FrancophonIA/ELRC3.0 huggingface dataset:
English: Even though the incidence of sudden death may have been too low to draw firm conclusions, the OR was 1.25 (0.90-1.72) for total mortality and 1.21 for MACE (0.96 - 1.52), so it is considered unlikely that a beneficial effect could have been shown with a larger trial.
Croatian: Iako je incidencija iznenadne smrti možda bila preniska da bi se došlo do čvrstih zaključaka, omjer izgleda (OR) iznosio je 1,25 (0,90 - 1,72) za ukupnu smrtnost i 1,21 za MACE (0,96 - 1,52), tako da se smatra malo vjerojatnim da bi se koristan učinak pokazao u većem ispitivanju.
English: • Whilst the results of the submitted retrospective cohort studies seemed to be in line with the results of the GISSI-P study, they suffered from methodological limitations which prevent drawing definite conclusions, in particular the lack of randomisation, selection bias and residual confounding.
Croatian: • Premda su rezultati dostavljenih retrospektivnih kohortnih ispitivanja naizgled bili u skladu s rezultatima ispitivanja GISSI-P, imali su stanovita metodološka ograničenja koja onemogućavaju izvođenje konačnih zaključaka, a to su posebice nepostojanje randomizacije, pristrani izbor ispitanika i rezidualni zbunjujući čimbenici.
English: 2013;8(5):e62772.
Croatian: PLoS One. 2013;8(5):e62772.
English: The original approval of Omacor (EU reference medicinal product) was based on an open-label study (GISSI-P) from 1999.
Croatian: Prvobitno odobrenje lijeka Omacor (referentni lijek u Europskoj uniji) temeljilo se na otvorenom ispitivanju (GISSI-P) iz 1999. godine.
English: Regarding the OMEGA study, the CHMP considered that although the trial could be considered to be underpowered this does not invalidate the study results entirely, in line with SAG on 19 March 2019.
Croatian: U pogledu ispitivanja OMEGA, CHMP smatra da iako se može smatrati da je ispitivanje male statističke snage dokaza, rezultati ispitivanja nisu potpuno nevažeći, što je u skladu s mišljenjem Znanstvene savjetodavne skupine od 19. ožujka 2019.
English: However, with respect to statin therapy, CHMP concluded that subjects in this subgroup analysis were not on optimal statin therapy.
Croatian: Međutim, za terapiju statinima CHMP je zaključio da ispitanici u toj analiziranoj podskupini nisu primali optimalnu terapiju statinima.
English: However, ignoring double blind by using no treatment as comparator (as in GISSI-P) ignores another important concept in clinical trials, i.e. the use of a (blinded) comparator in order to control the other effects than the investigational drug, and deviation of this principle should only be needed or suitable "when it is difficult or impossible to avoid" (ICH E10 guideline on Choice of control group in clinical trials).
Croatian: Međutim, zanemarivanjem potrebe da ispitivanje bude dvostruko slijepo i nepostojanjem terapije usporednim lijekom (kao u ispitivanju GISSI-P), zanemaruje se još jedan važan koncept u kliničkim ispitivanjima, tj. primjena (maskiranog) usporednog lijeka kako bi se kontrolirali i drugi učinci osim onih ispitivanog lijeka, a odstupanje od tog načela potrebno je ili prikladno samo onda „kada je to teško ili nemoguće izbjeći” (smjernica E10 ICH o izboru kontrolne skupine u kliničkim ispitivanjima).
English: The randomised controlled trials were considered most relevant for the evaluation of the efficacy of omega-3 fatty acids, in particular the results of the GISSI-P and OMEGA trials.
Croatian: Randomizirana kontrolirana ispitivanja smatrala su se najznačajnija za procjenu djelotvornosti omega3 masnih kiselina, a osobito rezultati ispitivanja GISSI-P i OMEGA.
English: The three retrospective studies (Poole et al 2013, Greene et al 2016, Macchia et al 2013) are considered to have sufficiently large populations of subjects diagnosed with acute MI and studied omega-3-fatty acids in the relevant dose of 1 g daily with all-cause mortality as the main endpoint.
Croatian: Za tri retrospektivna ispitivanja (Poole et al 2013, Greene et al 2016, Macchia et al 2013) smatra se da su obuhvatila dovoljno velike populacije ispitanika kojima je dijagnosticiran akutni infarkt miokarda, kojima su ispitivane omega-3 masne kiseline davane u relevantnoj dozi od 1 g dnevno, a glavna mjera ishoda bila je smrtnost svih uzroka.
English: With respect to the high risk group of known intolerance to one or more guideline recommended cardiovascular medications, there is no data available supporting better adherence to omega-3 acid ethyl esters compared to other pharmacological interventions and evidence for efficacy of Omacor in this specific population is lacking.
Croatian: U pogledu visokorizičnih skupina za koje je poznata netolerancija jednog ili više kardiovaskularnih lijekova preporučenih u smjernicama, nema podataka koji u većoj mjeri potkrepljuju primjenu etilnih estera omega-3 kiselina u usporedbi s drugim farmakološkim intervencijama i dokaz djelotvornosti lijeka Omacor u ovoj specifičnoj populaciji nedostaje.
English: Total mortality was also numerically higher in the omega-3 fatty acids group OR 1.25 (0.90-1.72).
Croatian: Ukupna smrtnost također je bila brojčano veća u skupini koja je primala omega-3 masne kiseline, omjer rizika 1,25 (0,90 − 1,72).
English: The primary objective of the OMEGA trial was to study the rate of sudden cardiac death testing one of the postulated mechanisms of action (antiarrhythmic) of Omega-3 in GISSI-P.
Croatian: Primarni cilj ispitivanja OMEGA bilo je ispitati stopu iznenadne srčane smrti testiranjem jednog od pretpostavljenih mehanizama djelovanja (antiaritmičko) Omega-3 u ispitivanju GISSI-P.
English: In GISSI-P, a reduction of sudden death events was seen in secondary two-way analyses of fatal events.
Croatian: U ispitivanju GISSI-P, u sekundarnim dvosmjernim analizama smrtnih ishoda opaženo je smanjenje broja iznenadnih smrtnih slučajeva.
English: Beta-blockers that are indicated in most patients post MI were only used in 37 - 44% in GISSI-P.
Croatian: Beta-blokatori, koji su indicirani u većine bolesnika nakon infarkta miokarda, primjenjivani su u ispitivanju GISSI-P u svega 37 - 44 % bolesnika.
English: Another concern for this study was its open-label design and that the control group did not receive placebo treatment.
Croatian: Drugo pitanje povezano s tim ispitivanjem bilo je to što je ono otvorenog nacrta te kontrolna skupina nije primala placebo.
English: The CHMP reviewed the results of the 3 submitted cohort studies, including subjects who had experienced a MI, which seem to be in line with the results of the GISSI-P study.
Croatian: CHMP je pregledao dostavljene rezultate za 3 podnesena kohortna ispitivanja, uključujući ispitanike koji su imali infarkt miokarda, i izgleda da su oni u skladu s rezultatima ispitivanja GISSI-P.
English: OMEGA trial was based on a more robust and adequate design than GISSI-P.
Croatian: Ispitivanje OMEGA bilo je robusnijeg i primjerenijeg nacrta nego ispitivanje GISSI-P.
English: ESC/EAS guidelines are recommendations made by various societies in consultation with task forces, expert groups or consensus panels, with the aim of assisting physicians in selecting the best management strategies for an individual patient with a given condition taking into account the impact on outcome as well as the risk/benefit ratio of particular diagnostic or therapeutic means.
Croatian: Smjernice Europskog kardiološkog društva i Europskog društva za aterosklerozu (ESC/EAS) preporuke su različitih stručnih udruženja izrađene u konzultaciji s radnim skupinama, skupinama stručnjaka ili panela za postizanje konsenzusa, s namjerom da se liječnicima pomogne u izboru najboljih strategija liječenja svakog pojedinog bolesnika s tom bolešću, vodeći računa o utjecaju na ishod kao i o omjeru koristi i rizika određenih dijagnostičkih ili terapijskih načina.
English: Omega-3 acid ethyl esters are an ethyl esters of long-chain polyunsaturated fatty acids with an eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) content of no less than 85% and an EPA to DHA ratio of 0.9 to 1.5.
Croatian: Etilni esteri omega-3 kiselina etilni su esteri dugolančanih polinezasićenih masnih kiselina koji sadrže eikosapentaenoatnu kiselinu (EPA) i dokosaheksaenoatnu kiselinu (DHA) u količini ne manjoj od 85 % s omjerom kiselina EPA i DHA od 0,9 do 1,5.
English: Acute coronary syndrome (ACS) associated with typical coronary artery disease (atherosclerosis) is the most common cause of a MI.
Croatian: Akutni koronarni sindrom, povezan s tipičnom bolešću koronarnih arterija (ateroskleroza), najčešći je uzrok infarkta miokarda.
English: The patient representative considered there was value to having these products available and not to discourage this aspect of patients' choice given the long history of the use of fish oils in adjunctive medicine and as dietary supplements particularly as there was no evidence of harm with omega-3 supplementation.
Croatian: Mišljenje predstavnika bolesnika bilo je da te lijekove vrijedi imati na raspolaganju, i da ne treba obeshrabriti taj aspekt bolesnikova izbora uzimajući u obzir dugu povijest ribljeg ulja kao pomoćnog lijeka i dodatka prehrani, a osobito zato što nema dokaza da je dodavanje omega-3 škodljivo.
English: All these studies carry the risk of a selection bias, which is supported by baseline data provided, e.g. in the retrospective cohort study by Polle (2013)7 only 1 % of post MI patients who were screened were included in the analysis.
Croatian: Sva ova ispitivanja nose rizik od pristranog izbora ispitanika, što podupiru i osnovni podatci iz npr. retrospektivnog kohortnog Polleovog ispitivanja (2013.)7 u kojem je od bolesnika na probiru, u analizu bio uključen samo 1 % bolesnika nakon infarkta miokarda.
English: Arch Intern Med. 2012 May 12;172(9):686-694
Croatian: 2012 May 12;172(9):686-694
English: 3 Kwak et al. Efficacy of omega-3 fatty acid supplements (eicosapentaenoic acid and decosahexaenoic acid) in the secondary prevention of cardiovascular disease: a meta-analysis of randomized, double-blind, placebo-controlled trials.
Croatian: Efficacy of omega-3 fatty acid supplements (eicosapentaenoic acid and decosahexaenoic acid) in the secondary prevention of cardiovascular disease: a meta-analysis of randomized, double-blind, placebo-controlled trials.
English: The statistical analysis and interpretation were not robust according to current standards.
Croatian: Prema sadašnjim standardima, statistička analiza i tumačenje rezultata nisu bili robusni.
English: Moreover, the population included in the REDUCE-IT trial is not comparable with the population of the GISSI-P trial and the indication under review (patients with history of MI), since in addition to established cardiovascular disease or diabetes and other risk factors, patients in the REDUCE-IT trial suffered also from hypertriglyceridemia (> 60% of the patients had TG levels ≥ 200 mg/dL)
Croatian: Osim toga, populacija uključena u ispitivanje REDUCE-IT nije usporediva s populacijom iz ispitivanja GISSI-P i indikacijom koja se razmatra (bolesnici s infarktom miokarda u povijesti bolesti) jer su bolesnici u ispitivanju REDUCE-IT, osim ustanovljene kardiovaskularne bolesti ili dijabetesa i drugih čimbenika rizika, imali i hipertrigliceridemiju (> 60% bolesnika imalo je razine triglicerida ≥ 200 mg/dl).
English: In this regard, the results of the GISSI-P trial are not in line with the current standard of care and therefore with the approved indication of Omacor “in addition to other standard therapy (e.g. statins, antiplatelet medicinal products, beta-blockers, ACE inhibitors”.
Croatian: U tom smislu, rezultati ispitivanja GISSI-P nisu u skladu sa sada važećom standardnom skrbi, a time ni s odobrenom indikacijom za Omacor „osim druge standardne terapije (npr. statini, antitrombotici, beta-blokatori, ACE inhibitori)”.
English: In addition, it may be questioned if the results are relevant in the context of current MI standard of care which has substantially evolved since the time the study was performed and secondary prevention of CVD.
Croatian: Nadalje, postavlja se pitanje jesu li rezultati relevantni u kontekstu sada važeće standardne skrbi infarkta miokarda koja se značajno razvila od vremena provedbe ispitivanja i sekundarne prevencije kardiovaskularne bolesti.
English: Moreover, the American Heart Association states that use of omega-3 fatty acid supplements is ‘reasonable' for patients with prevalent coronary heart disease such as MI, indication that strength of recommendation is therefore low (Class IIa/IIb Recommendation).
Croatian: Nadalje, Američko udruženje za bolesti srca navodi da je uzimanje dodataka prehrani s omega-3 masnim kiselinama „opravdano” u bolesnika u kojih prevladava koronarna bolest srca kao što je infarkt miokarda, što ukazuje na to da je snaga preporuke mala (preporuka klase IIa/IIb).
English: The OMEGA study included close to 2000 patients in both arms and over 300 MACE events were reported, more in the omega-3 group than in the placebo group OR 1.25 (0.96-1.52).
Croatian: Ispitivanje OMEGA uključivalo je gotovo 2 000 bolesnika u obje skupine i zabilježeno je više od 300 MACE događaja, s tim da je broj slučajeva u skupini koja je primala omega-3 bio veći nego u onoj koja je primala placebo, omjer rizika 1,25 (0,96 − 1,52).
English: Additionally, the level of evidence in these post-hoc subgroup analyses is not strong.
Croatian: Osim toga, te post hoc analize podskupina nisu pokazale snažnu razinu dokaza.
English: As the European guidelines do not recommend omega-3 fatty acid medicinal products, they apparently consider the level of evidence and the strength of the recommendation of omega-3 fatty acids in prevention of cardiovascular events both in patients after MI and in patients with other CV conditions rather weak.
Croatian: Budući da europske smjernice ne preporučuju lijekove koji sadrže omega-3 masne kiseline, očigledno smatraju da su razina dokaza i snaga preporuke za primjenu omega-3 masnih kiselina u prevenciji kardiovaskularnih događaja u bolesnika nakon infarkta miokarda kao i u bolesnika s drugim kardiovaskularnim bolestima, prilično slabe.
English: Even though the incidence of sudden death may have been too low to draw firm conclusions, the OR for MACE and total mortality was above 1.21 and 1.25 respectively with lower CI close to 1 not supporting an effect in the approved indication.
Croatian: Iako je incidencija iznenadne smrti možda bila preniska da bi se došlo do čvrstih zaključaka, omjer rizika za MACE i ukupna smrtnost bila je iznad 1,21 odnosno 1,25 s nižim intervalom pouzdanosti blizu 1, koji ne podupire učinak za odobrenu indikaciju.
English: However CHMP still considered that the results of the GISSI-P trial are inconclusive, since the study has several limitations.
Croatian: Međutim, CHMP je ipak smatrao da rezultati ispitivanja GISSI-P nisu omogućili donošenje zaključaka jer ispitivanje ima nekoliko ograničenja.
English: Even though doses and populations in these studies do not fully represent the approved secondary prevention indication, all studies include patients with cardiovascular disease and therefore, these studies are relevant in the context of omega-3 in secondary prevention after MI.
Croatian: Iako doze i populacije u ovim ispitivanjima ne opisuju u potpunosti odobrenu indikaciju sekundarne prevencije, sva ispitivanja uključuju bolesnike s kardiovaskularnim bolestima; stoga su ova ispitivanja relevantna u kontekstu primjene omega-3 za sekundarnu prevenciju nakon infarkta miokarda.
English: The increase in bleeding time may be relevant for patients post MI most of which are on single or dual antiplatelet therapy and/or on anticoagulants post MI or for associated diseases.
Croatian: Produljeno vrijeme krvarenja može biti relevantno za bolesnike nakon infarkta miokarda, od kojih većina prima jednostruku ili dvojnu terapiju antitromboticima i/ili antikoagulansima nakon infarkta miokarda ili za srodne bolesti.
English: Considering that the high-risk groups of patients with type 2 diabetes, patients with no acute PCI after MI, and patients with impaired systolic function (EF < 50%) have been identified based on post-hoc subgroup analyses conducted on GISSI-P and that these specific groups are not treated according to the current standard of care, the results of these subgroups are not representative and therefore do not support the proposed indication.
Croatian: Uzevši u obzir da su na temelju post hoc analiza podskupina provedenih za ispitivanje GISSI-P ustanovljene visokorizične skupine bolesnika s dijabetesom tipa 2, bolesnici kojima nije bila provedena akutna koronarna intervencija nakon infarkta miokarda i bolesnici s oštećenom sistoličkom funkcijom (EF < 50 %), i da te specifične skupine nisu liječene prema sada važećoj standardnoj skrbi, rezultati za te podskupine nisu reprezentativni i stoga ne mogu potkrijepiti predloženu indikaciju.
English: As discussed above, in the last PSUSA for omega-3-acid-ethyl esters, “increase in bleeding time in patients with haemorragic diathesis or receiving treatment with anticoagulants” and “increase in hepatic enzymes that require monitoring in hepatic patients” was included as identified risks.
Croatian: Prema gore navedenom, u posljednjem postupku PSUSA za etilne estere omega-3 kiselina, kao prepoznati rizici uključeni su „produljenje vremena krvarenja u bolesnika s hemoragijskom dijatezom ili tijekom liječenja antikoagulansima” i „povišenje jetrenih enzima koje zahtijeva praćenje bolesnika s bolestima jetre”.
English: The opinion of the Group was split: most experts believed that the level of evidence from GISSI-P together with the results from OMEGA is not supportive for using these products in secondary prevention after MI in addition to current standard of care.
Croatian: Mišljenje Skupine bilo je podijeljeno: većina stručnjaka smatrala je da razina dokaza iz ispitivanja GISSI-P zajedno s rezultatima ispitivanja OMEGA, ne podupiru primjenu ovih lijekova u sekundarnoj prevenciji nakon infarkta miokarda uz sadašnju standardnu skrb.
English: As stated above, RCT data are available which included sufficient number of patients and resulted in estimates of treatment effect with sufficient precision.
Croatian: Kao što je prethodno navedeno, dostupni su podatci randomiziranih kliničkih ispitivanja u koja je bio uključen dovoljno veliki broj bolesnika, a dobivene procjene učinka liječenja zadovoljavajuće su preciznosti.
English: • The Committee for Medicinal Products for Human Use (CHMP) considered the procedure under Article 31 of Directive 2001/83/EC for Omega-3 acid ethyl esters - containing medicinal products for oral in use in secondary prevention after myocardial infarction.
Croatian: • Odbor za lijekove za humanu uporabu (CHMP) razmotrio je postupak u skladu s člankom 31. Direktive 2001/83/EZ za lijekove koji sadrže etilne estere omega-3 kiselina za peroralnu primjenu u sekundarnoj prevenciji nakon infarkta miokarda.
English: In conclusion, the totality of data does not support the efficacy of omega-3 fatty acids in prevention after myocardial infarction, including in high-risk patients.
Croatian: Kao zaključak, ukupni podatci ne podupiru djelotvornost omega-3 masnih kiselina u prevenciji nakon infarkta miokarda, uključujući visokorizične bolesnike.
English: Studies investigating the effect of omega-3 acid ethyl esters medicinal products on atrial and ventricular arrhythmias did not demonstrate a clinically relevant antiarrhythmic efficacy.
Croatian: Ispitivanja koja su istraživala učinak lijekova koji sadrže etilne estere omega-3 kiselina na atrijske i ventrikularne aritmije nisu pokazala klinički relevantnu djelotvornost protiv aritmija.
English: The OMEGA trial was conducted in patients with the approved indication, i.e. MI and used the approved dose of Omacor (1 g/day).
Croatian: Ispitivanje OMEGA provedeno je u bolesnika s odobrenom indikacijom, tj. infarkt miokarda i uz primjenu odobrene doze lijeka Omacor (1 g dnevno).
English: With respect to the GISSI-P trial, no new issues have been identified, with the exception of the statement of the MAHs that post-hoc analyses conducted on GISSI-P demonstrated that concomitant treatment with anti-platelet agents, beta-blockers, ACE inhibitors and statins did not alter the therapeutic benefit of Omacor.
Croatian: U pogledu ispitivanja GISSI-P, nisu ustanovljena nova sporna pitanja, osim tvrdnje nositelja odobrenja da su post hoc analize provedene za ispitivanje GISSI-P pokazale da istodobno liječenje antitromboticima, beta-blokatorima, ACE inhibitorima i statinima nije promijenilo terapijsku dobrobit lijeka Omacor.
English: The registration of Omacor was based on the GISSI-P study, however, the results of the GISSI-P trial are considered rather weak, since the study has methodological limitations.
Croatian: Registracija lijeka Omecor temeljila se na ispitivanju GISSI-P, međutim, rezultati tog ispitivanja smatraju se prilično slabe snage dokaza zbog metodoloških ograničenja ispitivanja.
English: Studies included in the different meta-analysis are heterogeneous with respect to study population (e.g. patients with or without history of cardiovascular disease), study design (open-label or double-blind), source of omega-3 fatty acid intake (dietary or medication intervention), dose and composition of omega-3 fatty acid.
Croatian: Ispitivanja za koja su provedene različite metaanalize heterogena su s obzirom na ispitivanu populaciju (npr. bolesnici s kardiovaskularnom bolesti u povijesti bolesti ili bez nje), nacrt ispitivanja (otvoreno ili dvostruko slijepo), izvor unosa omega-3 masne kiseline (prehrana ili lijek), doza i sastav omega-3 masne kiseline.
English: For this, RCT data are available which included sufficient number of patients and resulted in estimates of treatment effect with sufficient precision.
Croatian: U tom smislu, dostupni su podatci randomiziranih kliničkih ispitivanja u koja je bio uključen dovoljno veliki broj bolesnika, a dobivene procjene učinka liječenja zadovoljavajuće su preciznosti.
English: The OMEGA study has several strengths compared to the GISSI-P study, e.g. administration of study drug within few days of a MI, a placebo-controlled double-blind design, optimal baseline therapy and endpoints investigated.
Croatian: Ispitivanje OMEGA ima nekoliko jakih strana u usporedbi s ispitivanjem GISSI-P, npr. primjena ispitivanog lijeka u roku od nekoliko dana od infarkta miokarda, nacrt dvostruko slijepog ispitivanja kontroliranog placebom, optimalna osnovna terapija i ispitivane mjere ishoda.
English: However, although the retrospective cohort studies seem to confirm the results of the GISSI-P study, they should be interpreted with caution given the known limitations of retrospective cohort studies.
Croatian: Međutim, iako se čini da retrospektivna kohortna ispitivanja potvrđuju rezultate ispitivanja GISSI-P, s obzirom na poznata ograničenja takvih ispitivanja rezultate treba tumačiti s oprezom.
English: Medicinal products containing omega-3 acid ethyl esters have been approved in the majority of the European Union Member States for secondary prevention after myocardial infarction (MI) and in the treatment of hypertriglyceridaemia.
Croatian: Lijekovi koji sadrže etilne estere omega-3 kiselina odobreni su u većini država članica Europske unije za sekundarnu prevenciju nakon infarkta miokarda (IM) te u liječenju hipertrigliceridemije.
English: In this study, there was a relative risk reduction for one of the two primary MACE endpoint (death, non-fatal MI and non-fatal stroke) of 10% with a rather poor precision (upper CI 0.99), whereas for the other primary endpoint including cardiovascular (CV), instead of all-cause death, statistical significance was not achieved.
Croatian: U tom je ispitivanju zabilježeno smanjenje relativnog rizika od 10 % u jednoj od dvije mjere primarnog ishoda velikog kardiovaskularnog štetnog događaja (MACE) (smrt, infarkt miokarda bez smrtnog ishoda i moždani udar bez smrtnog ishoda) uz prilično slabu preciznost (gornja granica intervala pouzdanosti od 0,99), dok za ostale mjere primarnog ishoda, uključujući kardiovaskularnu smrt umjesto one bilo kojeg uzroka, statistička značajnost nije dostignuta.