FrancophonIA/ELRC3.0 huggingface dataset:
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.
Danish: I betragtning af, at højrisikogrupperne af patienter med type 2-diabetes, patienter uden akut PCI efter hjerteinfarkt og patienter med nedsat systolisk funktion (EF < 50 %) er identificeret på grundlag af post hoc-delgruppeanalyser fra GISSI-Pstudiet, og at disse specifikke grupper ikke får den gængse standardbehandling, er delgrupperesultaterne ikke repræsentative; de understøtter således ikke den ansøgte indikation.
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.
Danish: De randomiserede kontrollerede studier blev anset for at være yderst relevante for evalueringen af effekten ved omega-3-fedtsyrer, navnlig resultaterne af GISSI-P og OMEGA.
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.
Danish: Selvom incidensen af pludselig død kan have været for lav til at drage endelige konklusioner, var OR 1,25 (0,90-1,72) for samlet dødelighed og 1,21 for MACE (0,96-1,52), og det anses derfor for usandsynligt, at en gavnlig effekt kunne være blevet påvist i et større studie.
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.
Danish: CHMP gennemgik resultaterne af de 3 indsendte kohortestudier, herunder for forsøgspersoner, der havde haft et hjerteinfarkt, og de synes at være i overensstemmelse med resultaterne af GISSI-Pstudiet.
English: The therapeutic effect of omega-3 fatty acids has been attributed to their possible involvement on eicosanoid balance, lipid metabolism, and cell membranes.
Danish: Den terapeutiske effekt af omega-3-fedtsyrer menes at kunne tilskrives en mulig indvirkning på eicosan-balancen, fedtstofmetabolismen og cellemembranerne.
English: A meta-analysis using individual participant data (IPD), selecting patients with a history of MI and treated with the same dose as for the indication under review (1 g) would have been more appropriate.
Danish: En metaanalyse med anvendelse af individuelle patientdata, hvor der var udvalgt patienter med tidligere hjerteinfarkt, som var behandlet med den samme dosis som dosen for den omhandlede indikation (1 g), ville have været mere passende.
English: Recently published RCTs (ASCEND by Bowman et al. 201812, VITAL by Manson et al. 201913, REDUCEIT by Bhatt et al. 201914) do not provide evidence for the efficacy of omega-3 administration (1 g daily) for the indication under review.
Danish: I nyligt offentliggjorte randomiserede kontrollerede studier (ASCEND af Bowman et al. 201812, VITAL af Manson et al. 201913, REDUCE-IT af Bhatt et al. 201914) er der ikke evidens for effekt af omega-3indgift (1 g dagligt) i den omhandlede indikation.
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.
Danish: Stigningen i blødningstid kan være relevant for patienter, der har haft et hjerteinfarkt, da de fleste af dem får enkeltstofs- eller dobbeltstofsbehandling med antitrombotika og/eller antikoagulantia efter hjerteinfarkt eller for relaterede sygdomme.
English: • As a consequence, the CHMP considered that the indication “Secondary prevention after myocardial infarction” at the dose of 1 g/day should be deleted with additional consequential changes in the product information.
Danish: • Følgelig vurderede CHMP, at indikationen "sekundær forebyggelse efter hjerteinfarkt" ved en dosis på 1 g/dag bør slettes fra produktinformationen, ligesom der bør indføres deraf følgende ændringer.
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).
Danish: OMEGA-studiet omfattede patienter med den godkendte indikation, dvs. hjerteinfarkt, og man anvendte den godkendte dosis Omacor (1 g/dag).
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.
Danish: Selvom de retrospektive kohortestudier synes at bekræfte resultaterne af GISSI-P-studiet, bør de imidlertid fortolkes med forsigtighed i betragtning af de kendte begrænsninger ved kohortestudierne.
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)
Danish: Desuden kan populationen og indikationen i REDUCE-IT ikke sammenlignes med populationen og indikationen i GISSI-P (patienter med tidligere hjerteinfarkt), da patienterne i REDUCE-IT ud over konstateret kardiovaskulær sygdom eller diabetes og andre risikofaktorer også led af hypertriglyceridæmi (> 60 % af patienterne havde TG-niveauer på ≥ 200 mg/dl).
English: In this study, there was a relative risk reduction for one of the two the co-primary MACE endpoints of 10% with a rather poor precision (upper CI 0.99) with the second co-primary endpoint just failing to show a significant result.
Danish: I dette studie var der en relativ risikoreduktion for ét af de to co-primære MACE-endepunkter på 10 % med en forholdsvis ringe præcision (øvre KI 0,99), mens der for det andet co-primære endepunkt akkurat ikke kunne påvises et signifikant resultat.
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.
Danish: De tre retrospektive studier (Poole et al. 2013, Greene et al. 2016 og Macchia et al. 2013) vurderes at have tilstrækkeligt store populationer af patienter med diagnostiseret akut hjerteinfarkt, og de undersøgte omega-3-fedtsyrer i den relevante dosis på 1 g dagligt med død uanset årsag som vigtigste endepunkt.
English: Acute coronary syndrome (ACS) associated with typical coronary artery disease (atherosclerosis) is the most common cause of a MI.
Danish: Akut koronart syndrom i forbindelse med typisk koronararteriesygdom (aterosklerose (åreforkalkning)) er den hyppigste årsag til hjerteinfarkt.
English: The MAHs proposed, as part of their grounds for re-examination, a modification of the indication for use in high-risk patients, i.e. type 2 diabetes, no acute PCI after MI, impaired systolic function (EF < 50%), known intolerance to one or more guideline recommended cardiovascular medications.
Danish: Som led i deres begrundelser for revurdering foreslog indehaverne af markedsføringstilladelse en ændring af indikationen, hvad angår brug hos højrisikopatienter, dvs. ved type 2-diabetes, ingen akut PCI efter hjerteinfarkt, nedsat systolisk funktion (EF < 50 %) og kendt intolerance over for et eller flere af de hjertelægemidler, der anbefales i retningslinjerne.
English: Upon request from the CHMP, a SAG CVS meeting was convened on 10 October 2018.
Danish: På CHMP's anmodning afholdt den videnskabelige rådgivende gruppe vedrørende kardiovaskulære sygdomme et møde den 10. oktober 2018.
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.
Danish: OMEGA-studiet har mange styrker sammenholdt med GISSI-P -studiet, f.eks. administration af forsøgslægemiddel inden for få dage efter et hjerteinfarkt, et placebo-kontrolleret dobbeltblindet design, optimal baseline-behandling og undersøgte endepunkter.
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.
Danish: • Resultaterne af de fremsendte retrospektive kohortestudier stemmer overens med resultaterne af GISSI-P-studiet, men de rummer en række metodemæssige begrænsninger, der gør det umuligt at drage endelige konklusioner, især manglen på randomisering, udvælgelsesbias og residual confounding.
English: Despite the lack of statistical power for the specific “sudden cardiac death” endpoint, the lack of substantial benefit can be concluded from this trial in a statistically valid way, as evidenced by the narrow confidence intervals.
Danish: På trods af den manglende statistiske styrke for det specifikke endepunkt "pludselig hjertedød" kan det konkluderes, at der ikke er opnået nogen væsentlig fordel i forsøget på en statistisk valid måde, jf. de snævre konfidensintervaller.
English: CHMP also considered the grounds submitted by the MAHs as basis for their request for re-examination of the CHMP recommendation as well as the views of a second Cardiovascular Scientific Advisory group held on the 19 of March 2019.
Danish: CHMP gennemgik også de begrundelser, som indehaverne af markedsføringstilladelse havde anført til støtte for deres anmodning om revurdering af CHMP's anbefaling, samt resultaterne fra det møde, som den videnskabelige rådgivende gruppe vedrørende kardiovaskulære sygdomme afholdt den 19. marts 2019.
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.
Danish: I den seneste PSUSA for omega-3-syreethylestere, jf. ovenfor, blev "stigning i blødningstid hos patienter med hæmoragisk diatese eller i behandling med antikoagulantia" og "stigning i leverenzymer, der kræver overvågning af patienter med leverproblemer" medtaget som identificerede risici.
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.
Danish: Hvad angår højrisikogruppen med kendt intolerance over for et eller flere af de hjertelægemidler, der anbefales i retningslinjerne, foreligger der ingen data, som understøtter bedre komplians med omega-3-syreethylestere sammenholdt med andre farmakologiske behandlinger, idet der mangler evidens for effekt ved Omacor i denne specifikke population.
English: Therefore, the CHMP considers that the validity of the meta-analyses is rather limited and that the meta-analyses can only be interpreted as being indicative, but not conclusive, with regards to potential efficacy or the lack of efficacy of omega-3 fatty acids in reducing the risk of cardiovascular events.
Danish: Derfor mener CHMP, at metaanalysernes validitet er ret begrænset, og at de kun kan anses som indikative og ikke konklusive, hvad angår en potentiel virkning eller mangel på virkning ved omega-3-fedtsyrer med henblik på at reducere risikoen for kardiovaskulære hændelser.
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.
Danish: Omega-3-syreethylestere er ethylestere af langkædede flerumættede fedtsyrer med et indhold af eicosapentaensyre (EPA) og docosahexaensyre (DHA) på minimum 85 % og et EPA:DHA-forhold på 0,9:1,5.
English: In GISSI-P, a reduction of sudden death events was seen in secondary two-way analyses of fatal events.
Danish: Der blev i studiet observeret et fald i antallet af pludselige dødsfald i sekundære tovejsanalyser af fatale hændelser.
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.
Danish: Der var delte meninger i gruppen; de fleste eksperter vurderede, at evidensen fra GISSI-P sammen med resultaterne fra OMEGA ikke understøtter brug af disse produkter til sekundær forebyggelse efter hjerteinfarkt i tillæg til gængs standardbehandling.
English: As stated above, RCT data are available which included sufficient number of patients and resulted in estimates of treatment effect with sufficient precision.
Danish: Som nævnt ovenfor foreligger der data fra randomiserede kontrollerede studier, der omfatter et tilstrækkeligt antal patienter, og som har resulteret i estimater af behandlingseffekt med tilstrækkelig nøjagtighed.
English: However CHMP still considered that the results of the GISSI-P trial are inconclusive, since the study has several limitations.
Danish: CHMP vurderer imidlertid fortsat, at resultaterne af GISSI-P er inkonklusive, da der er adskillige begrænsninger ved studiet.
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.
Danish: Godkendelsen af Omacor er baseret på GISSI-P; resultaterne af GISSI-P anses imidlertid for at være ret svage, da studiet har metodemæssige begrænsninger.
English: Therefore, these results do not support an effect in secondary prevention after MI.
Danish: Resultaterne understøtter derfor ikke en virkning ved sekundær forebyggelse efter hjerteinfarkt.
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.
Danish: Studier, der undersøgte virkningen af omega-3-syreethylester-holdige lægemidler på atrielle og ventrikulære arytmier, påviste ikke en klinisk relevant antiarytmisk virkning.
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.
Danish: Lægemidler, der indeholder omega-3-syreethylestere, er blevet godkendt i størstedelen af EU's medlemsstater til sekundær forebyggelse efter hjerteinfarkt og til behandling af hypertriglyceridæmi.
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.
Danish: Da de europæiske retningslinjer ikke anbefaler brug af lægemidler, der indeholder omega-3-fedtsyrer, må det betyde, at evidensen for og styrken af anbefalingen om omega-3-fedtsyrer til forebyggelse af kardiovaskulære hændelser både hos patienter med tidligere hjerteinfarkt og hos patienter med andre kardiovaskulære sygdomme vurderes at være ret svag.
English: For this, RCT data are available which included sufficient number of patients and resulted in estimates of treatment effect with sufficient precision.
Danish: I den forbindelse foreligger der data fra randomiserede kontrollerede studier, der omfatter et tilstrækkeligt antal patienter, og som har resulteret i estimater af behandlingseffekt med tilstrækkelig nøjagtighed.
English: The provided meta-analyses showed both positive and negative effects of omega-3 fatty acid treatment on the risk of cardiovascular events.
Danish: De fremlagte metaanalyser viste både positive og negative effekter ved behandling med omega-3fedtsyrer, hvad angår risikoen for kardiovaskulære hændelser.
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.
Danish: Selvom doserne og populationerne i disse studier ikke fuldt ud repræsenterer den godkendte indikation (sekundær forebyggelse), omfattede alle studierne patienter med kardiovaskulær sygdom, og de var derfor relevante i forhold til anvendelse af omega-3 til sekundær forebyggelse efter hjerteinfarkt.
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.
Danish: Hvad angår GISSI-P, er der ikke fundet nye problemer, bortset fra påstanden fra indehaverne af markedsføringstilladelse om, at post hoc-analyserne i GISSI-P viste, at samtidig behandling med trombocythæmmende midler, betablokkere, ACE-hæmmere og statiner ikke ændrede den terapeutiske fordel ved Omacor.
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.
Danish: Patientrepræsentanten vurderede, at det kan være værdifuldt, at disse produkter er tilgængelige, og at man ikke bør fraråde patienterne at tage fiskeolie, da der er en lang tradition for fiskeolie som tillægsbehandling og som kosttilskud, og da der navnlig ikke er nogen evidens for skade ved omega-3-tilskud.
English: The issue is highlighted by the fact that omega-3 acid ethyl esters had little effect when compared to the Vitamin E arm in the same trial.
Danish: Problemstillingen understreges af det faktum, at omega-3-syreethylestere havde ringe effekt sammenholdt med den gruppe, der fik E-vitamin i samme studie.
English: The Swedish national competent authority considered that in light of recent clinical trials, the clinical benefit of omega-3 acid ethyl esters containing products in prevention after MI should be re-evaluated.
Danish: Den nationale kompetente myndighed i Sverige vurderede i lyset af nylige kliniske studier, at den kliniske fordel ved omega-3-syreethylester-holdige lægemidler til forebyggelse efter hjerteinfarkt bør revurderes.
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.
Danish: I dette studie var der en relativ risikoreduktion for ét af de to primære MACEendepunkter (død, ikke-fatalt hjerteinfarkt og ikke-fatalt slagtilfælde) på 10 % med en forholdsvis ringe præcision (øvre KI 0,99), mens der ikke blev opnået statistisk signifikans for det andet primære endepunkt, herunder kardiovaskulær død (i stedet for død uanset årsag).
English: The current approval of omega-3 acid ethyl esters containing products in secondary prevention after myocardial infarction is based on the results of the GISSI-P study performed in 1999.
Danish: Den aktuelle godkendelse af omega-3-syreethylester-holdige lægemidler til sekundær forebyggelse efter hjerteinfarkt er baseret på resultaterne af GISSI-P-studiet i 1999.
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.
Danish: Det må derfor konkluderes, at de samlede data ikke understøtter en effekt ved omega-3-fedtsyrer til forebyggelse efter hjerteinfarkt, herunder hos højrisikopatienter.
English: Based on the results of studies available today the experts did not see a place for therapy with Omega-3 containing medicinal products at a dose of 1 g/day in the context of secondary cardiovascular prevention after MI given the considerations regarding RCTs (particularly OMEGA and GISSI-P studies), meta-analysis and retrospective cohort studies.
Danish: På grundlag af de studieresultater, der er tilgængelige i dag, fandt eksperterne ikke, at omega-3-holdige lægemidler i en dosis på 1 g/dag har nogen berettigelse som sekundær kardiovaskulær forebyggelse efter hjerteinfarkt, jf. overvejelserne vedrørende de randomiserede kontrollerede studier (især OMEGA og GISSI-P), metaanalyserne og de retrospektive kohortestudier.
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.
Danish: Studierne i de forskellige metaanalyser er ikke ens med hensyn til studiepopulation (f.eks. patienter med eller uden tidligere kardiovaskulær sygdom), studiedesign (åbent eller dobbeltblindet), kilden til omega-3-fedtsyrer (via kosten eller som præparat), dosen og sammensætningen af omega-3-fedtsyrer.
English: Treatment with icosapent ethyl 4g/day was associated with an increase in hospitalization for atrial fibrillation of flutter in the REDUCE-IT trial.
Danish: Behandling med icosapentethyl 4 g/dag blev forbundet med en stigning i indlæggelse for atrieflimren eller atrieflagren i REDUCE-IT-studiet.
English: Based on the above, the CHMP reiterates that RCTs conducted in other CV risk populations are relevant in support of the efficacy (GISSI-HF although borderline and inconclusive) or lack of efficacy (ORIGIN and SU.FOL.OM3) of omega-3 fatty acids in secondary prevention of cardiovascular disease.
Danish: På baggrund af ovenstående vil CHMP endnu en gang understrege, at randomiserede kontrollerede studier, der er udført hos andre populationer med kardiovaskulær risiko, er relevante til understøttelse af en effekt (GISSI-HF, om end resultaterne er borderline og inkonklusive) eller en manglende effekt (ORIGIN og SU.FOL.OM3) af omega-3-fedtsyrer til sekundær forebyggelse af kardiovaskulær sygdom.
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”.
Danish: Hvad det angår, er resultaterne af GISSI-P-studiet ikke i overensstemmelse med den gængse standardbehandling og dermed den godkendte indikation for Omacor "i tillæg til anden standardbehandling (f.eks. statiner, trombocythæmmende midler, betablokkere og ACE-hæmmere".
English: • Even though the meta-analyses by Aung et al. and the recent Cochrane review includes trials with products, doses and populations not exactly representing the approved secondary prevention indication, all studies include patients with cardiovascular disease and therefore, the results are considered as supportive of lack of efficacy.
Danish: • Selvom metaanalyserne af Aung et al. og den nylige Cochrane-gennemgang omfatter studier med produkter, doser og populationer, der ikke fuldt ud repræsenterer den godkendte indikation sekundær forebyggelse, omfatter alle studier patienter med kardiovaskulær sygdom, og derfor anses resultaterne for at indikere manglende virkning.