FrancophonIA/ELRC3.0 huggingface dataset:
English: On 9 March 2016, the European Commission triggered a referral under Article 31 of Directive 2001/83/EC resulting from pharmacovigilance data and requested the PRAC to assess the impact of the above concerns on the benefit-risk balance of gadolinium containing medicinal products and to issue a recommendation on whether the relevant marketing authorisations should be maintained, varied, suspended or revoked.
Danish: Den 9. marts 2016 indledte Europa-Kommissionen en indbringelse i henhold til artikel 31 i direktiv 2001/83/EF som følge af lægemiddelovervågningsdata og anmodede PRAC om at vurdere virkningen af de ovennævnte betænkeligheder med hensyn til benefit/risk-forholdet ved lægemidler, som indeholder gadolinium, og til at fremkomme med en anbefaling om, hvorvidt de relevante markedsføringstilladelser skal opretholdes, ændres, suspenderes eller tilbagekaldes.
English: Besides, as the variation was concluded in parallel to the PRAC review, the variation conclusions were understood as being without prejudice of the outcome of the ongoing EU review.
Danish: Og da ændringen blev indgået parallelt med PRAC-gennemgangen, blev ændringskonklusionerne desuden anset for ikke at blive anfægtet af resultatet af den igangværende EU-gennemgang.
English: For gadobenic acid, the available studies do not establish differences in relaxivity, image quality and technical performance.
Danish: Med hensyn til gadobensyre klarlægger de tilgængelige undersøgelser ikke forskelle i relaxivitet, billedkvalitet og teknisk ydeevne.
English: Particularly zinc, copper and iron (Frenzel et al., 2008) are described as competing metals which can liberate Gd; glycosaminoglycans like heparin may bind Gd and thereby remove it from its pharmacological chelator.
Danish: Især zink, kobber og jern (Frenzel et al., 2008) beskrives som konkurrerende metaller, der kan frigøre Gd; glycosaminoglycaner som heparin kan binde Gd og derved fjerne det fra dets farmakologiske chelatdanner.
English: It has shown clinical utility in imaging of the liver.
Danish: Den har vist klinisk anvendelighed ved billeddannelse af leveren.
English: • Linear GdCAs are associated with a significant risk of NSF, although current risk minimisation measures appear to be effective based on spontaneous adverse drug reaction reporting.
Danish: • Lineære GdCA'er er forbundet med en betydelig risiko for NSF, selvom aktuelle risikominimeringsforanstaltninger synes at være effektive baseret på rapportering af spontane bivirkninger.
English: In non-clinical studies (Robert et al. 2016 Lohrke et al. 2015; Lohrke et al. 2016; Kartamihardja et al. 2016a; Kartamihardja et al. 2016b; Smith et al. 2017; Rasschaert et al. 2016; MAH unpublished studies) the levels were typically around 10-fold higher with linear agents.
Danish: I ikkekliniske undersøgelser (Robert et al. 2016 Lohrke et al. 2015; Lohrke et al. 2016; Kartamihardja et al. 2016a; Kartamihardja et al. 2016b; Smith et al. 2017; Rasschaert et al. 2016; ikkepublicerede undersøgelser foretaget af indehavere af markedsføringstilladelse) var niveauerne typisk ca. 10 gange højere med lineære midler.
English: Another group of experts supported the view that macrocyclic agents are more stable and are preferable as first line contrast agents.
Danish: En anden gruppe af eksperter støttede det synspunkt, at makrocykliske midler er mere stabile og er de mest foretrukne kontrastmidler.
English: No such enhancement was observed with gadoterate meglumine (Dotarem).
Danish: Der blev ikke observeret en sådan forbedring med gadoterate meglumine (Dotarem).
English: Toxicity of GdCAs has primarily been attributed to the dissociation of Gd from the chelated complexes.
Danish: GdCA'ers toksicitet tilskrives primært til dissociationen af Gd fra de chelaterede komplekser.
English: Detailed explanation of the scientific grounds for the differences from the PRAC recommendation
Danish: Detaljeret forklaring til de videnskabelige begrundelser for afvigelserne fra PRAC's anbefaling
English: The CHMP, having considered the PRAC recommendation, is of the view that the following clarifications to the PRAC grounds and recommendation are necessary:
Danish: CHMP er, efter at have overvejet PRAC's anbefaling, af den opfattelse, at der er behov for følgende præciseringer PRAC's begrundelser og anbefaling:
English: The approved indications for GdCAs are general and relate to the whole body scanning/imaging, which includes all organs, with the exception of GdCAs with targeted indications related to the specific physicochemical properties that allow the enhancement of specific features.
Danish: De godkendte indikationer for GdCA'er er generelle og relaterer til hele kropsscanningen/billeddannelsen, som omfatter alle organer, med undtagelse af GdCA'er med målrettede indikationer relateret til de specifikke fysisk-kemiske egenskaber, der muliggør forbedringen af specifikke træk.
English: The regions of the brain with the greatest potential for brain accumulation are the dentate nucleus and globus pallidus.
Danish: De regioner i hjernen, er har størst potentiale for hjerneakkumulering, er den tandede kerne og globus pallidus.
English: Feasibility of clinical studies
Danish: Gennemførlighed af kliniske undersøgelser
English: Enhancement of the DN and globus pallidus (GP) in unenhanced scans after previous use of linear GdCAs has been observed across multiple studies in humans.
Danish: Forbedring af DN og globus pallidus (GP) i ikkeforbedrede scanninger efter tidligere brug af lineære GdCA'er er blevet observeret i flere undersøgelser i mennesker.
English: For the linear agents evaluated in non-clinical studies the T1 signal intensity in the DCN has been shown to persist for at least 1 year without any reduction in intensity.
Danish: For de lineære midler, der blev evalueret i ikkekliniske undersøgelser har T1-signalintensiteten i DCN vist sig at persistere i mindst 1 år uden nogen reduktion intensiteten.
English: In addition, macrocyclic agents are associated with a low risk of NSF.
Danish: Derudover er makrocykliske midler forbundet med en lav risiko for NSF.
English: However, they described the TEM finding of electrondense lumps in the tissues of ProHance-treated animals which at first were assumed to be Gd deposits, obviously because they looked like them.
Danish: Imidlertid beskrev de TEM-fundet af elektrontætte klumper i vævene hos ProHance-behandlede dyr, hvilket i starten blev antaget at være Gdaflejringer, tydeligvis fordi de lignede sådanne.
English: • the significance of the study by Welk et al. (2016) is limited and the conclusion that these results do not indicate an association between exposure to GdCAs and the development of parkinsonism is premature.
Danish: • betydningen af undersøgelsen udført af Welk et al. (2016) er begrænset, og det er for tidligt at konkludere, at disse resultater ikke indikerer nogen forbindelse mellem eksponeringen for GdCA'er og udviklingen af parkinsonisme.
English: However, they did not favour the suspension of linear agents which could be preferred by some radiologists for their technical characteristics in some conditions (e.g., breast or brain imaging), especially in conditions that do not require frequent imaging procedures, or which could be used as “second line” agents.
Danish: Men de støttede ikke suspenderingen af lineære agenter, som kunne være foretrukket af nogle radiologer pga. deres tekniske karakteristika under visse forhold (f.eks. billeddannelse af bryst eller hjerne), især under forhold der ikke kræver hyppige billeddannelsesprocedurer, eller som kunne anvendes som "næstmest foretrukne" midler.
English: Prolonged elimination time in patients with renal impairment and release of gadolinium from GdCAs are the main factors that contribute to the development of NSF.
Danish: Langvarig elimineringstid hos patienter med nedsat nyrefunktion og frigivelse af gadolinium fra GdCA'er er de vigtigste faktorer, som bidrager til udviklingen af NSF.
English: • To update the SmPC to make the physician aware of the accumulation in the brain and to reduce exposure and communicate about such update;
Danish: • Opdatering af produktresuméet for at gøre lægen opmærksom på akkumuleringen i hjernen og reducere eksponeringen samt kommunikere om en sådan opdatering;
English: • High Gd levels with high inter-individual variability were detected in saline-treated controls.
Danish: • Høje Gd-niveauer med høj inter-individuel variabilitet blev påvist i saltopløsningsbehandlede kontroller.
English: Following the adoption of the PRAC recommendation during the March 2017 PRAC meeting, two MAHs (Bracco and GE Healthcare) expressed their disagreement with the initial PRAC recommendation.
Danish: Efter vedtagelse af PRAC's anbefaling på PRAC's møde i marts 2017 udtrykte to indehavere af markedsføringstilladelse (Bracco og GE Healthcare) sig uenige i den første anbefaling fra FRAC.
English: Also PRAC was not able to define a safe threshold level for exposure to gadolinium and retention of gadolinium in the brain, or to define a period of time during which a potential adverse effect would have time to manifest.
Danish: Heller ikke PRAC kunne definere et sikkert tærskelniveau for eksponering for gadolinium og retention af gadolinium i hjernen eller definere en tidsperiode, hvor en potentiel skadelig virkning ville have tid til at manifestere sig.
English: The evidence strongly suggests a correlation between the potential for release of gadolinium from the ligand and the extent of retention in these tissues and organs.
Danish: Evidensen indikerer kraftigt en sammenhæng mellem potentialet for frigivelse af gadolinium fra liganden og omfanget af retention i disse væv og organer.
English: Hypersensitivity or anaphylactoid reactions with GdCAs can manifest as a range of clinical signs and symptoms.
Danish: Hypersensitivitet eller anafylaktoide reaktioner over for GdCA'er kan manifestere sig som en række kliniske tegn og symptomer.
English: In order to address the serious concerns of the potential neurological effects, PRAC considered the feasibility of clinical safety studies, both observational and interventional, and concluded that these would not be feasible within a reasonable period of time.
Danish: For at imødegå de alvorlige bekymringer for de potentielle neurologiske virkninger vurderede PRAC muligheden for kliniske sikkerhedsundersøgelser, både observatoriske og interventionelle, og konkluderede, at disse ikke ville være mulige inden for en rimelig tidsperiode.
English: The study also found that changes in signal intensity were strongly correlated with the amount of gadolinium detected by ICP-MS.
Danish: Undersøgelsen fandt også, at ændringer i signalintensitet var stærkt korreleret med den mængde gadolinium, der blev detekteret via ICP-MS.
English: In January 2016, in the framework of a PSUSA procedure, the PRAC reviewed all available literature and data related to the accumulation of gadolinium in the brain and recommended the removal of statements from the product information of all GdCAs that the products do not pass the intact blood brain barrier.
Danish: Som led i en PSUSA-procedure gennemgik PRAC i januar 2016 al tilgængelig litteratur og alle data i forbindelse med akkumulering af gadolinium i hjernen og anbefalede fjernelse af udsagn fra produktinformationen for alle GdCA'er om, at lægemidlerne ikke passerer den intakte blodhjernebarriere.
English: Spontaneous release of Gd from its chelator, competition of Gd with other metals (e.g. in metal rich areas of the brain), and competition of the chelator with other chelators (e.g. macromolecules) can occur in the body.
Danish: Spontan frigivelse af Gd fra dets chelatdanner, Gd's konkurrence med andre metaller (f.eks. i metalrige områder af hjernen) og chelatdannerens konkurrence med andre chelatdannere (f.eks. makromolekyler) kan forekomme i kroppen.
English: However, these studies have significant limitations (e.g. studies could not exclude exposure to linear GdCA prior to study period) and do therefore not establish a causal relationship with macrocyclic agents.
Danish: Disse undersøgelser har dog væsentlige begrænsninger (f.eks. at undersøgelserne ikke kunne udelukke eksponering for lineært GdCA inden undersøgelsesperioden) og kan derfor ikke bevise en kausal sammenhæng med makrocykliske agenter.
English: The precise molecular forms of the soluble macromolecular bound Gd are not known but it is plausible that the macromolecules are bound to a dechelated Gd3+ ion.
Danish: De præcise molekylære former af opløseligt makromolekylær-bundet Gd er ikke kendt, men det er sandsynligt, at makromolekylerne er bundet til et dechelateret Gd3+-ion.
English: Since the finalisation of the referral, several studies in animals and in humans have been published showing accumulation of gadolinium following administration of GdCAs in tissues such as liver, kidney, muscle, skin and bone.
Danish: Siden indbringelsens afslutning er der blevet offentliggjort flere undersøgelser hos dyr og mennesker, som viser akkumulering af gadolinium efter administration af GdCA'er i væv såsom lever, nyre, muskel, hud og knogle.
English: Many preparations especially of linear Gd-based contrast agents contain free chelator in surplus in order to rapidly catch liberated Gd.
Danish: Mange præparater, især med lineære Gd-baserede kontrastmidler, indeholder rigeligt med fri chelatdanner for hurtigt at kunne opfange frigjort Gd.
English: Lanthanide ions such as gadolinium can bind to Ca2+ binding enzymes and interfere with calcium channels, due to competition with Ca2+ in cellular and biochemical processes, which can lead to adverse biological effects (Sherry et al. 2009).
Danish: Lanthanidioner såsom gadolinium kan binde til Ca2+ bindende enzymer og interferere med calciumkanaler på grund af konkurrence med Ca2+ i cellulære og biokemiske processer, hvilket kan føre til negative biologiske effekter (Sherry et al. 2009).
English: However, after the use of linear agents gadolinium is retained longer at measurable levels and persists for up to one year or more.
Danish: Men efter anvendelsen af lineære midler bevares gadolinium længere ved målelige niveauer og persisterer i op til et år eller mere.
English: • The rather high and particularly highly variable Gd tissue level in saline control animals.
Danish: • Det ret høje og særdeles varierende Gd-vævsniveau i saltvands-kontroldyr.
English: • CHMP considered options for risk minimisation measures.
Danish: • CHMP overvejede muligheder for risikominimeringsforanstaltninger.
English: The T1 signal enhancement was documented in several non-clinical as well as clinical studies, demonstrating that the data is consistent across mouse, rat and human, which confirms the robustness of the findings of signal intensity increases.
Danish: T1-signal-forbedringen er blevet dokumenteret i adskillige ikkekliniske og kliniske undersøgelser, som har påvist, at dataene er konsekvente i både mus, rotter og mennesker, hvilket bekræfter robustheden af de fundne stigninger i signal-intensiteten.
English: In view of available observational data which did not confirm a risk related to Gd accumulation in the brain so far, the PRAC considered that:
Danish: I lyset af tilgængelige observationsdata, som hidtil ikke bekræftede nogen risiko i forbindelse med Gdakkumulering i hjernen, fandt PRAC, at:
English: In summary, the PRAC considered that there are no new arguments which could convincingly challenge its previous views regarding the dechelation of Gd and hence the low stability of linear GdCA complexes playing a major role for its tissue disposition.
Danish: Sammenfattende vurderede PRAC, at der ikke er nye argumenter, som på overbevisende måde kunne udfordre de tidligere synspunkter vedrørende dechelatering af Gd og dermed den lave stabilitet af lineære GdCA-komplekser, der spiller en vigtig rolle for vævsaflejringen.
English: Linear GdCAs are associated with a significant risk of NSF.
Danish: Lineære GdCA'er er forbundet med en betydelig risiko for NSF.
English: • Clinical studies, both observational and interventional, to fully address the serious concerns of potential neurological effects are not considered feasible within a reasonable period of time.
Danish: • Kliniske undersøgelser, både observationelle og interventionelle, med henblik på fuldstændig adressering af de alvorlige bekymringer om potentielle neurologiske virkninger, anses ikke for mulige inden for en rimelig tid.
English: Overall summary of the scientific evaluation by the PRAC Background
Danish: Samlet resumé af PRAC's videnskabelige vurdering Baggrund
English: Notwithstanding this, and given the detailed grounds provided by the MAHs, the PRAC carried out a new assessment of the available data in the context of the reexamination.
Danish: På trods af dette og i betragtning af de detaljerede begrundelser, som indehaverne af markedsføringstilladelse fremlagde, foretog PRAC en ny vurdering af de foreliggende data i forbindelse med revurderingen.
English: Gadolinium bound to macromolecules is expected to have a higher relaxivity and would be capable of generating a T1-weighted signal at low concentration.
Danish: Gadolinium bundet til makromolekyler forventes at have en højere relaksivitet og ville være i stand til at generere et T1-vægtet signal ved lav koncentration.
English: The benefit of GdCAs has been demonstrated based on their ability to improve the quality of imaging for MRIs compared to unenhanced MRI scans by supporting the diagnostic performance of such scans in the detection of disease, prognosis and patient management in order to achieve a particular clinical outcome.
Danish: Fordelen ved GdCA'er er blevet påvist baseret på deres evne til at forbedre billeddannelseskvaliteten for MRI'er sammenlignet med ikkeforbedrede MRI-scanninger ved at understøtte den diagnostiske ydeevne af sådanne scanninger med hensyn til påvisning af sygdom, prognose og patientadministration for at opnå et bestemt klinisk resultat.
English: Therefore, it can be concluded that renal impairment is not a requirement for Gd deposition, but it may however increase the amount of Gd deposited in the brain.
Danish: Derfor kan det konkluderes, at nedsat nyrefunktion ikke er et krav for Gd-aflejring, men det kan imidlertid øge mængden af Gd aflejret i hjernen.
English: In addition, PRAC considered that it is not possible to restrict the use of intravenous linear GdCAs to certain indications or certain groups of patients as:
Danish: Desuden anså PRAC, at det ikke er muligt at begrænse anvendelsen af intravenøse lineære GdCA'er til visse indikationer eller visse patientgrupper, idet:
English: There is also a concern that gadolinium deposits in some tissues, particularly bone, could be released at a later stage for example during loss of bone density in aging or pregnancy/breastfeeding, exposing patients to further systemic distribution of gadolinium.
Danish: Der er også en bekymring for, at gadolinium-aflejringer i nogle typer væv, især knogle, kan blive frigivet på et senere tidspunkt, for eksempel under tab af knogletæthed i forbindelse med aldring eller graviditet/amning, hvilket udsætter patienter for yderligere systemisk fordeling af gadolinium.
English: Enhancement after gadobenate dimeglumine (Multihance) or gadopentetate dimeglumine (Magnevist) appeared more progressively compared with gadodiamide.
Danish: Forbedring efter gadobenatdimeglumin (MultiHance) eller dimeglumingadopentetat (Magnevist) forekom at være mere progressiv sammenlignet med gadodiamid.
English: The design of any future clinical study to investigate the long-term safety of GdCAs in patients would require large numbers of patients to have sufficient power to detect small adverse effects on cognition (cognitive disorders) or physical abilities (fine motor skills).
Danish: Udformningen af en evt. fremtidig klinisk undersøgelse af langtidssikkerheden for GdCA'er hos patienter ville kræve et stort antal patienter med tilstrækkelig styrke til at påvise små bivirkninger på kognition (kognitive lidelser) eller fysiske evner (finmotoriske færdigheder).
English: In view of a potential difference in the frequency of hypersensitivity reactions, PRAC pointed out that these are known infrequent reactions for all GdCAs.
Danish: Med henblik på en potentiel forskel i frekvensen af hypersensitivitetsreaktioner påpegede PRAC, at disse er kendte, sjældne reaktioner for alle GdCA'er.
English: The clinical finding (e.g. Radbruch et al.) that macrocyclic agents do not cause brain T1 hyperintensity was replicated by other groups and can therefore be considered to be substantiated.
Danish: Det kliniske fund (f.eks. Radbruch et al.), at makrocykliske midler ikke forårsager hjerne-T1-hyperintensitet, blev replikeret af andre grupper og kan derfor anses for at være underbygget.
English: PRAC considered potential clinical studies to be conducted in order to fully address the serious concerns of plausible neurological effects.
Danish: PRAC vurderede, at der skulle gennemføres potentielle kliniske undersøgelser for at adressere de alvorlige bekymringer for plausible neurologiske virkninger.
English: There is no strong evidence of a true difference in the rate of hypersensitivity reactions or other acute reactions associated with GdCAs or of a difference in the rate of ADRs with a fatal outcome across the class.
Danish: Der findes ikke stærk evidens for en reel forskel i hyppigheden af hypersensitivitetsreaktioner eller andre akutte reaktioner forbundet med GdCA'er eller for en forskel i ADR-hyppigheden med dødeligt udfald i klassen.
English: Based on the data available, no specific patient group that would not experience Gd retention in the brain could be identified, as both children and adults are expected to show accumulation of Gd in the brain.
Danish: Ud fra de foreliggende data kunne der ikke identificeres nogen specifik patientgruppe, der ikke ville opleve Gd-retention i hjernen, da både børn og voksne forventes at vise akkumulering af Gd i hjernen.
English: Therefore, data shows that linear agents are deposited in the brain and are retained and persist for up to one year or longer.
Danish: Dataene viser således, at lineær agenter aflejres i hjernen og opbevares dér og persisterer i op til et år eller længere.
English: Gd presence in the brain following the last administration of other linear agents, gadopentetic acid and gadobenic acid also remained at the same level after the same period.
Danish: Tilstedeværelse af Gd i hjernen efter sidste indgivelse af andre lineære midler, gadopentetinsyre og gadoterinsyre forblev ligeledes på samme niveau efter samme periode.
English: • Gadolinium accumulation has also been reported in a range of other tissues including the liver, kidney, muscle, skin and bone in non-clinical and clinical studies.
Danish: • Gadolinium-akkumulering er også blevet rapporteret i en række andre væv herunder lever, nyre, muskel, hud og knogle i ikkekliniske og kliniske undersøgelser.
English: Therefore, a conclusion that there are significant and clinically relevant differences in diagnostic performance between two GdCAs needs to be supported by robust evidence from clinical studies including evidence on a better clinical outcome and patient management, which is currently lacking; the impact on diagnostic thinking and patient management was not proven.
Danish: Derfor skal en konklusion gående ud på, at der er betydelige og klinisk relevante forskelle med hensyn til diagnostisk ydeevne mellem to GdCA'er, understøttes af solid dokumentation fra kliniske undersøgelser herunder bevis på bedre klinisk resultat og patientadministration, hvilket mangler p.t.; indflydelsen på diagnostiske tænkning og patientadministration er ikke blevet bevist.
English: These conclusions are in line with the opinion of the experts expressed at the ad hoc expert meeting, i.e. that linear and macrocyclic agents can be used interchangeably for cardiac imaging and that there is no established or perceived difference in their clinical utility.
Danish: Disse konklusioner er i tråd med den udtalelse, der blev udtrykt af eksperterne på ad hocekspertmødet, nemlig at lineære og makrocykliske midler kan anvendes i flæng til billeddannelse af hjertet, og at der ikke er nogen etableret eller opfattet forskel i deres kliniske anvendelighed.