FrancophonIA/ELRC3.0 huggingface dataset:
English: With the current patient evaluation tools, the distinction between mild or moderate cognitive impairment and early stage of Alzheimer or of other dementia is difficult.
Danish: Med de nuværende værktøjer til patientvurdering er det vanskeligt at skelne mellem let til moderat kognitiv funktionsnedsættelse og det tidlige stadium af Alzheimer eller anden form for demens.
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.
Danish: For et lægemiddel, der undersøges i prodromstadierne af demens, vil der sædvanligvis skulle påvises bedring i kognitiv funktion og desuden forsinkelse af progression til demens.
English: However, the CHMP also noted that the MAH provided information only for their product (Hydergine) and that underreporting is likely.
Danish: CHMP bemærkede imidlertid også, at indehaveren af markedsføringstilladelsen kun forelagde oplysninger om sit eget produkt (Hydergine), og at underindberetning er sandsynlig.
English: It acts as an agonist to dopaminergic and serotonergic receptors and an antagonist for alpha-adrenoreceptors.
Danish: Det er en agonist til dopaminerge og serotoninerge receptorer og en antagonist til alfaadrenerge receptorer.
English: The MAH submitted a number of papers with efficacy clinical studies, 2 reviews (the medical letter, 1974, Mc Donald, 1979) and one Cochrane review (2009).
Danish: Indehaveren af markedsføringstilladelsen forelagde en række artikler med kliniske undersøgelser af virkningen, to oversigtsartikler (The Medical Letter, 1974, Mc Donald, 1979) og en Cochranegennemgang (2009).
English: Furthermore, those reporting positive results are claiming improvement in different parameters in scales intended to capture important aspects of impaired cognition.
Danish: I de undersøgelser, der beskriver positive resultater, påberåbtes der desuden forbedring af en række parametre på skalaer, der er bestemt til at fange vigtige aspekter af nedsat kognitiv funktion.
English: In such cases, administration of dihydroergotoxine may delay the administration of an appropriate treatment for dementia.
Danish: I sådanne tilfælde kan administration af dihydroergotoxin indebære forsinkelse af initieringen af en egnet demensbehandling.
English: A review of all other available data (i.e. literature data, pre-clinical data, and other clinical data including epidemiological studies) that were relevant to evaluate the risk of fibrosis was provided where possible.
Danish: Der blev desuden forelagt en gennemgang, der så vidt muligt dækkede alle andre foreliggende data (dvs. litteraturdata, prækliniske data og andre kliniske data, herunder epidemiologiske undersøgelser), som var relevante for vurdering af risikoen for fibrose.
English: Based on the overall documentation provided, the CHMP concluded that the studies suffer from substantial methodological deficiencies which preclude any conclusion on the efficacy of the product.
Danish: På grund af den samlede forelagte dokumentation konkluderede CHMP, at undersøgelserne er behæftet med væsentlige metodologiske mangler, som udelukker enhver konklusion om virkningen af produktet.
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.
Danish: CHMP gentog, at de undersøgelser, der var fremlagt til støtte for virkningen af dihydroergotoxin, blev publiceret i halvfjerdserne og firserne med deraf følgende risiko for skævhed i vurderingen, og at de har adskillige begrænsninger.
English: Five were uncontrolled, open designed, without any well-defined primary efficacy objective, and they were conducted in patients with heterogeneous ocular disorders.
Danish: Fem var ukontrollerede med åbent design uden veldefineret primært mål for virkning og blev udført hos patienter med heterogene øjensygdomme.
English: The SAG unanimously agreed that there is no distinct clinical entity for cognitive impairment no dementia (CIND), the diagnostic criteria and definitions have changed over time and this wording does not correspond to a current clinically defined group.
Danish: Den videnskabelige rådgivende gruppe fastslog enstemmigt, at der ikke findes nogen særlig klinisk entitet for kognitiv funktionsnedsættelse uden demens (CIND), at diagnosekriterier og definitioner har ændret sig med tiden, og at denne ordlyd ikke afspejler en aktuel klinisk defineret gruppe.
English: • The suspension of the marketing authorisation for dihydroergotoxine containing medicinal products referred to in Annex I if no other indications are approved as part of their marketing authorisation.
Danish: • suspendering af markedsføringstilladelsen for de i bilag I omhandlede lægemidler indeholdende dihydroergotoxin, når ingen andre indikationer er godkendt som en del af markedsføringstilladelsen.
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.
Danish: Ved en national gennemgang af lægemiddelovervågning i 2011 konstateredes der nye spontane indberetninger af alvorlige tilfælde af fibrose og ergotisme med nogle af disse produkter, og Frankrig fandt, at den begrænsede dokumentation for virkning ikke opvejer denne sikkerhedsmæssige betænkelighed.
English: • The Committee maintained its opinion that the benefit-risk balance of dihydroergotoxine containing products:
Danish: • udvalget fastholdt som sit standpunkt, at benefit/risk-forholdet for lægemidler indeholdende dihydroergotoxin:
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.
Danish: Indehaverne af markedsføringstilladelserne fremlagde alle foreliggende data om virkningen fra kliniske undersøgelser og observationsundersøgelser, herunder data, der er blevet tilgængelige siden udstedelsen af den oprindelige markedsføringstilladelse.
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):
Danish: Af de godkendte indikationer for lægemidler indeholdende dihydroergotoxin omfatter denne indbringelsesprocedure følgende, som er godkendt i mindst én medlemsstat (den konkrete ordlyd af indikationen kan afvige fra produkt til produkt):
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.
Danish: Efter gruppens opfattelse kan det ikke på forhånd udelukkes, at lægemidlet kan være effektivt hos en undergruppe af veldefinerede patienter i henhold til nuværende kriterier, men at dette ikke kan afgøres på grundlag af de givne oplysninger med stærkt heterogene parametre for undersøgelsernes patientpopulation og udfald.
English: For the indication “ancillary treatment of visual acuity decrease and visual field disturbances presumably of vascular origin”, seven clinical studies have been submitted.
Danish: For indikationen “supplerende behandling af synsnedsættelse og synsfeltforstyrrelser af formodet vaskulær årsag” er der er forelagt syv kliniske undersøgelser.
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.
Danish: Gruppen fremhævede, at den påberåbte indikation ikke længere benyttes i klinisk praksis, og at der på nuværende tidspunkt ikke er evidens for et terapeutisk behov for dette aktive stof til behandling af kognitiv og neurosensorisk funktionsnedsættelse hos ældre.
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.
Danish: CHMP's overordnede synspunkt var, at ingen situation berettiger at udsætte en patient for risiko for fibrose og ergotisme, når de meget begrænsede data om virkning tages i betragtning.
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.
Danish: CHMP bemærkede, at patienterne i undersøgelserne frembød forskellige symptomer eller formodede diagnoser, at virkningen hovedsagelig blev vurderet med subjektive scoreværdier, de iagttagne symptomer var meget heterogene, de forskellige undersøgelser gav ikke samstemmende resultater, og langtidsdata taler ikke for, at dihydroergotoxin har virkning i forhold til placebo.
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
Danish: Videnskabelige konklusioner og begrundelse for ændring af betingelserne for markedsføringstilladelserne eller, i givet fald, suspendering af markedsføringstilladelserne, alt efter de godkendte indikationer for hvert produkt
English: In addition, severe cases of peripheral vasoconstrictive symptoms were reported in the literature.
Danish: Desuden blev der i litteraturen indberettet alvorlige tilfælde af symptomer på perifer vasokonstriktion.
English: • The Committee considered that a potential causal association between fibrotic reactions or ergotism and dihydroergotoxine cannot be excluded.
Danish: • udvalget fandt, at der ikke kan udelukkes potentiel årsagssammenhæng mellem dihydroergotoxin og fibrotiske reaktioner eller ergotisme.
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.
Danish: CHMP fremhævede, at “kronisk kognitiv funktionsnedsættelse med undtagelse af Alzheimers sygdom og anden demens” ikke anses for at være en almindeligt anerkendt definition af en patologisk tilstand med henblik på fordel af behandling.
English: Dementia and dementia related indications, as well as the acute treatment of migraine, are outside the scope of this referral procedure.
Danish: Demens og demensrelaterede indikationer er ligesom akut migrænebehandling ikke omfattet af denne indbringelse.
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:
Danish: • ændring af betingelserne for markedsføringstilladelsen for de i bilag I anførte lægemidler indeholdende dihydroergotoxin, således at nedenstående indikationer slettes fra produktinformationen (den konkrete ordlyd af indikationerne kan variere fra produkt til produkt og fra land til land) ligesom enhver relevant omtale af disse indikationer, når andre terapeutiske indikationer er godkendt som en del af markedsføringstilladelsen:
English: • Acute retinopathies of vascular origin
Danish: • Akutte retinopatier af vaskulær årsag
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.
Danish: På ovenstående baggrund fandt udvalget, at der er risiko for sjældne, men svære fibrotiske reaktioner og ergotisme ved behandling med dihydroergotoxin.
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.
Danish: Disse bestod i ændring af udleveringsstatus, begrænsning af behandlingsvarigheden ved visse sygdomme, kontraindikation af produktet ved præeksisterende fibrose og sammen med andre lægemidler, udsendelse af en direkte henvendelse til sundhedspersoner, hvor risikoen påpeges, en tjekliste for ordinerende læger og en farmakologisk en vitro-undersøgelse med henblik på affiniteten af receptorer i 5-HT-subklassen for produktet.
English: Ergot derivatives are recognised as being capable of inducing fibrosis, in particular heart valve fibrosis.
Danish: De fleste ergotderivater er kendt for at kunne fremkalde fibrose, navnlig af hjerteklapperne.
English: Agonism to 5-HT2B receptors induces a proliferative response and mitogenicity of the cells expressing this receptor leading to fibrogenesis.
Danish: Agonistisk påvirkning af 5-HT2B-receptorer fremkalder en proliferativ og mitogen respons af de celler, der udtrykker denne receptor, hvilket medfører fibrogenese.
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.
Danish: Andre fibrosefremkaldende mekanismer kan således ikke udelukkes, hvilket peger på en årsagssammenhæng mellem fibrose og agonistisk påvirkning af 5-HT2A- og 5-HT1B-receptorer og sandsynligvis også en virkning på serotonintransporteren.
English: • The Committee considered the overall submitted data and grounds provided by the MAHs and the outcome of the scientific advisory groups.
Danish: • udvalget gennemgik alle data, der var forelagt af indehaverne af markedsføringstilladelse, og resultatet fra de videnskabelige rådgivende grupper,
English: Moreover the severity of such adverse effects, their possible fatal outcome and the raised risk for patient to develop a fibrotic disorder with long term use according to the authorised indications should be underlined.
Danish: Det må derudover understreges, at der er tale om alvorlige bivirkninger med muligt fatalt udfald, og at der er forhøjet risiko for udvikling af en fibrotisk sygdom ved langvarig behandling i henhold til de godkendte indikationer.
English: Dihydroergotoxine modulates synaptic neurotransmitter levels and increases blood flow to the brain; at one time, it was believed that the latter mechanism was the primary mode of action by which dihydroergotoxine exerts clinical effects.
Danish: Dihydroergotoxin modulerer koncentrationerne af de synaptiske neurotransmittere og øger blodtilførslen til hjernen; denne sidstnævnte mekanisme mentes tidligere at være den primære virkningsmekanisme for dihydroergotoxins kliniske virkninger.
English: The CHMP has considered the totality of the available data on the safety and efficacy of dihydroergotoxine.
Danish: CHMP har vurderet samtlige foreliggende data om sikkerheden og virkningen af dihydroergotoxin.
English: Based on these data and based on the pharmacological plausibility, dihydroergotoxine is considered to be associated with fibrotic reactions.
Danish: På grundlag af disse data og den farmakologiske plausibilitet anses dihydroergotoxin for at have sammenhæng med fibrotiske reaktioner.
English: Consequently, it was not possible for the CHMP to draw scientific conclusions regarding the benefit of dihydroergotoxine in peripheral vascular disease based on these study results and subsequently no conclusions could be drawn for the ancillary treatment of Raynaud's syndrome.
Danish: CHMP var derfor ikke i stand til at drage videnskabelige konklusioner om fordelen af dihydroergotoxin ved perifer vaskulær sygdom ud fra disse undersøgelser, og der kunne efterfølgende ikke drages konklusioner om supplerende behandling af Raynauds syndrom.
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.
Danish: Dataene fra de indberettede tilfælde af fibrose (n=9) er begrænsede i forhold til at drage faste konklusioner, men det kan ikke udelukkes, at dihydroergotoxin er i stand til at inducere fibrotiske reaktioner lokaliseret i det retroperitoneale, pulmonale og kardiale område, navnlig fordi der i visse af de vurderede tilfælde ikke var nogen anden ætiologi, og på grund af ergotderivaters virkningsmekanisme.
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.
Danish: • udvalget finder, at der kun er meget begrænset evidens for en væsentlig klinisk virkning af oralt dihydroergotoxin til de aktuelt vurderede indikationer og til den indikation, der foreslås af markedsføringstilladelsesindehaveren ved den fornyede overvejelse, og at de potentielle fordele for patienterne ved disse indikationer derfor ikke opvejer den ovenfor omtalte risiko,
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.
Danish: På ovenstående baggrund fandt CHMP, at de forelagte undersøgelser ikke godtgjorde, at dihydroergotoxin har klinisk relevant virkning på patienter med nedsat kognitiv funktion.
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.
Danish: Fibrotiske reaktioner er blevet sat i forbindelse med kronisk brug af ergotderivater, og skønt indberetningshyppigheden for dihydroergotoxin er lav, er risikoen for alvorlig til at kunne lades ude af betragtning, navnlig i lyset af den potentielle langtidsanvendelse hos en bred patientpopulation.
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.
Danish: På grundlag af de kliniske erfaringer fandt gruppen, at der ikke er nogen nærmere bestemt population, der kan have fordel af behandling med dette aktive stof til forebyggelse af migræne.
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.
Danish: Dihydroergotoxinmesilat er et ergotalkaloid, der også kaldes codergocrinmesilat og ergoloidmesilat og består af lige dele mesilater af dihydroergocornin, dihydroergocristin og dihydroergocryptin.
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.
Danish: De foreslåede risikominimeringsforanstaltninger blev af udvalget ikke fundet effektive til at reducere risikoen for de to betragtede reaktioner (fibrose og ergotisme) ved anvendelse til den brede indikation, der foreslås af indehaveren af markedsføringstilladelsen.
English: In addition, dihydroergotoxine is composed of dihydroergocryptine and dihydroergocristine which are also considered to be associated with the induction of fibrotic reactions.
Danish: Desuden består dihydroergotoxin af dihydroergocryptin og dihydroergocristin, som også anses for at have sammenhæng med fibrotiske reaktioner.
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.
Danish: Skønt propranolol og flunarizin er anerkendt til forebyggelse af migræne, kan der på grund af den manglende placebogruppe ikke drages konklusioner om virkningen af dihydroergotoxin til forebyggelse af migræne.
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”).
Danish: Om indikationen “supplerende behandling af Raynauds syndrom” bemærkede CHMP, at den af markedsføringstilladelsesindehaveren påberåbte indikation er perifer vaskulær sygdom, og at supplerende behandling af Raynauds syndrom i nogle medlemsstater er godkendt for dihydroergotoxin som del af en mere generel indikation (f.eks. “perifer vaskulær sygdom”).
English: Overall, the CHMP reiterated that the risk minimisation measures proposed by the MAH are not considered by the Committee to effectively reduce the risk of fibrotic reactions and ergotism.
Danish: Overordnet gentog CHMP, at det ikke anser markedsføringstilladelsesindehaverens foreslåede risikominimeringsforanstaltninger for at være i stand til effektivt at nedsætte risikoen for fibrotiske reaktioner og ergotisme.
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).
Danish: Mere konkret anførte CHMP, at bortset fra “ergotisme” er også andre foretrukne betegnelser forbundet med symptomer på ergotisme (således paræstesi, formikation, snurren, intestinal/cerebrovaskulær/perifer iskæmi eller iskæmi af tungen, angina pectoris, koronaropati, brystsmerter, kvalme, opkastning, diarré, abdominalsmerter, kuldefornemmelse, trombose, apopleksi, gangræn, nekrose, vasokonstriktion/vasospasme, cyanose, myalgi, muskelkramper, ekstremitetssmerter, vertigo, hypæstesi, følelsesløshed, hovedpine, konfusion og hallucinationer).
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.
Danish: Indehaverne af markedsføringstilladelserne fremlagde desuden deres egne oversigter og kritiske sammenfatninger af alle spontane indberetninger af fibrotiske reaktioner (kardiale med eller uden pulmonal arteriel hypertension, pulmonale, pleurale, peritoneale, retroperitoneale mm.) samt ergotisme med deres lægemidler indeholdende ergotderivater.