FrancophonIA/ELRC3.0 huggingface dataset:
English: The studies mainly assessed functional symptoms, capillaroscopic parameters and plethysmographic parameters whose clinical relevance was considered questionable by the CHMP.
Danish: Undersøgelserne vurderede hovedsageligt funktionelle symptomer, kapillæroskopiske parametre og pletysmografiske parametre, hvis kliniske relevans CHMP vurderede som tvivlsom.
English: • The Committee considered the procedure under Article 31 of Directive 2001/83/EC for ergot derivatives containing medicinal products in the concerned indications.
Danish: • Udvalget vurderede proceduren ifølge artikel 31 i direktiv 2001/83/EF for lægemidler, der indeholder ergotderivater i de omfattede indikationer
English: • The Committee considered that a potential causal association between fibrotic reactions or ergotism and dihydroergocryptine/caffeine cannot be excluded.
Danish: • Udvalget vurderede, at en mulig årsagssammenhæng mellem fibrøse reaktioner eller ergotisme og dihydroergocryptin/koffein ikke kan udelukkes.
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.
Danish: Selvom nogle af de foreslåede foranstaltninger kunne hjælpe med at identificere patienter med præ-eksisterende fibrose, relevant anden samtidig medicin og øget risiko, påpegede udvalget, at foranstaltningerne er utilstrækkelige til undgå, at nogle patienter udvikler fibrose og ergotisme under behandlingen.
English: • The Committee is of the opinion that the evidence for clinically significant efficacy of dihydroergocryptine/caffeine in the currently assessed indications is very limited, and therefore the potential benefit for patients in these indications is outweighed by the above identified risk.
Danish: • Udvalget er af den opfattelse, at beviserne for klinisk signifikant virkning af dihydroergocryptin/koffein i de aktuelt vurderede indikationer, er meget begrænsede, og derfor er den potentielle fordel for patienter i disse indikationer opvejet af de ovenfor identificerede risici
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: Desuden skal alvorligheden af sådanne bivirkninger, deres mulige dødelige udgang, og den øgede risiko for, at patienten udvikler en fibrøs lidelse ved langvarig brug i henhold til de godkendte indikationer understreges.
English: The clinical efficacy endpoints were numerous and heterogeneous with no defined primary efficacy endpoint.
Danish: De kliniske effektmål var talrige og heterogene uden nogen definerede primære effektmål.
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: Samlet set var CHMP af den opfattelse, at ingen situation kan retfærdiggøre at udsætte en patient for risikoen for fibrose og ergotisme, når man tager de meget begrænsede data vedrørende virkningen i betragtning.
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.
Danish: Den 18. januar 2012 udløste Frankrig en henvisning i henhold til artikel 31 i Direktiv 2001/83/EF for følgende lægemidler, der indeholder ergotderivater: dihydroergocryptin/koffein, dihydroergocristin, dihydroergotamin, dihydroergotoxin og nicergolin.
English: The studies included young and old patients (1878 years old) with idiopathic acrosyndrome.
Danish: Undersøgelserne omfattede unge og ældre patienter (18-78 år) med idiopatisk perifert karsyndrom.
English: Dihydroergocryptine only containing products are approved in other EU Member States but their indications were not in the scope of this referral procedure (e.g. Parkinson's disease) and were excluded from this review.
Danish: Produkter, der kun indeholder dihydroergocryptin, er godkendt i andre EU-medlemsstater, men deres indikationer var ikke omfattet af denne indbringelsesprocedure (f.eks. Parkinsons sygdom), og blev udelukket fra denne gennemgang.
English: In general the CHMP was of the opinion that the methodological flaws and the absence of primary efficacy endpoint do not allow to draw conclusions on clinical efficacy or to support an indication with standardised diagnosis.
Danish: Generelt var CHMP af den opfattelse, at de metodiske fejl og fraværet af primære effektmål hverken giver mulighed for at drage konklusioner vedrørende klinisk effekt eller understøtter en indikation med standardiseret diagnose.
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 understregede, at den ansøgte indikation ikke længere anvendes i den kliniske praksis, og at der på nuværende tidspunkt fra et klinisk synspunkt ikke findes nogen beviser på, at der er et terapeutisk behov for dette aktive stof i behandlingen af kognitiv og neurosensorisk funktionsnedsættelse hos ældre.
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: Efter en national gennemgang af lægemiddelovervågning afholdt i 2011, identificerede nye spontane indberetninger, der er relateret til nogle af disse produkter, alvorlige tilfælde af fibrose og ergotisme, og Frankrig mente, at dette sikkerhedsproblem ikke opvejes af den begrænsede dokumentation for virkningen.
English: It is available in combination with caffeine that may improve the digestive absorption of this ergot alkaloid.
Danish: Det fås i kombination med koffein, som kan forbedre fordøjelsesabsorption af dette ergotalkaloid.
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 markedsføringstilladelsen (MAH'er) indgav alle tilgængelige data om virkning fra kliniske undersøgelser og observationsstudier, herunder data, der blev tilgængelige siden udstedelsen af den oprindelige markedsføringstilladelse.
English: Overall summary of the scientific evaluation of dihydroergocryptine/caffeine containing medicinal products (see Annex I)
Danish: Generelt sammendrag af den videnskabelige vurdering af lægemidler, der indeholder dihydroergocryptin/koffein (se Bilag I).
English: The CHMP considered the MAHs proposals for risk minimisation measures.
Danish: CHMP tog hensyn til indehaverne af markedsføringstilladelsernes forslag til foranstaltninger til risikominimering.
English: In fact, dihydroergocryptine being part of the class of ergot derivatives containing medicinal products covered by this procedure is only approved in the above mentioned indications in France and only in combination with caffeine since 1979.
Danish: Dihydroergocryptin, som er en del af klassen af lægemidler, der indeholder ergotderivater, og som er omfattet af denne procedure, er kun godkendt i ovennævnte indikationer i Frankrig og kun i kombination med koffein siden 1979.
English: Regarding ergotism, there were several cases reported in the French Pharmacovigilance database where dihydroergocryptine/caffeine was the suspected drug for symptoms related to ergotism.
Danish: Der var vedrørende ergotisme flere indberettede tilfælde i den franske lægemiddelovervågningsdatabase, hvor dihydroergocryptin/koffein var et mistænkt lægemiddel vedrørende symptomer, der er relateret til ergotisme.
English: • The Committee considered the overall submitted data provided by the MAHs and the outcome of the scientific advisory group.
Danish: • Udvalget tog hensyn til de generelle data, der er indgivet af indehaverne af markedsføringstilladelsen samt resultatet fra den videnskabelige rådgivende gruppe
English: Considering the several reported cases of vasoconstriction and the pharmacological structure of this ergot alkaloid derivative product, ergotism cannot be ruled out.
Danish: I betragtning af adskillige indberettede tilfælde af vasokonstriktion og den farmakologiske konstruktion af dette ergotalkaloid-derivatprodukt kan ergotisme ikke udelukkes.
English: Based on these data and based on the pharmacological plausibility, dihydroergocryptine is considered to be associated with fibrotic reactions.
Danish: På baggrund af disse data og baseret på den farmakologiske sandsynlighed anses dihydroergocryptin for at være tilknyttet fibrøse reaktioner.
English: The data from the reported cases of fibrosis (n=3) are limited in order to draw any firm conclusions, however, the risk cannot be excluded considering the improvement observed when dihydroergocryptine/caffeine was discontinued in one of the three reported cases of pulmonary fibrosis occurring with recommended daily dose.
Danish: Dataene fra de indberettede tilfælde af fibrose (n= 3), er begrænsede med henblik på at kunne drage sikre konklusioner, men risikoen kan ikke udelukkes i betragtning af den observerede forbedring, der opstod, når dihydroergocryptin/koffein blev indstillet i et af de tre rapporterede tilfælde af lungefibrose med anbefalet daglig dosis.
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.
Danish: Samlet set kan den varierende affinitet for serotonerge receptorer med forskellige ergotderivater og de anvendte terapeutiske doser forklare de forskelle, der er observeret i forbindelse med indberetningsfrekvensen for fibrøse reaktioner.
English: • The suspension of the marketing authorisation for dihydroergocryptine /caffeine containing medicinal products referred to in Annex I in the event that no other indications are approved as part of their marketing authorisation.
Danish: • Suspenderingen af markedsføringstilladelsen for lægemidler, der indeholder dihydroergocryptin/koffein, som nævnt i Bilag I, i tilfælde af, at ingen andre indikationer er godkendt, som en del af deres markedsføring.
English: In 2 studies patients presented a clinical diagnosis of mild organic brain syndrome (stage 2-3 on the Global Deterioration Scale) (Scarzella study) and an early stage senile cerebral deterioration without dementia or major dependence with respect to the environment, based on DSM-III criteria (Babeau study).
Danish: I 2 undersøgelser viste patienter en klinisk diagnose af let organisk hjernesygdom (trin 2-3 på Global Deterioration Scale) (Scarzellaundersøgelsen) og et tidligt stadie af senil cerebral forringelse uden demens eller større afhængighed med hensyn til miljøet, baseret på DSM-III kriterierne (Babeau-undersøgelse).
English: • Orthostatic hypotension
Danish: • Otostatisk hypotension
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 og eventuel suspendering af markedsføringstilladelserne, under hensyntagen til de godkendte indikationer for hvert produkt
English: Under-reporting can also be suspected because the substance is marketed for a long time as well as because fibrosis is already mentioned as an adverse drug reaction in the product information.
Danish: Underrapportering kan også være årsagen, fordi stoffet har været markedsført i lang tid, og fordi fibrose allerede er nævnt som en bivirkning på indlægssedlen.
English: Ergot derivatives are recognised as being capable of inducing fibrosis, in particular heart valve fibrosis.
Danish: Det er anerkendt, at ergotderivater kan forårsage fibrose, navnlig hjerteklapfibrose.
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 markedsføringstilladelsen indgav også deres egne oversigter og kritiske sammendrag af alle spontane indberetninger af fibrotiske reaktioner (hjerterelateret med eller uden pulmonal arteriel hypertension, pulmonal, pleural, peritoneal, retroperitoneal, osv.) og ergotisme sammen med deres lægemidler indeholdende ergotderivater.
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 omfattede ændring af ordinationsoplysningerne, begrænsning af behandlingsvarighed under visse betingelser, kontraindicering af produktet hos patienter med allerede eksisterende fibrose eller i forbindelse med andre stoffer, udstedelse af en DHPC, der understreger risikoen, en tjekliste for ordinerende læger og en farmakologisk in vitro-undersøgelse for 5-HT underklasse-receptorers affinitet til produktet.
English: Data provided during a referral under Article 31 in 2007-2008 (EMEA/H/A-31/881) including dihydroergocryptine showed that several cases of fibrosis either pulmonary or cardiac or retroperitoneal were suspected to be associated to the treatment with dihydroergocryptine use for Parkinson's disease treatment (involving dosage five times higher).
Danish: Data, der er tilvejebragt i løbet af en indbringelsesprocedure i henhold til artikel 31 i 2007-2008 (EMEA/H/A-31/881), der omfatter dihydroergocryptin, viste, at flere tilfælde af fibrose enten pulmonal eller hjerte- eller retroperitoneal var mistænkt for at være forbundet med behandlingen ved brug af dihydroergocryptin til behandling af Parkinsons sygdom (hvilket omfattede dosering, der var fem gange højere).
English: 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 symptomatic treatment of chronic pathological cognitive and neurosensorial impairment in elderly (excluding Alzheimer's disease and other dementia).
Danish: En videnskabelig rådgivende gruppe (SAG) blev indkaldt i december 2012 efter anmodning fra CHMP, hvor eksperterne på baggrund af deres kliniske erfaring drøftede, om dette stof spiller en rolle i symptomatisk behandling af kronisk patologisk kognitiv og neurosensorisk funktionsnedsættelse hos ældre (eksl.
English: The CHMP has considered the totality of the available data on the safety and efficacy of dihydroergocryptine/caffeine.
Danish: CHMP har taget hensyn til alle tilgængelige data vedrørende dihydroergocryptin/koffeins sikkerhed og virkning.
English: In rats, dihydroergocryptine showed to activate antioxidant enzymatic systems physiologically alterated during aging.
Danish: Det er dokumenteret, at dihydroergocryptin hos rotter aktiverede enzymatiske antioxidanter, der ændrede sig fysiologisk ved ældning.
English: For the indication “ancillary treatment of Raynaud's syndrome”, all the studies submitted in support of this indication were considered by the CHMP of poor methodological quality (i.e. uncontrolled, open designed, with a low number of patients (n=20-37)).
Danish: Alle de undersøgelser, der forelægges til støtte for indikationen "accessorisk behandling af Raynauds syndrom", blev betragtet som af dårlig metodologisk kvalitet (dvs. ukontrolleret, åbent design, med et lavt antal patienter (n=20-37) ).
English: In order to lift the suspension, MAHs must identify a specific patient population for which the benefits of the product outweigh the risk.
Danish: For at opnå ophævelse af suspenderingen skal indehaverne af markedsføringstilladelserne fremlægge overbevisende data til udpegelse af en patientpopulation, hos hvem fordelene ved lægemidlet overstiger de fundne risici.
English: The absence of such reports claimed from the MAH, raised questions to the CHMP with regard to the way that the data collection was performed.
Danish: Indehaveren af markedsføringstilladelsen havde ikke havde indhentet sådanne indberetninger, hvilket gav anledning til betænkelighed hos CHMP med hensyn til den måde, hvorpå dataindsamlingen var udført.
English: The relationship between fibrosis and serotoninergic receptor activation, particularly 5-HT2B receptors by ergot derivatives is extensively described in the literature.
Danish: Forholdet mellem fibrose og ergotderivaters aktivering af serotonerge receptorer, især 5-HT2B-receptorer, er udførligt beskrevet i litteraturen.
English: • Ancillary treatment of visual acuity decrease and visual field disturbances presumably of vascular origin
Danish: • Accessorisk behandling af fald i synsstyrke og forstyrrelser i det visuelle felt formentlig af vaskulær oprindelse
English: Dihydroergocryptine is an ergot alkaloid that has an agonist activity on D2 dopaminergic receptors and a partial agonist activity on D1 receptors.
Danish: • Symptomatisk behandling af venøs lymfeinsufficiens Dihydroergocryptin er et ergotalkaloid, der har en agonist-aktivitet på D2 dopaminergiske receptorer og en partiel agonist-aktivitet på D1-receptorer.
English: Is not favourable for ancillary treatment of Raynaud's syndrome.
Danish: ikke er fordelagtigt til accessorisk behandling af Raynauds syndrom.
English: Grounds for the variation/suspension to the terms of the marketing authorisations
Danish: Begrundelse for ændring/suspendering af betingelserne for markedsføringstilladelserne Ud fra følgende betragtninger:
English: Agonism to 5-HT2B receptors induces a proliferative response and mitogenicity of the cells expressing this receptor leading to fibrogenesis.
Danish: Agonisme til 5-HT2B-receptorer forårsager en proliferativ respons og medfører celledeling og dannelse af fibrøst væv.
English: • The variation to the terms of the marketing authorisation for dihydroergocryptine/caffeine 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 country to country) as well as any relevant reference to these indications in the Product Information, when there are other therapeutic indications approved as part of their marketing authorisation:
Danish: • en ændring af betingelserne i markedsføringstilladelsen for lægemidler, der indeholder dihydroergocryptin/koffein, som omhandlet i Bilag I, for at slette nedenstående indikationer fra indlægssedlen (den specifikke ordlyd af indikationen kan variere fra produkt til produkt og fra land til land) samt enhver relevant reference til disse indikationer i indlægssedlen, når der findes andre terapeutiske indikationer, der er godkendt som en del af deres markedsføring: Symptomatisk behandling af kronisk patologisk kognitiv og neurosensorisk funktionsnedsættelse hos ældre (ekskl.
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.
Danish: Derfor, selvom det er meget sandsynligt farmakologisk set, at ergotderivater, der optræder som 5-HT2B-receptoragonister, kan fremkalde "serotonerg" hjerteklapsygdom svarende til den, der forårsages af carcinoidtumorer eller fibrøse læsioner i andet væv, skal det erindres, at nogle ergotderivater ikke er 5-HT2B-receptoragonister Derfor kan andre mekanismer, der forårsager fibrose ikke udelukkes, hvilket tyder på en årsagssammenhæng mellem fibrose og agonisme af 5-HT2A- og 5-HT1B-receptorer, og også sandsynlig virkning på serotonintransporteren.
English: The Committee concluded that the benefit-risk balance of dihydroergocryptine/caffeine containing products is not favourable pursuant to Article 116 of Directive 2001/83/EC for symptomatic treatment of chronic pathological cognitive and neurosensorial impairment in elderly (excluding Alzheimer's disease and other dementia) and for ancillary treatment of Raynaud's syndrome.
Danish: Udvalget konkluderede, at benefit/risk-forholdet for brug af dihydroergocryptin/koffein ikke er gunstigt i henhold til artikel 116 i direktiv 2001/83/EF til symptomatisk behandling af kronisk patologisk kognitiv og neurosensorisk funktionsnedsættelse hos ældre (eksl.
English: • The Committee considered that the benefit-risk balance of dihydroergocryptine/caffeine containing products: Is not favourable for symptomatic treatment of chronic pathological cognitive and neurosensorial impairment in elderly (excluding Alzheimer's disease and other dementia).
Danish: • Udvalget vurderede, at benefit/risk-forholdet for lægemidler, der indeholder dihydroergocryptin/koffein: ikke er fordelagtigt til symptomatisk behandling af kronisk patologisk kognitiv og neurosensorisk funktionsnedsættelse hos ældre (ekskl.
English: • Symptomatic treatment of chronic pathological cognitive and neurosensorial impairment in elderly
Danish: • Symptomatisk behandling af kronisk patologisk kognitiv og neurosensorisk funktionsnedsættelse hos ældre (ekskl.
English: • Ancillary treatment of intermittent claudication in symptomatic peripheral arterial occlusive disease
Danish: • Accessorisk behandling af claudicatio intermittens ved symptomatisk perifere okklusive kredsløbsforstyrrelser (PAOD Stage II)
English: From the approved indications of the dihydroergocryptine 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: Følgende indikationer (den specifikke ordlyd kan variere fra produkt til produkt) i henhold til de godkendte indikationer for lægemidler, der indeholder dihydroergocryptin og dem, der er omfattet af denne indbringelsesprocedure, og som er godkendt i mindst en medlemsstat:
English: Overall, for the indication “symptomatic treatment of chronic pathological cognitive and neurosensorial impairment in elderly (excluding Alzheimer's disease and other dementia)”, the MAHs provided 6 publications (dated from 1983 to 1998) with an adequate design (randomised, double-blind, placebo controlled) to support the claim for efficacy, plus one study in vascular cognitive impairment which wasnot further discussed.
Danish: Indehaverne af markedsføringstilladelsen opgav 6 publikationer (dateret 1983-1998) med et passende design (randomiseret, dobbelt-blindt, placebo-kontrolleret) til støtte for påstanden om effekten, samt et studie i vaskulær kognitiv forringelse som ikke blev drøftet yderligere i forbindelse med indikationen "symptomatisk behandling af kronisk patologisk kognitiv og neurosensorisk funktionsnedsættelse hos ældre (ekskl.
English: • Symptomatic treatment of veno-lymphatic insufficiency
Danish: • Accessorisk behandling af Raynauds syndrom
English: • Prophylaxis of migraine headache
Danish: • Migræneprofylakse
English: • Choose a different site each time you give yourself an injection.
Danish: • Vælg et nyt sted, hver gang De giver Dem selv en indsprøjtning.
English: ▼This medicinal product is subject to additional monitoring.
Danish: ▼Dette lægemiddel er underlagt supplerende overvågning.