FrancophonIA/ELRC3.0 huggingface dataset:
English: Conclusions on efficacy
Danish: Konklusioner vedrørende virkning
English: CPA/EE (2mg/0.035mg) is often used in combination with cyproterone 10 mg (CPA 10 mg) in different daily doses to increase anti-androgenic effects.
Danish: CPA/EE (2 mg/0,035 mg) bruges ofte i kombination med cyproteron 10 mg (CPA 10 mg) i forskellige daglige doser for at øge de antiandrogene virkninger.
English: In July 2002, the Pharmacovigilance Working Party (PhVWP) discussed the increased venous thromboembolic (VTE) and arterial thromboembolic (ATE) risks and concluded that the use of cyproterone acetate/ethinylestradiol (2mg/0.035mg) should be restricted taking into account the thromboembolic events.
Danish: I juli 2002 drøftede Arbejdsgruppen vedrørende Lægemiddelovervågning (PhVWP) de øgede venøse tromboemboliske (VTE) og arterielle tromboemboliske (ATE) risici og konkluderede, at anvendelsen af cyproteronacetat/ethinylestradiol (2 mg/0,035 mg) bør begrænses i betragtning af de tromboemboliske hændelser.
English: According to the 2012 IMS data issued from 16 European countries, the percentage of CPA/EE (2mg/0.035mg) prescription in acne varies from 0 to 54% with a median at 9%.
Danish: I henhold til IMS-data fra 2012 fra 16 europæiske lande er andelen af ordinationer af CPA/EE (2 mg/0,035 mg) til acne mellem 0 og 54 % med median 9 %.
English: No comparative safety data vs products that are registered for the treatment for acne/hirsutism/PCOS are presented.
Danish: Der er ikke forelagt sikkerhedsdata, hvor der sammenlignes med produkter, der er registreret til behandling af acne/hirsutisme/polycystisk ovariesyndrom.
English: More specifically the excess risk of VTE is highest during the first year a woman starts CPA/EE (2mg/0.035mg) or when restarting or switching after a pill-free interval of at least a month.
Danish: Mere konkret er overrisikoen for venøs tromboemboli højst i det første år, hvor en kvinde påbegynder behandling med CPA/EE (2 mg/0,035 mg) og ved genoptagelse af eller overgang til anden behandling efter mindst 1 måneds pause uden piller.
English: In conclusion, the thromboembolic events are known adverse drug reactions associated with the use of estrogen-progestogen containing preparations.
Danish: Som konklusion er de tromboemboliske hændelser kendte bivirkninger ved anvendelse af præparater indeholdende østrogen-progestogen.
English: Cyproterone acetate exerts its anti-androgenic effect by blocking androgen receptors.
Danish: Cyproteronacetats antiandrogene virkning skyldes blokering af androgenreceptorer.
English: The effect of CPA/EE (2mg/0.035mg) on seborrhoeic symptoms, such as greasy skin and hair, starts after 3-4 cycles of treatment, and results are more pronounced with longer treatment.
Danish: Virkningen af CPA/EE (2 mg/0,035 mg) på seborrésymptomer såsom fedtet hud og hår begynder efter 3-4 behandlingsforløb, og resultaterne af mere udtalte ved længerevarende behandling.
English: The PRAC endorsed a Direct Healthcare Professional Communication (DHPC), to communicate the outcome of the present review and to communicate to the healthcare professionals the updated indication and to highlight the risk of the thromboembolic events.
Danish: PRAC godkendte en direkte meddelelse til fagfolk i sundhedssektoren (DHPC) om resultatet af denne gennemgang og om den opdaterede indikation med fremhævelse af risikoen for tromboemboliske hændelser.
English: The MAH conducted a systematic review of the scientific literature (cut-off date: 14 Feb 2013) in MEDLINE, EMBASE, Derwent Drug File, and BIOSIS Previews on clinical studies covering cardiovascular diseases and CPA/EE(2mg/0.035mg).
Danish: Indehaveren af markedsføringstilladelsen foretog en systematisk gennemgang af den videnskabelige litteratur (skæringsdato: 14. februar 2013) i MEDLINE, EMBASE, Derwent Drug File og BIOSIS Previews vedrørende kliniske undersøgelser, der dækker kardiovaskulære sygdomme og CPA/EE (2 mg/0,035 mg).
English: The overall Pearl Index for CPA/EE (2mg/0.035mg) in a large clinical trial was 0.12 with an upper 95%-confidence limit of 0.44.
Danish: Det samlede Pearl-index for CPA/EE (2 mg/0,035 mg) i en stor klinisk undersøgelse var 0,12 med en øvre grænse på 0,44 af 95 % sikkerhedsintervallet.
English: The recent Cochrane review (Arowojolu, AO. et al., 2012), which evaluated efficacy of combined oral contraceptives in acne, reported that regarding the differences in the comparative effectiveness of the contraceptives, data were too limited for any conclusive comparison.
Danish: I den nylige Cochrane-gennemgang (Arowojolu, AO. et al., 2012) af virkningen af kombinerede orale antikonceptionsmidler ved acne var dataene for begrænsede til at drage konklusioner om forskelle i virkning af de forskellige antikonceptionsmidler.
English: Of these 76 reports, 67 (88.2%) cases reported pulmonary embolism with or without reported DVT or unspecified thrombosis, 8 (10.5%) reports described cerebral events, and 1 (1.3%) reported events of dyspnoea, disseminated intravascular coagulation and circulatory disorder in context of multi-organ failure, acute hepatic failure, coma hepatic, bone marrow failure, fungal sepsis, pneumonia and histiocytosis haematophagic in a female patient with condition of alcohol abuse, acute myeloid leukaemia, polychemotherapy and antibiotics therapy.
Danish: Af disse 76 indberetninger vedrørte 67 (88,2 %) lungeemboli med eller uden dyb venetrombose eller uspecificeret trombose, 8 (10,5 %) vedrørte cerebrale hændelser, og 1 (1,3 %) vedrørte hændelser med dyspnø, dissemineret intravaskulær koagulation og kredsløbsforstyrrelser i forbindelse med multiorgansvigt, akut leversvigt, coma hepaticum, knoglemarvssvigt, mykotisk sepsis, pneumoni og hæmatofag histiocytose hos kvindelige patienter med alkoholmisbrug, akut myeloid leukæmi, polykemoterapi og antibiotikabehandling.
English: Early studies reported that the risk of (idiopathic) VTE in users of CPA/EE is greater in comparison to users of levonorgestrel-containing COC, or conventional COC respectively, with low estrogen (<50μg) (Vasilakis-Scaramozza & Jick 2001, Seaman et al, 2003).
Danish: I de tidlige undersøgelser fandtes risikoen for (idiopatisk) venøs tromboemboli hos CPA-/EE-brugere at være større end hos brugere af kombinerede antikonceptionsmidler indeholdende levonorgestrel eller af konventionelle kombinerede antikonceptionsmidler med lavt østrogenindhold (<50μg) (Vasilakis-Scaramozza & Jick, 2001, Seaman et al, 2003).
English: The PRAC in accordance with Article 107j(3) of Directive 2001/83/EC, recommended by majority that a. the marketing authorisation holders should sponsor a post-authorisation safety study together with the follow up evaluation of the results of that study, as well as a drug utilisation study (see Annex IV - Conditions of marketing Authorisations); b. the marketing authorisation holders should implement risk minimisation measures; c. the marketing authorisations of the cyproterone acetate/ethinylestradiol (2mg/0.035mg) containing medicinal products (see Annex I) should be varied (in accordance with changes to the product information as set out in Annex III).
Danish: I overensstemmelse med artikel 107, stk. 1, i direktiv 2001/83/EF anbefalede CHMP efter en flertalsafgørelse, at: a. indehaverne af markedsføringstilladelsen sponsorerer en sikkerhedsundersøgelse efter markedsføring tillige med opfølgende evaluering af resultaterne af denne undersøgelse samt en undersøgelse af lægemiddelanvendelse (se bilag IV - Betingelser for markedsføringstilladelserne, b. indehaverne af markedsføringstilladelsen gennemfører risikominimeringsforanstaltninger, og c. markedsføringstilladelser for lægemidler indeholdende cyproteronacetat/ethinylestradiol (2 mg/0,035 mg) (se bilag I) ændres (i overensstemmelse med ændringerne i produktinformationen, som fremgår af bilag III).
English: CPA/EE (2mg/0.035mg) was prescribed according to the indication (i.e. androgenic symptoms) in 40% of cases and prescribed off-label in 31% (as a contraceptive or for menstrual irregularities).
Danish: CPA/EE (2 mg/0,035 mg) blev i 40 % af tilfældene ordineret i henhold til indikationen (dvs. androgene symptomer), og i 31 % til ikke-godkendt anvendelse (dvs. som antikonception eller mod uregelmæssig menstruation).
English: To assess venous and arterial thromboembolic effects from clinical studies with CPA/EE, only clinical studies that documented adverse events are discussed here.
Danish: Til vurdering af venøse og arterielle tromboemboliske virkninger omtales her kun kliniske undersøgelser med CPA/EE, hvor der er registreret bivirkninger.
English: The PRAC considered all the cumulative efficacy and safety data submitted for the indications of acne and seborrhea, hirsutism and alopecia.
Danish: PRAC tog i betragtning alle de kumulative data om virkning og sikkerhed, der var forelagt for indikationerne acne og seborré, hirsutisme og alopeci.
English: It has to be noted that Polycystic ovarian syndrome (PCOS) mentioned by HCPs as an indication reflects the use of CPA/EE for the treatment of androgen related symptoms of PCOS such as acne or hirsutism.
Danish: Det må bemærkes, at når sundhedspersoner angiver polycystisk ovariesyndrom (PCOS) som indikation, afspejler det anvendelse af CPA/EE til behandling af androgenrelaterede symptomer på polycystisk ovariesyndrom, såsom acne eller hirsutisme.
English: In view of the above, on 4 February 2013 France requested the PRAC under Article 107i of Directive 2001/83/EC1 to assess the above concerns regarding thromboembolism and its impact on the benefitrisk balance for cyproterone acetate/ethinylestradiol (2 mg/0.035 mg) containing medicinal products, and to give its opinion on measures necessary to ensure the safe and effective use, and on whether the marketing authorisation for this product should be maintained, varied, suspended or withdrawn.
Danish: På denne baggrund anmodede Frankrig den 4. februar 2013 i henhold til artikel 107, stk. 1, i direktiv 2001/83/EF1 PRAC om at vurdere de nævnte betænkeligheder ved tromboemboli og betydningen heraf for benefit/risk-forholdet for lægemidler indeholdende cyproteronacetat/ethinylestradiol (2 mg/0,035 mg) og fremsætte en udtalelse om foranstaltninger, der er nødvendige for at garantere sikker og effektiv anvendelse, og om, hvorvidt markedsføringstilladelserne for dette produkt burde opretholdes, ændres, suspenderes eller inddrages.
English: In addition the PRAC noted that these medicinal products have hormonal contraceptive effects and as such the concomitant use with another hormonal contraceptive is contraindicated.
Danish: PRAC bemærkede desuden, at disse lægemidler har hormonal antikonceptiv virkning og derfor er kontraindicerede i kombination med anden hormonal antikonception.
English: • The PRAC also considered all the cumulative efficacy and safety data submitted for the indications of acne and seborrhea, hirsutism and alopecia.
Danish: • PRAC gennemgik desuden alle de kumulative data om virkning og sikkerhed, der er forelagt for indikationerne acne og seborré, hirsutisme og alopeci,
English: For 879 (90.8%) of 968 TE cases, CPA/EE (2mg/0.035mg) was the only suspected drug.
Danish: I 879 (90,8 %) af 968 tilfælde af tromboemboli var CPA/EE (2 mg/0,035 mg) det eneste mistænkte lægemiddel.
English: None of the studies presents information on the fatality rate of VTE among CPA/EE users, except for the Seaman 2003 study stating that none of the 179 VTE events, including the 23 events among CPA/EE (2mg/0.035mg) exposed, was fatal.
Danish: Ingen af undersøgelserne indeholder oplysninger om dødeligheden ved venøs tromboemboli hos CPA-/EE-brugere bortset fra Seaman 2003-undersøgelsen, som angiver, at der ikke var dødsfald blandt de 179 venøse tromboemboliske hændelser, hvoraf 23 vedrørte personer eksponeret for CPA/EE (2 mg/0,035 mg).
English: b. the marketing authorisation holders should implement risk minimisation measures;
Danish: b. indehaverne af markedsføringstilladelse gennemfører risikominimeringsforanstaltninger, og c. markedsføringstilladelserne ændres.
English: There is only sparse data on arterial thrombotic and thromboembolic diseases with CPA/EE (2mg/0.035mg) or cyproterone acetate alone.
Danish: Der findes kun sparsomme data om arterielle trombotiske og tromboemboliske sygdomme med CPA/EE (2 mg/0,035 mg) eller med cyproteronacetat alene.
English: Two studies compared CPA/EE (2mg/0.035mg) with levonorgestrel/EE (LNG/EE).
Danish: To undersøgelser sammenlignede CPA/EE (2 mg/0,035 mg) med levonorgestrel/EE (LNG/EE).
English: Therefore retrieved cases of reporting TE adverse reactions from worldwide sources comprise also cases occurring in association with CPA/EE (2mg/0.035mg) in combination with CPA 10 mg (n = 48 [5%] cases in total).
Danish: Indberetningerne af tromboemboliske bivirkninger fra kilder verden over omfatter derfor også tilfælde, der optræder i forbindelse med CPA/EE (2 mg/0,035 mg) kombineret med CPA 10 mg (i alt: n = 48 (5 %)).
English: For the condition of alopecia in view of the very limited efficacy data, the PRAC concluded that the benefit-risk balance is not favourable and therefore these medicinal products should no longer be indicated in this therapeutic indication.
Danish: I betragtning af de meget begrænsede data om virkningen ved alopeci konkluderede PRAC, at benefit/riskforholdet ikke er gunstigt, og at disse lægemidler derfor ikke længere bør være indiceret til denne terapeutiske indikation.
English: In January 2013 the French medicines agency (ANSM) took the decision to suspend cyproterone acetate/ethinylestradiol (CPA/EE) (2mg/0.035mg) containing medicinal products in France within three months.
Danish: I januar 2013 besluttede den franske lægemiddelstyrelse (ANSM) at suspendere markedsføringstilladelserne for lægemidler indeholdende cyproteronacetat/ethinylestradiol (CPA/EE) (2 mg/0,035 mg) i Frankrig inden for tre måneder.
English: The MAH of the originator has submitted in the annual Periodic Safety Update Reports (PSURs) for CPA/EE information on thromboembolic events.
Danish: Indehaveren af markedsføringstilladelsen for det oprindelige produkt har givet oplysninger om tromboemboliske hændelser for CPA/EE i de årlige periodiske, opdaterede sikkerhedsberetninger (PSUR).
English: The overall global spontaneous reporting rate for all cases reporting any TE event at data lock point (DLP) 06 Mar 2013 is estimated as 1.5 per 100,000 women-years, 1.4 non-fatal TE reports per 100,000 women-years, and 0.1 fatal TE reports per 100,000 women-years with CPA/EE (91 fatal cases (8%) in total of 1143 cases).
Danish: Den samlede globale spontane indberetningshyppighed for alle tilfælde af tromboemboliske hændelser på skæringstidspunktet den 6. marts 2013 er anslået til 1,5 per 100 000 kvindeår, heraf 1,4 indberetninger om tromboemboli per 100 000 kvindeår uden dødelig udgang og 0,1 indberetninger om tromboemboli per 100 000 kvindeår med dødelig udgang i forbindelse med CPA/EE (91 tilfælde (8 %) med dødelig udgang ud af i alt 1 143 tilfælde).
English: Studies show considerable variability in their relative risk compared to non-use or other COCs and in their absolute risk for VTE.
Danish: Undersøgelserne viser betydelig variation, dels i den relative risiko sammenlignet med ingen anvendelse eller med anvendelse af andre kombinerede orale antikonceptionsmidler, dels i den absolutte risiko for venøs tromboemboli.
English: In addition the PRAC requested a study protocol to be provided within the risk management plan submission, for a drug utilisation study in order to better characterise prescribing practices for these medicinal products during typical clinical use in representative groups of prescribers and to assess main reasons for prescription.
Danish: Desuden anmodede PRAC om, at der i forbindelse med indsendelsen af risikostyringsplanen forelægges en protokol til undersøgelse af lægemiddelanvendelse for at opnå en bedre beskrivelse af den typiske ordineringspraksis for disse lægemidler hos repræsentative grupper af ordinerende læger samt en vurdering af hovedgrundene til ordinering.
English: As of last PSUR (reporting period 01 Jun 2011 ─ 31 May 2012, DLP: 31 May 2012), the reporting frequency of all (arterial, venous and unspecified) thrombotic / thromboembolic events received during the reporting period was 1.3 per 100,000 womenyears.
Danish: I henhold til den seneste PSUR (indberetningsperiode 1. juni 2011 til 31. maj 2012, databasen låst 31. maj 2012) var indberetningshyppigheden 1,3 per 100 000 kvindeår for alle (arterielle, venøse og uspecificerede) trombotiske /tromboemboliske hændelser, der er indberettet i perioden.
English: For the treatment of acne, topical therapies are applied for mild to moderate acne without hyperandrogenic state.
Danish: Til behandling af let til moderat acne uden hyperandrogen tilstand anvendes topiske præparater.
English: The PRAC considered all the above data for the CPA/EE (2mg/0.035mg) containing medicinal products and recommended clarification on the indication of the products.
Danish: PRAC gennemgik alle ovennævnte data for lægemidler indeholdende CPA/EE (2 mg/0,035 mg) og anbefalede præcisering af indikationen for produkterne.
English: The off-label use was defined according to the therapeutic indications for CPA/EE (2mg/0.035mg) as SmPC indication statements differ from country to country on the basis of national responses of health authorities to the EMA Pharmacovigilance Working Party (PhVWP) review of the product conducted in
Danish: Ikke godkendt anvendelse blev defineret i henhold til de terapeutiske indikationer for CPA/EE (2 mg/0,035 mg), idet der i forskellige lande angives forskellige indikationer i produktresuméet som oplyst i de nationale sundhedsmyndigheders besvarelse til den gennemgang af produktet, der blev foretaget af EMA's Arbejdsgruppe vedrørende Lægemiddelovervågning i 2002.
English: For the period since the global launch of CPA/EE (2mg/0.035mg) through 30 Jan 2013, 968 cases (serious (93%) and non-serious (7%), medically confirmed (85%) and non-medically confirmed (15%) reporting thrombotic/thromboembolic events irrespective of their nature (arterial, venous and unspecified) occurring in female patients were received by the MAH from worldwide sources.
Danish: For perioden siden den globale lancering af CPA/EE (2 mg/0,035 mg) frem til den 13. januar 2013 modtog indehaveren af markedsføringstilladelsen fra kilder verden over indberetninger om 968 tilfælde (alvorlige (93 %) og ikke-alvorlige (7 %) lægeligt bekræftede (85 %) og ikke lægeligt bekræftede (15 %)) af trombotiske /tromboemboliske hændelser uanset art (arterielle, venøse og uspecificerede) hos kvindelige patienter.
English: In general, cyproterone acetate/ethinylestradiol (2mg/0.035mg) containing medicinal products are authorised for treatment of androgenic symptoms in women, such as pronounced forms of acne, seborrhoea, and mild forms of hirsutism.
Danish: Generelt er lægemidler indeholdende cyproteronacetat/ethinylestradiol (2 mg/0,035 mg) godkendt til behandling af androgene symptomer såsom udtalte former for acne og seborré og milde former for hirsutisme hos kvinder.
English: The study (currently ongoing) seeks to assess the risks of short- and longterm use of Qlaira (dienogest/estradiol valerate, step down dose regimen) and of oral contraceptives and including CPA/EE (2mg/0.035mg).
Danish: Denne igangværende undersøgelse sigter mod at vurdere risiciene ved kort- og langtidsanvendelse af Qlaira (dienogest/estradiolvalerat, nedtrapningsdosering) og af orale antikonceptionsmidler, herunder CPA/EE (2 mg/0,035 mg).
English: Interruption and restarting is likely to be more frequent for CPA/EE (2mg/0.035mg) which is indicated for treatment of androgen-dependent diseases such as acne, and for which the product label implies that the medication may be discontinued after improvement of symptoms and be restarted in case of recurrence of symptoms.
Danish: Afbrydelse og genoptagelse må formodes at være hyppigere for CPA/EE (2 mg/0,035 mg), der er indiceret til behandling af androgenafhængige sygdomme såsom acne, og som i produktoplysningerne giver mulighed for seponering ved bedring og genoptagelse ved tilbagevenden af symptomer.
English: • The PRAC confirmed the known risk of thromboembolism of cyproterone acetate/ ethinylestradiol (2mg/0.035mg) containing medicinal products, and recommended clear labelling of symptoms of thromboembolic events, as well as the risk factors for thromboembolic events.
Danish: • PRAC bekræftede den kendte risiko for tromboemboli ved lægemidler indeholdende cyproteronacetat/ethinylestradiol (2 mg/0,035 mg) og anbefalede tydelig mærkning med symptomer på tromboemboliske hændelser samt risikofaktorer for tromboemboliske hændelser,
English: In addition the contraceptive effect of CPA/EE (2mg/0.035mg) was investigated in a European Active Surveillance (EURAS) study.
Danish: Den antikonceptive virkning af CPA/EE (2 mg/0,035 mg) blev desuden undersøgt i en europæisk aktiv overvågningsundersøgelse (EURAS).
English: Pearl Index based on CPA/EE (2mg/0.035mg) clinical trial data (Study 8186, Aydinlik et al., 1990) Method failure
Danish: Tabel 1 Pearl-index baseret på en klinisk undersøgelse med CPA/EE (2 mg/0,035 mg) (undersøgelse 8186, Aydinlik et al., 1990)
English: 892 (92.1%) of 968 cases reported non-fatal TE in association with CPA/EE (2mg/0.035mg) use, of which 760 were medically confirmed.
Danish: 892 (92,1 %) af 968 blev indberettet som tilfælde af tromboemboli uden dødelig udgang ved anvendelse af CPA/EE (2 mg/0,035 mg), heraf 760 lægeligt bekræftede.
English: The estimate is based on the calculated patient exposure of 75,417,345 women-years and 52 reports of arterial embolic and thrombotic events worldwide.
Danish: Tallet er baseret på den beregnede patienteksponering på 75 417 345 kvindeår og 52 indberetninger af arterielle emboliske og trombotiske hændelser på verdensbasis.
English: • For the condition of alopecia in view of the overall available safety data, in particular in relation to the risk of serious thromboembolic events, and very limited efficacy data, the PRAC concluded in accordance with Article 116 of Directive 2001/83/EC that the risk-benefit balance is not favourable and therefore these medicinal products should no longer be indicated in this therapeutic indication.
Danish: • hvad angår alopeci tog PRAC hensyn til de foreliggende overordnede sikkerhedsdata, navnlig vedrørende risikoen for alvorlige tromboemboliske hændelser og de meget begrænsede data om virkning, hvorfor udvalget i overensstemmelse med artikel 116 i direktiv 2001/83/EF konkluderede, at benefit/risk-forhold ikke er gunstigt, og at disse lægemidler derfor ikke længere bør være indiceret til denne terapeutiske indikation,
English: The fact that the women recalled the link with acne / PCOS indicates that the need for treatment of the skin condition / hyperandrogenism of the individual woman was specifically discussed during the visit and drove the prescription of CPA/EE (2mg/0.035mg).
Danish: At kvinderne huskede forbindelsen med acne/polycystisk ovariesyndrom, tyder på, at den enkelte kvindes behov for behandling af hudlidelsen eller hyperandrogenisme er blevet konkret omtalt under besøget og har været afgørende for ordinationen af CPA/EE (2 mg/0,035 mg).
English: The comparison of Pearl Indices in the EURAS study demonstrated the Pearl Index of CPA/EE (2mg/0.035mg) to be 0.37 (95% CI 0.19-0.65), which is comparable with that obtained for approved combined contraceptives (which vary between 0.48 and 0.63).
Danish: I EURAS-undersøgelsen blev Pearl-indeks for CPA/EE (2 mg/0,035 mg) beregnet til 0,37 (95 % SI [0,19- 0,65]) og var således sammenligneligt med det, der opnåedes med godkendte kombinerede antikonceptionsmidler (mellem 0,48 og 0,63).
English: A drug utilisation study to characterise prescribing practices for the medicinal products during typical clinical use in representative groups of prescribers was also considered.
Danish: Udvalget overvejede ligeledes en undersøgelse af lægemiddelanvendelse til karakterisering af typisk ordinationspraksis for lægemidlerne hos repræsentative grupper af ordinerende læger.