu indikacije za upotrebu u visokorizičnih bolesnika, tj. bolesnika s dijabetesom tipa 2, bez akutne perkutane koronarne intervencije nakon infarkta miokarda, s oštećenom sistoličkom funkcijom
English: However, some experts in the SAG saw a place in therapy for omega-3containing medicinal products in secondary prevention after MI.
Croatian: Ipak, neki stručnjaci iz Znanstvene savjetodavne skupine smatrali su da i za lijekove koji sadrže omega-3 ima mjesta u terapiji sekundarne prevencije nakon infarkta miokarda.
English: The Committee, as a consequence, considers that the benefit-risk balance of Omega-3 acid ethyl esters medicinal products for oral use in secondary prevention after myocardial infarction is not favourable.
Croatian: Odbor posljedično smatra da omjer koristi i rizika lijekova koji sadrže etilne estere omega-3 kiselina za peroralnu primjenu u sekundarnoj prevenciji nakon infarkta miokarda nije povoljan.
English: Therefore, the key concern that standard of care after MI has intensified since the time of the GISSI-P study, in particular statin therapy, beta-blockers and PCI, still remains.
Croatian: Prema tome, i dalje kao ključno pitanje ostaje to što se od vremena kad je provedeno ispitivanje GISSI-P standardna skrb bolesnika nakon infarkta miokarda pojačala, a posebice terapija statinima, beta-blokatorima i perkutana koronarna intervencija.
English: The ASCEND and VITAL studies did not show an effect of omega3 fatty acids on the primary or secondary cardiovascular endpoints and, as such, were considered as negative studies.
Croatian: Ispitivanja ASCEND i VITAL nisu pokazala učinak omega-3 masnih kiselina na mjere primarnog i sekundarnog kardiovaskularnog ishoda
English: Rizos EC, Ntzani EE, Bika E, Kostapanos MS, Elisaf MS. Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis.
Croatian: Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis.
English: In addition to MI, ACS is also associated with unstable angina.
Croatian: Osim s infarktom miokarda, akutni koronarni sindrom povezan je s nestabilnom anginom pektoris.
English: • Based on the totality of the data emerging after the original approval as well as the limitations of the GISSI-P trial, the CHMP concluded that efficacy is not established in secondary prevention after myocardial infarction at the dose of 1 g/day and, although the safety profile of omega-3 -acid ethyl esters is unchanged, the CHMP concluded that the benefit-risk balance in this indication is no longer favourable.
Croatian: • Na temelju ukupnih podataka koji su se pojavili nakon prvobitnog davanja odobrenja, kao i zbog ograničenja ispitivanja GISSI-P, CHMP je zaključio da nije utvrđena djelotvornost za sekundarnu prevenciju nakon infarkta miokarda u dozi od 1 g na dan.
English: Based on the totality of the data emerging after the original approval as well as the serious limitations of the GISSI-P trial, the CHMP concluded that efficacy is not established in secondary cardiovascular prevention at the dose of 1 g/day and whereas the safety profile of omega-3 -acid ethyl esters is unchanged, the CHMP concluded that the benefit-risk balance in this indication is no longer favourable.
Croatian: Na temelju ukupnih podataka koji su se pojavili nakon prvobitnog odobrenja, kao i ozbiljnih ograničenja ispitivanja GISSI-P, CHMP je zaključio da djelotvornost nije utvrđena u sekundarnoj kardiovaskularnoj prevenciji u dozi od 1 g na dan.
English: Based on the results of studies available today the experts did not see a place for therapy with Omega-3 containing medicinal products at a dose of 1 g/day in the context of secondary cardiovascular prevention after MI given the considerations regarding RCTs (particularly OMEGA and GISSI-P studies), meta-analysis and retrospective cohort studies.
Croatian: Na temelju rezultata danas dostupnih ispitivanja te s obzirom na razmatranja o randomiziranim kliničkim ispitivanjima (posebice ispitivanjima OMEGA i GISSI-P), metaanalizu i retrospektivna kohortna ispitivanja, stručnjaci su zaključili da terapija lijekovima koji sadrže omega-3 u dozi od 1 g na dan nije prikladna u kontekstu sekundarne kardiovaskularne prevencije nakon infarkta miokarda.
English: Deepak L. Bhatt, P. Gabriel Steg, Michael Miller, Eliot A. Brinton, Terry A. Jacobson, Steven B. Ketchum, Ralph T. Doyle, Jr., Rebecca A. Juliano, Lixia Jiao, Craig Granowitz, Jean‑Claude Tardif, and Christie M. Ballantyne, for the REDUCE-IT Investigators.
Croatian: Doyle, Jr., Rebecca A. Juliano, Lixia Jiao, Craig Granowitz, Jean‑Claude Tardif, and Christie M.
English: JoAnn E. Manson, Nancy R. Cook, I‑Min Lee, William Christen, Shari S. Bassuk, Samia Mora, Heike Gibson, Christine M. Albert, David Gordon, Trisha Copeland, Denise D'Agostino, Georgina Friedenberg, Claire Ridge, Vadim Bubes, Edward L. Giovannucci, Walter C. Willett, and Julie E. Buring, for the VITAL Research Group.
Croatian: Albert, David Gordon, Trisha Copeland, Denise D'Agostino, Georgina Friedenberg, Claire Ridge, Vadim Bubes, Edward L.
English: 11 Weisman D, Beinart R, Erez A, Koren-Morag N, Goldenberg I, Eldar M, Glikson M, Luria D. Effect of supplemented intake of omega-3 fatty acids on arrhythmias in patients with ICD: fish oil therapy may reduce ventricular arrhythmia.
Croatian: 11 Weisman D, Beinart R, Erez A, Koren-Morag N, Goldenberg I, Eldar M, Glikson M, Luria D.
English: Recently published RCTs (ASCEND by Bowman et al. 201812, VITAL by Manson et al. 201913, REDUCEIT by Bhatt et al. 201914) do not provide evidence for the efficacy of omega-3 administration (1 g daily) for the indication under review.
Croatian: 201914) ne pružaju dokaze o djelotvornosti primjene omega-3 (1 g dnevno) za indikaciju koja se razmatra.
English: 7 Poole CD, Halcox JP, Jenkins-Jones S, Carr ES, Schifflers MG, Ray KK, et al. Omega-3 Fatty acids and mortality outcome in patients with and without type 2 diabetes after myocardial infarction: a retrospective, matched-cohort study.
Croatian: Omega-3 Fatty acids and mortality outcome in patients with and without type 2 diabetes after myocardial infarction: a retrospective, matched-cohort study.
English: Further information
Croatian: Dodatne informacije
English: Your healthcare professional will give you this information.
Croatian: Te će vam informacije pružiti vaš zdravstveni djelatnik.
English: • If you have any questions about your treatment speak to your healthcare professional.
Croatian: • Ako imate pitanja o liječenju, obratite se svojem zdravstvenom djelatniku.
English: • During the switch to this type of combination medicine and in the weeks after the switch you should measure your blood sugar levels more frequently.
Croatian: • Tijekom prijelaza na tu vrstu kombiniranog lijeka i u tjednima nakon prijelaza trebali biste češće mjeriti razinu šećera u krvi.
English: 30 Churchill Place ● Canary Wharf ● London E14 5EU ● United Kingdom
Croatian: 30 Churchill Place ● Canary Wharf ● London E14 5EU ● United Kingdom27. studenoga 2015. EMA/134144/2015
English: These types of combination medicines are advantageous to patients since they reduce the number of injections they need to have and may help them keep to their treatment.
Croatian: Te vrste kombiniranih lijekova povoljnije su za bolesnike jer smanjuju broj injekcija koje trebaju primiti te im mogu pomoći pri pridržavanju liječenja.