FrancophonIA/ELRC3.0 huggingface dataset:
English: Although the mechanisms by which increased renal injury and mortality occur is not well established, it is possible that the degree of inflammatory processes seen in sepsis and critically ill patients is greater and associated with significant capillary leakage compared with other patient populations such as the perioperative setting after elective surgery or un-complicated trauma where the systematic inflammatory process and the extent of capillary leak may be lower.
Danish: Skønt de mekanismer, der medfører øget nyreskade og dødelighed, ikke er velbeskrevet, er det muligt, at det iagttagne omfang af inflammatoriske processer hos sepsispatienter og kritisk syge patienter er større og er forbundet med betydelig kapillærutæthed sammenlignet med andre patientpopulationer såsom patienter i det perioperative forløb ved elektive operationer eller patienter med ukomplicerede traumer, hvor den systemiske inflammatoriske proces og omfanget af kapillærutætheden kan være mindre.
English: Whilst recognising the limitations of these studies which included limited size and short duration of follow-up, the PRAC noted that some volume sparing effect was reported in Madi-Jebara et al. 2008, that suggested that HES 130/0.4 6% seems to have benefits over twice the volume of Ringer's lactate in preventing spinal anaesthesia induced hypotension.
Danish: PRAC noterede sig begrænsningerne i disse undersøgelser, herunder deres begrænsede størrelse og kortvarige opfølgningsperiode, men bemærkede, at der var beskrevet nogen volumenbesparende virkning i MadiJebara et al. 2008, der tydede på, at HES 130/0,4 6 % synes at have fordele frem for det dobbelte volumen Ringers laktat til forebyggelse af hypotension fremkaldt af spinalanæstesi.
English: In addition, special warnings in surgery and trauma patients have been included.
Danish: Der er desuden tilføjet særlige advarsler vedrørende operationspatienter og traumepatienter,
English: It is on the basis of the totality of the data available, including the new evidence, that the PRAC issued conclusion on the procedure provided for in Article 107i of Directive 2001/83/EC in October 2013.
Danish: Det er på grundlag af alle foreliggende data, herunder den nye evidens, at PRAC fremsatte sin konklusion om proceduren i oktober 2013, der er fastlagt ved artikel 107i af direktiv 2001/83/EF.
English: The PRAC therefore acknowledged the results of this studies which shows no risk of mortality associated with the use of HES but considered that given the limitations of this study its findings could not negate the findings from 6S and VISEP studies that had shown an increased risk of mortality in critically ill patients.
Danish: PRAC anerkendte derfor resultaterne af disse undersøgelser, der ikke viser dødelighedsrisiko forbundet med anvendelse af hydroxyethylstivelse, men fandt, at denne undersøgelse i betragtning af sine begrænsninger ikke kunne tilsidesætte resultaterne af 6S- og VISEP-undersøgelserne, der havde vist øget dødelighedsrisiko hos kritisk syge patienter.
English: Despite the studies' limitations which were noted, the results from the CRYSTAL study comparing colloids to crystalloids showed that in patients with hypovolaemia, the use of colloids vs crystalloids did not result in a significant difference in 28-day mortality.
Danish: Trods de konstaterede begrænsninger af undersøgelserne viste sammenligningen af kolloider med krystalloider i CRYSTAL-undersøgelsen, at kolloider til hypovolæmiske patienter ikke medførte signifikant forskellig 28-dages dødelighed fra krystalloider.
English: However, it was noted that short-term haemodynamic improvements have been observed in other patient populations, including surgical and trauma patients.
Danish: Det blev dog konstateret, at der er iagttaget kortvarige hæmodynamiske forbedringer hos andre patientpopulationer, herunder operationspatienter og traumepatienter.
English: HES products are contraindicated in patients with renal impairment or renal replacement therapy but the contraindications should also be extended to include other patient populations including patients with sepsis, critically ill patients and burns patients.
Danish: Produkter indeholdende HES er kontraindiceret hos patienter med nedsat nyrefunktion eller renal substitutionsterapi, men kontraindikationerne bør udvides til andre patientpopulationer, herunder sepsispatienter, kritisk syge patienter og brandsårspatienter.
English: In addition, two phase IV randomised clinical trials with an appropriate control and clinically meaningful endpoints will need to be conducted to provide more evidence on the efficacy and safety, including the risk of 90-day mortality and renal failure, in perioperative and trauma populations.
Danish: Desuden skal der udføres to randomiserede kliniske fase IV-undersøgelser med passende kontrol og klinisk meningsfulde endepunkter for at tilvejebringe mere evidens om virkningen og sikkerheden, herunder 90-dages mortalitet og nyresvigt, samt hos populationerne perioperative patienter og traumepatienter.
English: Therefore the conclusions on the Article 107i reflect the most complete and up-to-date evaluation of the available data relating to HES containing medicinal products.
Danish: Konklusionerne vedrørende artikel 107i afspejler således den mest fuldstændige og ajourførte vurdering af de foreliggende data vedrørende lægemidler indeholdende HES.
English: Consequently, a second review of HES solutions under Article 107i of Directive 2001/83/EC was initiated, and it ran separately but in parallel with the re-examination of the Article 31, also finalising in October 2013.
Danish: Der blev derfor indledt endnu en gennemgang af opløsninger af HES i henhold til artikel 107i i direktiv 2001/83/EC; denne gennemgang foregik særskilt, men sideløbende med den fornyede overvejelse i henhold til artikel 31, der ligeledes skulle være afsluttet i oktober 2013.
English: On the basis of the available data, in particular results from VISEP, 6S and CHEST studies, the PRAC concluded that HES is associated with an increased risk of mortality and renal failure in patients with sepsis, in critically ill and burn patients and that the benefits of HES do not outweigh the risks in these patient populations.
Danish: Af de foreliggende data, navnlig resultaterne af VISEP-, 6S- og CHEST-undersøgelserne, konkluderede PRAC, at HES er forbundet med øget risiko for dødelighed og nyresvigt hos sepsispatienter, kritisk syge patienter og brandsårspatienter, og at fordelene ved HES ikke overstiger risiciene hos disse patientpopulationer.
English: The CMDh having considered the PRAC recommendation dated 10 October 2013 pursuant to Article 107k(1) and (2) of Directive 2001/83/EC and the oral explanations by the Marketing Authorisation Holders on 21 October 2013, reached a position on the variation to the terms of the marketing authorisations of Hydroxyethyl starch solutions for infusion containing medicinal products for which the relevant sections of the summary of product characteristics and package leaflet are set out in Annex III and subject to the conditions set out in Annex IV.
Danish: CMDh gennemgik PRAC's anbefaling af 10. oktober 2013 i henhold til artikel 107k, stk. 1 og 2, i direktiv 2000/83/EF og de mundtlige fremlæggelser fra indehaverne af markedsføringstilladelse den 21. oktober 2013 og indtog på dette grundlag sit standpunkt om ændring af betingelserne for markedsføringstilladelserne for lægemidler indeholdende opløsninger af hydroxyethylstivelse til infusion, for hvilke de relevante afsnit af produktresuméet og indlægssedlen er gengivet i bilag III, og betingelserne fremgår af bilag IV.
English: The MAHs should submit within 6 months of the European Commission Decision, the core elements (including protocol of DUS, protocols of the RCTs) of a risk management plan in EU format and this was included in Annex IV.
Danish: Senest seks måneder efter Europa-Kommissionens beslutning skulle indehaverne af markedsføringstilladelse forelægge hovedelementerne i en risikostyringsplan i EU-format (protokol for undersøgelse af lægemiddelanvendelse, protokoller for randomiserede kliniske undersøgelser), og dette blev indført i bilag IV.
English: Therefore, the PRAC agreed that the therapeutic indication of hydroxyethyl starch containing products should be restricted to treatment of hypovolaemia due to acute blood loss when crystalloids alone are not considered sufficient.
Danish: PRAC fandt derfor, at den terapeutiske indikation for produkter indeholdende hydroxyethylstivelse bør begrænses til behandling af hypovolæmi ved akut blodtab, hvor krystalloider alene ikke skønnes at have sufficient virkning.
English: HES solutions should be restricted to the initial phase of volume resuscitation with a maximum time interval of 24 h. The posology section should identify the maximum daily dose and should recommend that the lowest possible effective dose should be employed.
Danish: Afsnittet om dosering bør fastlægge den maksimale dagsdosis og anbefale, at der anvendes den lavest mulige effektive dosis.
English: The PRAC also considered that studies should be conducted to provide more evidence on the efficacy and safety of hydroxyethyl starch in the perioperative setting and trauma.
Danish: PRAC fandt desuden, at der burde udføres undersøgelser til tilvejebringelse af mere evidens om virkningen og sikkerheden af hydroxyethylstivelse hos perioperative patienter og traumepatienter,
English: • The Pharmacovigilance Risk Assessment Committee (PRAC) considered the procedure under Article 107i of Directive 2001/83/EC, for hydroxyethyl starch containing products for solutions for infusion.
Danish: • Udvalget for Risikovurdering inden for Lægemiddelvurdering (PRAC) fulgte proceduren i overensstemmelse med artikel 107i, i direktiv 2001/83/EF for lægemidler indeholdende hydroxyethylstivelse til infusion,
English: This new evidence was not available when the PRAC recommendation on the procedure under Article 31 of Directive 2001/83/EC was issued in June 2013 and could therefore not be considered in the re-examination of the latter in October 2013.
Danish: Denne nye evidens forelå endnu ikke ved fremsættelsen af PRAC's anbefaling om proceduren i henhold til artikel 31 i direktiv 2001/83/EF i juni 2013 og kunne derfor ikke blive omfattet af den fornyede overvejelse heraf i oktober 2013.
English: • The PRAC considered that the use of hydroxyethyl starch is associated with an increased risk of mortality and renal replacement therapy or renal impairment in patients with sepsis, critically ill and burn patients.
Danish: • PRAC fandt, at anvendelse af hydroxyethylstivelse er forbundet med øget risiko for dødelighed og nyresubstitutionsterapi eller nedsat nyrefunktion hos sepsispatienter, kritisk syge patienter og brandsårspatienter,
English: The CMDh also considered that the direct healthcare professional communication (DHPC) should be submitted to the NCAs where HES products are marketed, within one week of the CMDh adopted position as per agreed communication plan.
Danish: CMDh fandt desuden, at den direkte henvendelse til sundhedspersoner i henhold til den aftalte kommunikationsplan senest en uge efter vedtagelsen af CMDh's stillingtagen skulle forelægges de nationale kompetente myndigheder, hvor HES-produkterne markedsføres.
English: • The PRAC concluded that hydroxyethyl starch containing products should be contraindicated in patients with sepsis, in critically ill and burn patients.
Danish: • PRAC konkluderede, at produkter indeholdende hydroxyethylstivelse bør være kontraindiceret hos sepsispatienter, kritisk syge patienter og brandsårspatienter.
English: However, it must be noted that new evidence was considered in the procedure under Article 107i of Directive 2001/83/EC.
Danish: Det må dog bemærkes, at der i proceduren i henhold til artikel 107i i direktiv 2001/83/EF blev vurderet ny evidens.
English: In view of the totality of the evidence available in the procedure under Article 107i of Directive 2001/83/EC, the PRAC considered that Hydroxyethyl starch should be restricted to the treatment of hypovolaemia due to acute blood loss when crystalloids alone are not considered sufficient subject to agreed restrictions, contraindications, warnings, other changes to the product information and additional risk minimisation measures.
Danish: På baggrund af den samlede foreliggende evidens i proceduren i henhold til artikel 107i i direktiv 2001/83/Ef fandt PRAC, at anvendelsen af hydroxyethylstivelse bør begrænses til behandling af hypovolæmi ved akut blodtab, hvor krystalloider alene ikke skønnes at give sufficient virkning, og at der indføres de vedtagne begrænsninger, kontraindikationer, advarsler, andre ændringer af produktinformationen og supplerende risikominimeringsforanstaltninger.
English: Therefore the conclusions on the Article 107i of Directive 2001/83/EC reflect the most complete and up-to-date evaluation of the available data relating to the HES containing medicinal products.
Danish: Konklusionerne vedrørende artikel 107i i direktiv 2001/83/EF afspejler således den mest fuldstændige og ajourførte vurdering af de foreliggende data om lægemidler indeholdende HES.
English: Therefore, the PRAC noted the available data from studies in surgical and trauma patients and considered that although these studies were limited in size and duration of follow-up they did provide some reassurance that the risks of mortality and renal injury in surgical and trauma patients may be lower than those in the critically ill and sepsis patients.
Danish: PRAC tog derfor de foreliggende data fra undersøgelser hos operationspatienter og traumepatienter til efterretning og fandt, at uanset disse undersøgelsers begrænsede størrelse og opfølgningsvarighed gav de faktisk anledning til nogen formodning om, at risikoen for dødelighed og nyreskader hos operationspatienter og traumepatienter er lavere end hos kritisk syge patienter og sepsispatienter.
English: The PRAC concluded that the benefit-risk balance for hydroxyethyl starch containing medicinal products remains favourable in treatment of hypovolaemia due to acute blood loss when crystalloids alone are not considered sufficient subject to the agreed restrictions, contraindications, warnings, other changes to the product information and additional risk minimisation measures.
Danish: konkluderede PRAC, at benefit/risk-forholdet for lægemidler indeholdende hydroxyethylstivelse til behandling af hypovolæmi ved akut blodtab fortsat er gunstigt, hvor krystalloider alene ikke anses for at have sufficient virkning, under forudsætning af de vedtagne restriktioner, kontraindikationer, advarsler, andre ændringer i produktinformationen og supplerende risikominimeringsforanstaltninger.
English: The CMDh considered the below PRAC recommendations following the procedure under Article 107i of Directive 2001/83/EC dated 10 October 2013 with regards to Hydroxyethyl starch containing medicinal products solutions for infusion:
Danish: CMDh tog i betragtning nedenstående anbefalinger fra PRAC efter proceduren af 10. oktober 2013 i henhold til artikel 107i i direktiv 2001/83/EF for lægemidler indeholdende opløsninger af hydroxyethylstivelse til infusion.
English: Results from the RaFTinG registry in intensive care units, an observational, non-randomised study aiming to gather more information in ‘real-life' clinical practice showed no statistically significant differences between patients treated with crystalloids only (n=2482) and those treated with colloids (all HES preparations and gelatin, n=2063) for the endpoints of 90-day mortality.
Danish: Undersøgelsen viste ikke statistisk signifikant forskel mellem de patienter, der blev behandlet med krystalloider alene (n=2 482) og dem, der blev behandlet med kolloider (alle HES- og gelatinepræparater, n=2 063), hvad angår endepunkterne for 90-dages dødelighed.
English: The PRAC conclusion in the context of the referral procedure under Article 107i of Directive 2001/83/EC included additional data that was not available when the PRAC issued its recommendation on the referral in accordance with Article 31 of Directive 2001/83/EC in June 2013 and therefore could not be considered in the re-examination of the latter in October 2013.
Danish: PRAC's konklusion i forbindelse med indbringelsesproceduren i henhold til artikel 107i i direktiv 2001/83/EF omfattede supplerende data, der ikke forelå ved fremsættelsen af PRAC's anbefaling om indbringelsen i overensstemmelse med artikel 31 i direktiv 2001/83/EF i juni 2013, og kunne derfor ikke indgå i den fornyede overvejelse heraf i oktober 2013.
English: The experts agreed that the benefits may be observed in severe hypovolaemia in short duration only at the beginning i.e. perioperative setting and disappearing faster with patient's stabilisation.
Danish: Eksperterne var enige om, at det kun er ved kortvarig svær hypovolæmi i indledningsfasen, at der kan iagttages en fordel,
English: Meybohm P et al. 2013 suggest that use of HES should be restricted to the initial phase of volume resuscitation with a maximum time interval of 24 h. Martin et al 2002 showed that HES treatment resulted in a significantly lower estimated blood loss and that there was no difference in red blood cells, or blood product utilisation among the groups.
Danish: Martin et al., 2002, viste, at behandling med hydroxyethylstivelse resulterede i væsentlig lavere skønnet blodtab, og at der ikke var forskel mellem grupperne i anvendelsen af erytrocytter eller blodprodukter.
English: Scientific conclusions and grounds for the variation to the terms of the marketing authorisations subject to conditions and detailed explanation for the differences from the PRAC recommendation
Danish: Videnskabelige konklusioner og begrundelse for ændring af markedsføringstilladelserne på visse betingelser samt detaljeret redegørelse for afvigelserne fra anbefalingen fra PRAC (Det Europæiske Lægemiddelagenturs Udvalg for Risikovurdering inden for Lægemiddelvurdering)
English: • The PRAC considered, in view of the new evidence which includes data from clinical trials, further expert advice, new proposals for additional risk minimisation measures, including restrictions on use and a commitment from the MAHs to perform additional studies in patients with trauma and in elective surgery, that the benefit of hydroxyethyl starch containing products outweighs the risk in the treatment of hypovolaemia due to acute blood loss when crystalloids alone are not considered sufficient.
Danish: • PRAC gennemgik den nye evidens bestående af data fra kliniske undersøgelser, yderligere ekspertrådgivning, nye forslag til supplerende risikominimeringsforanstaltninger, herunder begrænsninger i anvendelsen, og forpligtelse af markedsføringstilladelsesindehaverne til at udføre supplerende undersøgelser hos traumepatienter og elektive operationspatienter.
English: The PRAC considered that the use of HES must be discontinued at the first sign of renal injury.
Danish: PRAC fandt, at hydroxyethylstivelse skal seponeres ved første tegn på nyrebeskadigelse.
English: Annex II Scientific conclusions and grounds for variation to the terms of the marketing authorisations and detailed explanation for the differences from the PRAC recommendation
Danish: Videnskabelige konklusioner og begrundelse for ændring af betingelserne for markedsføringstilladelserne samt detaljeret redegørelse for afvigelserne fra anbefalingen fra PRAC (Det Europæiske Lægemiddelagenturs Udvalg for Risikovurdering inden for Lægemiddelvurdering)
English: Under the framework of Article 107i of Directive 2001/83/EC, the PRAC considered recommendations on HES rendered in the referral under Article 31 of Directive 2001/83/EC and also reviewed available data including clinical studies, meta-analyses of clinical studies, post-marketing experience, responses submitted by the marketing authorisation holders (MAHs) in writing and at oral explanations, spontaneous reports on the safety and efficacy of hydroxyethyl starch containing products for solutions for infusion, as well as stakeholders' submissions in particular with regards to the risk of mortality and renal failure.
Danish: Udvalget gennemgik desuden de foreliggende data i form af kliniske undersøgelser, metaanalyser af kliniske undersøgelser, erfaringer efter markedsføring, markedsføringstilladelsesindehavernes skriftlige besvarelser og mundtlige fremlæggelser, spontane indberetninger om sikkerheden og virkningen af produkter til infusionsvæsker indeholdende hydroxyethylstivelse samt materiale indsendt af interesserede parter, navnlig om risikoen for dødelighed og nyresvigt.
English: However, for the current procedure under Article 107i of Directive 2001/83/EC the PRAC reviewed new available data, with a focus on risk of mortality and renal failure, including clinical studies, meta-analyses of clinical studies, post-marketing experience, responses submitted by the marketing authorisation holders (MAHs) in writing and at oral explanations and stakeholders' submissions.
Danish: Ved den aktuelle procedure i henhold til artikel 107i i direktiv 2001/83/EF gennemgik PRAC imidlertid nye foreliggende data navnlig vedrørende risikoen for dødelighed og nyresvigt, herunder kliniske undersøgelser, metaanalyser af kliniske undersøgelser,
English: However, with regards to the two phase IV randomised clinical trials (RCTs) requested to provide more evidence on the efficacy and safety in perioperative and trauma populations, including the risk of 90-day mortality and renal failure, , the CMDh encouraged the MAHs to jointly submit common study protocols.
Danish: CMDh opfordrede imidlertid indehaverne af markedsføringstilladelse til sammen at indsende fælles undersøgelsesprotokoller for de to randomiserede kliniske fase IV-undersøgelser, der var anmodet om for at tilvejebringe mere evidens om virkning og sikkerhed hos den perioperative population og traumepopulationen, herunder risikoen for 90-dages dødelighed og nyresvigt.
English: Side effects may occur up to 4 months or more after the last Halimatoz injection.
Danish: Bivirkninger kan forekomme op til 4 måneder eller mere efter den sidste Halimatoz-injektion.
English: Keep this Patient Reminder Card with you during your treatment and for 4 months after your (or your child's) last injection of Halimatoz.
Danish: Opbevar patientkortet på dig under din behandling og i 4 måneder efter din (eller dit barns) sidste injektion af Halimatoz.
English: The decision to stop using Halimatoz should be discussed with your doctor.
Danish: Beslutningen om at stoppe med at bruge Halimatoz skal diskuteres med din læge.
English: • On rare occasions, treatment with Halimatoz could result in lupus-like syndrome.
Danish: • I sjældne tilfælde kan behandling med Halimatoz resultere i lupus-lignende syndrom.
English: The potential risk with the combination of azathioprine or 6mercaptopurine and Halimatoz should be carefully considered.
Danish: Den potentielle risiko ved kombination af azathioprin eller 6-mercaptopurin og Halimatoz bør nøje overvejes.
English: • If you are over 65 years you may be more susceptible to infections while taking Halimatoz.
Danish: • Hvis du er over 65 år, kan du være mere modtagelig for infektioner, mens du tager Halimatoz.
English: You and your doctor should pay special attention to signs of infection while you are being treated with Halimatoz.
Danish: Du og din læge bør være særligt opmærksomme på tegn på infektion mens du er i behandling med Halimatoz.
English: Halimatoz in combination with methotrexate, is indicated for:
Danish: Halimatoz i kombination med methotrexat er indiceret til:
English: Halimatoz can also be given alone.
Danish: Halimatoz kan også anvendes alene.
English: Detailed instructions on how to inject Halimatoz are provided in section 7, “Instructions for use”.
Danish: Detaljeret vejledning om, hvordan Halimatoz injiceres, gives i punkt 7 ”Brugsvejledning”.
English: If you have any questions, please talk to a doctor, pharmacist or nurse who is familiar with Halimatoz.
Danish: Hvis du har nogen spørgsmål, så tal med en læge, apotekspersonalet eller en sygeplejerske, som kender Halimatoz.
English: Halimatoz should be used with caution in patients with mild heart failure (NYHA class I/II).
Danish: Halimatoz bør anvendes med forsigtighed til patienter med let hjerteinsufficiens (NYHA, klasse I/II).