FrancophonIA/ELRC3.0 huggingface dataset:
English: Furthermore, the CHMP noted that the changes to the package leaflet for Multihance (gadobenic acid) had not been fully implemented in the PRAC assessment report; the correct wording is provided in the Annex to this opinion.
Slovenian: Poleg tega je opozoril, da spremembe navodila za uporabo sredstva Multihance (gadobenska kislina) v poročilu odbora PRAC o oceni niso bile v celoti izvedene; pravilno besedilo je navedeno v prilogi k temu mnenju.
English: Another group of experts supported the view that macrocyclic agents are more stable and are preferable as first line contrast agents.
Slovenian: Druga skupina strokovnjakov je podprla stališče, da so makrociklična sredstva stabilnejša in zaželena kot prva izbira kontrastnih sredstev.
English: The experts at the ad-hoc expert meeting shared these same views.
Slovenian: Enako stališče so zavzeli strokovnjaki na ad hoc strokovnem sestanku.
English: • The shape and size of the T1 signal is markedly different from the signal shape reported in two other recent publications, (Jost et al., 2016, and Robert et al., 2015) and it is not fully clear whether the region of enhanced signal indeed corresponds to the DN, or other regions in the brain.
Slovenian: • oblika in velikost signala T1 se izrazito razlikujeta od oblike signala, navedene v dveh drugih nedavnih publikacijah (Jost idr., 2016, ter Robert idr., 2015), in ni popolnoma jasno, ali predel s povečanim signalom dejansko ustreza DN ali pa drugim predelom v možganih;
English: This is due to the range of potential outcomes of interest, the requirement for long term follow-up, and the heterogeneity of the patient population that undergoes MRI.
Slovenian: Vzrok za to so različni mogoči izidi interesov, zahteva za dolgoročno nadaljnje spremljanje in heterogenost populacije bolnikov, ki opravijo MRI;
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.
Slovenian: Po sprejetju priporočila odbora PRAC marca 2017 na sestanku odbora PRAC sta dva imetnika dovoljenja za promet z zdravilom (Bracco in GE Healthcare) izrazila nestrinjanje s prvotnim priporočilom odbora PRAC.
English: For gadobenic acid, the available studies do not establish differences in relaxivity, image quality and technical performance.
Slovenian: Za gadobensko kislino razpoložljive študije ne ugotavljajo razlik v relaksivnosti, kakovosti slike in tehnični zmogljivosti.
English: The PRAC considered that a 2nd ad-hoc expert meeting was warranted to address some of the aspects that formed part of the detailed grounds submitted by Bracco and GE Healthcare.
Slovenian: Odbor PRAC je menil, da je drugi ad hoc strokovni sestanek omogočil obravnavanje nekaterih vidikov iz podrobno opisanih razlogov, ki sta jih predložila Bracco in GE Healthcare.
English: It is not fully clear how reliable the method of Gd quantification in tissue was.
Slovenian: Ni popolnoma jasno, kako zanesljiva je bila metoda količinske opredelitve gadolinija v tkivu;
English: Also, according to this view, it would be important to complement this strategy by efforts to better inform healthcare professionals, particularly practitioners requesting imaging, on the choice of contrast agents depending on the different conditions and indications; to allow for increased overall awareness of risk benefit analysis.
Slovenian: V skladu s tem stališčem bi bilo tudi pomembno to strategijo dopolniti s prizadevanjem za boljše obveščanje zdravstvenih delavcev, zlasti zdravnikov, ki naročijo slikanje, o izbiri kontrastnih sredstev glede na različne bolezni in indikacije, za večjo splošno ozaveščenost o analizi razmerja med tveganji in koristmi.
English: Toxicity of non-chelated gadolinium
Slovenian: Toksičnost nekelatiranega gadolinija
English: They are used for contrast enhancement in magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA).
Slovenian: Uporabljajo se za izboljšanje kontrasta pri magnetnoresonančnem slikanju (MRI) in magnetnoresonančni angiografiji (MRA).
English: In accordance with Article 107k of Directive 2001/83/EC, the CHMP considered the PRAC recommendation adopted on 6 July 2017.
Slovenian: Odbor za zdravila za uporabo v humani medicini (CHMP) je v skladu s členom 107k Direktive 2001/83/ES proučil priporočilo Odbora za oceno tveganja na področju farmakovigilance (PRAC), sprejeto 6. julija 2017.
English: In addition, macrocyclic agents are associated with a low risk of NSF.
Slovenian: Poleg tega so makrociklična sredstva povezana z majhnim tveganjem NSF.
English: Population-specific indication for Multihance
Slovenian: Indikacija sredstva Multihance za določeno populacijo
English: The levels remained low at 20 weeks and no further reduction was observed at week 50, suggesting that there may be retention of gadolinium in the brain in the long term with no evidence of clearance up to 1 year.
Slovenian: Ravni so 20 tednov ostale nizke, do 50. tedna pa ni bilo ugotovljeno dodatno znižanje, kar kaže, da se gadolinij v možganih morda zadrži dolgoročno, pri čemer ni dokazov, da bi v enem letu izginil.
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.
Slovenian: Vendar pa so te študije precej omejene (študije na primer niso mogle izključiti izpostavljenosti linearnemu sredstvu GdCA pred obdobjem študije), zato ne ugotavljajo vzročne povezanosti z makrocikličnimi sredstvi.
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.
Slovenian: Podaljšani čas izločanja pri bolnikih z ledvično okvaro in sproščanje gadolinija iz sredstev GdCA sta glavna dejavnika, ki prispevata k razvoju NSF.
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.
Slovenian: Ker je bila sprememba zaključena hkrati s pregledom odbora PRAC, se je razumelo, da zaključki v zvezi s spremembo ne vplivajo na rezultat pregleda, ki je potekal na ravni EU.
English: Furthermore, the frequency and timing of applications may not be completely recorded in radiologist's patient file/and or accessible to future contacted radiologist or general practitioner, because the patient has changed the radiologist/general practitioner several times due to change of residence or due to other reasons.
Slovenian: Poleg tega v kartoteki, ki jo za bolnika vodi radiolog, morda ne bi bila v celoti zabeležena pogostnost in časovni razpored uporabe ali pa ta ne bi bila dostopna naslednjemu radiologu ali splošnemu zdravniku, s katerim bi bolnik stopil v stik, ker bi večkrat spremenil radiologa/splošnega zdravnika zaradi spremembe bivališča ali iz drugih razlogov.
English: The study also found that changes in signal intensity were strongly correlated with the amount of gadolinium detected by ICP-MS.
Slovenian: V študiji je bilo tudi ugotovljeno, da so bile spremembe intenzivnosti signala močno povezane s količino gadolinija, ugotovljenega z ICP-MS.
English: 1 ICP-MS: Inductively coupled plasma mass spectrometry
Slovenian: 1 ICP-MS: masna spektrometrija z induktivno sklopljeno plazmo.
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.
Slovenian: Evropska komisija je 9. marca 2016 na podlagi farmakovigilančnih podatkov sprožila napotitev v skladu s členom 31 Direktive 2001/83/ES in odbor PRAC zaprosila, naj oceni vpliv navedenih pomislekov na razmerje med koristmi in tveganji, ki vsebujejo gadolinij, ter izda priporočilo o tem, ali je treba zadevna dovoljenja za promet z zdravilom ohraniti, spremeniti, začasno umakniti ali ukiniti.
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.
Slovenian: Ti zaključki so v skladu z mnenjem strokovnjakov, izraženim na ad hoc strokovnem sestanku, in sicer, da je mogoče linearna in makrociklična sredstva pri slikanju srca uporabljati zamenljivo ter da ni bila ugotovljena ali zaznana razlika v njihovi klinični koristnosti.
English: With these uncertainties, conclusions on different or similar behaviour of the different contrast agents studied by McDonald et al. are not possible.
Slovenian: Glede na te negotovosti ni mogoče sprejeti zaključkov o različnem ali podobnem obnašanju različnih kontrastnih sredstev, ki so jih proučili McDonald idr.
English: Observational clinical studies will have limitations because methods for measuring adverse cognitive or motor neurological outcomes may not be captured by standard methods, or not be measured routinely, and may neither be reliable nor valid.
Slovenian: Opazovalne klinične študije bi imele omejitve, ker metode merjenja neželenih učinkov na kognitivne ali motorično nevrološke sposobnosti morda v standardnih metodah niso zajete ali se ne merijo redno, zato morda ne bi bile zanesljive in veljavne.
English: A number of studies have shown a correlation between the number of exposures to linear GdCAs and the signal intensity changes.
Slovenian: Več študij je dokazalo povezavo med številom izpostavljenosti linearnim sredstvom GdCA in spremembami intenzivnosti signala.
English: Impact of renal impairment
Slovenian: Učinek ledvične okvare
English: The increased potential to release gadolinium in the brain would be expected with the linear agents, which have a lower kinetic and thermodynamic stability and are thus more prone to release gadolinium in the tissue environment.
Slovenian: Večja možnost sproščanja gadolinija v možgane bi se pričakovala pri linearnih sredstvih, ki imajo manjšo kinetično in termodinamično stabilnost ter so zato bolj nagnjena k sproščanju gadolinija v okolje tkiv.
English: A restriction by number of doses may not be possible in clinical practice, because previous exposures to GdCAs may not have been recorded sufficiently with regard to the type of GdCA used.
Slovenian: Omejitev števila odmerkov v klinični praksi morda ne bi bila mogoča, ker predhodne izpostavljenosti sredstvom GdCA morda ne bi bile ustrezno evidentirane glede na vrsto uporabljenega sredstva GdCA.
English: All GdCAs have some degree of renal elimination, which varies from 50% for gadoxetic acid to 100% for most other members of the class.
Slovenian: Vsa sredstva GdCA se v določeni meri izločajo skozi ledvice, gadoksetna kislina v 50 %, večina drugih članov tega razreda pa v 100 %.
English: Moreover, there is concern that gadolinium deposition could worsen existing inflammatory diseases, as accumulation in inflammatory lesions has been observed.
Slovenian: Poleg tega obstaja pomislek, da bi odlaganje gadolinija lahko poslabšalo obstoječe vnetne bolezni, saj je bilo kopičenje ugotovljeno v vnetnih lezijah.
English: Gadolinium containing contrast agents (GdCAs) are complexes of paramagnetic gadolinium (III) with different types of organic chelators.
Slovenian: Kontrastna sredstva, ki vsebujejo gadolinij (GdCA), so kompleksi paramagnetnega gadolinija (III) z različnimi vrstami organskih kelatorjev.
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).
Slovenian: Vsaka prihodnja klinična študija za proučitev dolgoročne varnosti sredstev GdCA pri bolnikih bi morala biti zasnovana tako, da bi vključevala veliko bolnikov, da bi bilo mogoče ugotoviti majhne neželene učinke na kognitivne (kognitivne motnje) ali fizične sposobnosti (finomotorične sposobnosti).
English: In general, appropriate medications, equipment and staff experienced in the management of hypersensitivity reactions can be expected in any radiological practice.
Slovenian: Na splošno je mogoče pričakovati, da imajo v vsaki radiološki ambulanti ustrezna zdravila, opremo in osebje, ki ima izkušnje z obvladovanjem preobčutljivostnih reakcij.
English: However linear agents are retained and persist for up to one year or longer.
Slovenian: Vendar pa se linearna sredstva zadržijo in ohranijo do enega leta ali dlje.
English: Having reviewed the PRAC recommendation, the CHMP agrees with the PRAC overall conclusions and grounds for recommendation.
Slovenian: Potem ko je odbor CHMP pregledal priporočilo odbora PRAC, se je strinjal s končnimi zaključki in razlogi za priporočilo.
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.
Slovenian: Obstaja tudi pomislek, da bi se lahko depoziti gadolinija v nekaterih tkivih, zlasti kostnih, sprostili pozneje, npr. med izgubo kostne gostote zaradi staranja ali med nosečnostjo/dojenjem, zaradi česar bi bili bolniki izpostavljeni nadaljnjemu sistemskemu razdeljevanju gadolinija.
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.
Slovenian: Odbor PRAC je januarja 2016 v okviru postopka za redno posodobljeno poročilo o varnosti zdravila (PSUSA) pregledal vso razpoložljivo literaturo in podatke v zvezi s kopičenjem gadolinija v možganih ter priporočil, da se za vsa sredstva GdCA iz informacij o izdelku odstranijo navedbe, da izdelki ne prehajajo skozi nepoškodovano krvno-možgansko pregrado.
English: It was also mentioned that there is currently little, if any, concern amongst experts specifically about the use of macrocyclic agents in clinical practice, and the current safety concern laying over all GdCAs arises from the clinical use of linear GdCAs.
Slovenian: Povedali so tudi, da je med strokovnjaki malo pomislekov, če sploh kaj, posebej glede uporabe makrocikličnih sredstev v klinični praksi, zdajšnji pomisleki v zvezi z varnostjo vseh sredstev GdCA pa izhajajo iz klinične uporabe linearnih sredstev GdCA.
English: Thus, rather weak binding of linear chelators to Gd becomes obvious in various experiments (including Port et al 2009, Sieber et al 2008), and this makes it unlikely that the complex is fully stable in vivo.
Slovenian: Precej šibka vezava linearnih kelatorjev na gadolinij postane očitna pri različnih poskusih (vključno s Port idr., 2009, Sieber idr., 2008), zato ni verjetno, da bi bil kompleks in vivo povsem stabilen.
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.
Slovenian: Kljub temu in glede na podrobno opisane razloge imetnikov dovoljenja za promet je v okviru ponovne proučitve znova ocenil razpoložljive podatke.
English: PRAC considered the detailed grounds as submitted by the MAHs within this re-examination procedure and the scientific data underlying these grounds.
Slovenian: Odbor PRAC je proučil podrobno opisane razloge, ki sta jih predložila imetnika dovoljenja za promet z zdravilom v okviru tega postopka ponovne proučitve, in znanstvene podatke, na katerih temeljijo ti razlogi.
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.
Slovenian: Odbor PRAC prav tako ni mogel opredeliti varne mejne vrednosti za izpostavljenost gadoliniju in zadrževanje gadolinija v možganih ter časovnega obdobja, v katerem bi se morebitni neželeni učinek lahko pokazal.
English: The PRAC also noted that in contrast, for NSF a specific patient group (renal insufficiency and patients in the perioperative liver transplantation period) could be identified, and avoidance of use in these populations appears to have minimised the risk of NSF.
Slovenian: Odbor PRAC je tudi poudaril, da je v nasprotju s tem za NSF mogoče opredeliti specifično skupino bolnikov (bolniki z ledvično insuficienco in bolniki v perioperativnem obdobju presaditve jeter), in zdi se, da se je zaradi izogibanja uporabi pri teh populacijah tveganje NSF zmanjšalo.
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.
Slovenian: Prisotnost gadolinija v možganih po prejemu zadnjega odmerka drugih linearnih sredstev, gadopentetske kisline in gadobenske kisline, je prav tako po enakem obdobju ostala na isti ravni.
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.
Slovenian: Povečanje signala T1 je bilo dokumentirano v več nekliničnih in kliničnih študijah, kar dokazuje skladnost podatkov pri miših, podganah in ljudeh, kar potrjuje trdnost ugotovitev glede povečanja intenzivnosti signala.
English: The PRAC concluded that based on the available data Multihance can continue to be used in paediatric patients for delayed phase liver imaging.
Slovenian: Odbor PRAC je zaključil, da se na podlagi razpoložljivih podatkov lahko sredstvo Multihance pri pediatričnih bolnikih za slikanje jeter v zapozneli fazi uporablja še naprej.
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.
Slovenian: Niso pa podprli začasnega umika dovoljenja za promet z linearnimi sredstvi, ki jim nekateri radiologi morda dajejo prednost zaradi njihovih tehničnih značilnosti v nekaterih primerih (npr. pri slikanju dojk ali možganov), zlasti v primerih, kjer se postopek slikanja ne zahteva pogosto, ali ki bi se lahko uporabljali kot sredstva „druge izbire“.
English: • Gd retention was studied rather early (one week) after cessation of treatment so that detected Gd may not represent the long-term storage form.
Slovenian: • zadrževanje gadolinija se je proučevalo precej zgodaj (en teden) po prekinitvi obravnave, tako da ugotovljeni gadolinij morda ne pomeni oblike dolgotrajnega shranjevanja.
English: Furthermore, recent publications have shown that gadolinium also accumulates in the brain.
Slovenian: Poleg tega so nedavne publikacije dokazale, da se gadolinij kopiči tudi v možganih.
English: However, after the use of linear agents gadolinium is retained longer at measurable levels and persists for up to one year or more.
Slovenian: Vendar pa se po uporabi linearnih sredstev gadolinij dlje zadrži na merljivih ravneh in se ohrani do enega leta ali dlje;
English: • To extend the posology to lower doses in specific applications and clinical settings where the advances in technology have shown that to be appropriate.
Slovenian: • razširitev odmerjanja na manjše odmerke pri specifičnih uporabah in v kliničnem okolju, kjer je to ustrezno glede na tehnološki napredek.
English: These areas are involved in the regulation of voluntary and involuntary movement; adverse events could potentially include events such as ataxia, tremors and other movement disorders.
Slovenian: Ta predela sta vključena v nadzorovanje hotnih in nehotnih gibov; neželeni dogodki bi lahko med drugim vključevali ataksijo, tremor in druge motnje gibanja.
English: Many of these are common but typically non-serious reactions, such as rash, urticaria, and flushing.
Slovenian: Mnogi med njimi so pogosti, vendar pa navadno to niso hude reakcije, npr. izpuščaj, koprivnica in rdečica.
English: According to the current knowledge about gadolinium deposition in the brain, linear compounds have been detected in the brain at a higher magnitude than the macrocyclic compounds and they appear to be stored there in a form that does not allow an early washout.
Slovenian: V skladu s sedanjimi podatki o odlaganju gadolinija v možganih so bile v možganih linearne spojine ugotovljene v večjem obsegu kot makrociklične spojine, pri čemer se zdi, da se tam shranjujejo v obliki, ki ne omogoča zgodnjega izpiranja.
English: It has shown clinical utility in imaging of the liver.
Slovenian: Izkazala se je za klinično koristno pri slikanju jeter.
English: Toxicity has been seen in other tissues where it accumulates (including NSF, skin plaques) and in non-clinical data.
Slovenian: Toksičnost je bila ugotovljena v drugih tkivih, kjer se ta kopiči (vključno z NSF, kožnimi plaki), in v nekliničnih podatkih.
English: Therefore, data shows that linear agents are deposited in the brain and are retained and persist for up to one year or longer.
Slovenian: Podatki torej kažejo, da se linearna sredstva odlagajo v možganih in tam ohranijo do enega leta ali dlje.
English: • No specific patient group with less risk of accumulation in the brain can currently be identified.
Slovenian: • trenutno ni mogoče opredeliti specifične skupine bolnikov z manjšim tveganjem kopičenja.
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.
Slovenian: Skratka, odbor PRAC je menil, da ni na voljo novih argumentov, s katerimi bi bilo mogoče prepričljivo izpodbijati njegovo predhodno stališče glede dekelacije gadolinija, zaradi česar ima nizka stabilnost linearnih kompleksov GdCA glavno vlogo pri njegovem odlaganju v tkivu.
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.
Slovenian: Odbor PRAC je za obravnavanje resnih pomislekov glede morebitnih nevroloških učinkov proučil izvedljivost kliničnih opazovalnih in intervencijskih študij varnosti ter zaključil, da v razumnem času ne bi bile izvedljive.
English: Also the restriction of the number of doses administered during the lifetime of a patient raises practical difficulties and therefore would not be effective.
Slovenian: Tudi pri omejitvi števila odmerkov, ki jih bolnik prejme v svojem življenju, bi se pojavile praktične težave, zato ta ne bi bila učinkovita.
English: Hence, the potential risk of brain accumulation and retention in the body tissues cannot be minimised by recommendations to contraindicate use in particular groups (e.g. children, pregnant women, those with renal impairment, other groups) or by avoiding use for particular scans or clinical settings, including repeated use or by restricting re-exposure to certain agents or product classes.
Slovenian: Morebitnega tveganja kopičenja v možganih in zadrževanja v telesnih tkivih zato ni mogoče zmanjšati s priporočili o kontraindicirani uporabi pri določenih skupinah (npr. pri otrocih, nosečnicah, bolnikih z ledvično okvaro, drugih skupinah) ali s preprečevanjem uporabe za določeno slikanje ali klinično okolje, vključno z večkratno uporabo, ali z omejitvijo ponovne izpostavljenosti nekaterim sredstvom ali razredom izdelkov.