FrancophonIA/ELRC3.0 huggingface dataset:
English: Potential negative effects on cardiovascular risk factors may counteract the potential beneficial effect on CV outcome due to reduction in LDL-C.
Danish: Potentielle negative effekter på kardiovaskulære risikofaktorer kan modvirke den gavnlige virkning på det kardiovaskulære udfald, der måtte opnås ved reduktion af LDL-C.
English: • CHMP ground 1: The long-term consequences of mipomersen-induced liver steatosis are of major concern and difficult to monitor in clinical practice through non-invasive tests;
Danish: • CHMP's begrundelse 1: Der er stærk betænkelighed ved de langsigtede konsekvenser af den af mipomersen forårsagede leversteatose, som er vanskelige at overvåge ved ikke-invasive test i klinisk praksis.
English: Thus, the CHMP concluded that with respect to mipomersen´s hepatotoxicity, no aspects other than the ones already assessed in the initial procedure, which could lead to different conclusions, were presented by the applicant.
Danish: Vedrørende hepatotoksiciteten af mipomersen konkluderede CHMP derfor, at ansøgeren, ud over, hvad der blev vurderet ved den indledende procedure, ikke har redegjort for andre aspekter, der kan lede til andre konklusioner.
English: Treatment with mipomersen results in a statistically significant decline of 24.7% and 35.9% in LDL-C levels at Primary Efficacy Time point (PET) versus baseline in patients with homozygous familial hypercholesterolaemia (HoFH) and severe heterozygous familial hypercholesterolaemia (HeFH) on top of statins, respectively.
Danish: Mipomersen som tillægsbehandling til statiner resulterer i et statistisk signifikant fald på 24,7 % og 35,9 % i LDL-C fra baseline til tidspunktet for vurdering af primær virkning (PET) hos patienter med henholdsvis homozygot familiær hyperkolesterolæmi (HoFH) og svær heterozygot familiær hyperkolesterolæmi (HeFH).
English: In the Open-Label Extention study, patients showed ALT increases (18%), AST increases (16%), hepatic enzyme increases (3%), abnormal liver function tests (2%), and transaminases increases (0.7%).
Danish: I den ublindede forlængede undersøgelse forekom der stigninger i ALT (18 %), AST (16 %) og leverenzymer (3 %), abnorm leverfunktionstest (2 %) og stigning i transaminaser (0,7 %).
English: It cannot be taken for granted that the proposed extrapolations apply, i.e. whether the observed LDL reduction in HoFH patients, starting from LDL levels at the upper end of the scale, will translate into equally large CVS risk reductions as claimed for statin treated broad hyperlipidaemic populations of different states of health.
Danish: Det kan ikke tages for givet, at de foretagne ekstrapolationer er gyldige, dvs. om den iagttagne reduktion i LDL hos HoFH-patienter fra et niveau i den øvre ende af skalaen vil resultere i en lige så stor reduktion af kardiovaskulær sikkerhedsrisiko som ved statinbehandling af en generelt hyperlipidæmisk population med anderledes helbredstilstand.
English: Therefore, the lack of predefined adjudication of CVS events is clearly a deficiency and, if a marked difference in CVS events is observed, this may raise a concern despite a small database.
Danish: Den manglende prædefinerede bedømmelse af kardiovaskulære sikkerhedshændelser er derfor en klar mangel, og en markant forskel i kardiovaskulære hændelser kan derfor give grund til betænkelighed, selv om databasen er lille.
English: - 61.8% (63/102) of mipomersen treated patients with paired MRI studies experienced a ≥5% increase from baseline in hepatic fat.
Danish: - Hos 61,8 % (63/102) af de patienter, der blev behandlet med mipomersen og fik udført MRI-scanning to gange, steg leverens fedtfraktion ≥5 % fra baseline.
English: In the pooled phase 3 studies, thirty six (13.8%) mipomersen-treated patients experienced increases in ALT and AST that met protocol-defined monitoring/safety rules for liver chemistry.
Danish: I de poolede fase 3-undersøgelser fik 36 (13,8 %) af patienterne behandlet med mipomersen stigninger i ALT og AST, som modsvarede de protokoldefinerede overvågnings- og sikkerhedsregler for leverkemi.
English: These patients would not have experienced any CVS benefit.
Danish: Sådanne patienter vil ikke have haft fordele hvad angår kardiovaskulær sikkerhed.
English: However, while it is agreed that the LDL reduction is predictive of a long-term CVS risk reduction, the implied magnitude of reduction of CHD risk of 50% is speculative.
Danish: Skønt det medgives, at reduktion af LDL er prædiktiv for langsigtet mindskelse af kardiovaskulær risiko, er den angivne 50 % risikonedsættelse for koronar hjertesygdom spekulativ.
English: • CHMP ground 2: Uncertainties remain regarding effects of mipomersen on longterm cardiovascular outcome.
Danish: • CHMP's begrundelse 2: Der tilbagestår usikkerhed omkring virkningerne af mipomersen på det langsigtede kardiovaskulære udfald.
English: The benefits of mipomersen-induced reductions in LDL-C in this population, which is at great risk of premature death, are anticipated to be large (potentially greater than 50% risk reduction of CHD, based on meta-analysis of multiple clinical trials), in contrast to the known and hypothetical risks of treatment with mipomersen.
Danish: Der forventes at være stor fordel forbundet med reduktion af LDL-C hos denne population, som har høj risiko for tidlig død (potentielt med større risikoreduktion end 50 % for koronar hjertesygdom, baseret på metaanalyse af en række kliniske undersøgelser), i modsætning til de kendte og hypotetiske risici ved behandling med mipomersen.
English: In the pivotal study in HoFH patients (ISIS 301012-CS5), hepatic fat was not routinely measured postbaseline, however, according to the applicant, there were 11 patients from CS5 with liver fat content assessment at baseline and at 12 months or longer on mipomersen treatment.
Danish: I hovedundersøgelsen hos HoFH-patienter (ISIS 301012-CS5) blev leverens fedtfraktion ikke rutinemæssigt målt efter baseline, men ansøgeren oplyste, at 11 patienter fra CS5 fik foretaget bestemmelse af leverens fedtfraktion ved baseline og efter behandling med mipomersen i 12 måneder eller længere.
English: The pivotal studies with mipomersen have neither been prospectively planned nor adjudicated for CVS safety outcome and thus, only limited conclusions can be drawn from the presented data.
Danish: De kliniske undersøgelser med mipomersen er ikke prospektivt planlagt eller vurderet med henblik på kardiovaskulære sikkerhedsudfald, hvorfor der kun kan drages begrænsede konklusioner af de forelagte data.
English: Uncertainties remain regarding effects of mipomersen on long-term cardiovascular outcome.
Danish: Der tilbagestår usikkerhed omkring virkningerne af mipomersen på det langsigtede kardiovaskulære udfald.
English: For the individual patient, the worst case scenario could be that they might not obtain the potential benefit of mipomersen in terms of reduced CVS morbidity/mortality because they cannot tolerate long-term treatment, but might be harmed by progressive liver disease resulting from mipomersen-induced steatohepatitis.
Danish: For den enkelte patient kan det værste scenarie tænkes at bestå i, at patienten på grund af manglende tolerans over for langvarig behandling ikke opnår de potentielle fordele ved mipomersen i form af mindsket kardiovaskulær morbiditet/mortalitet, men pådrager sig progressiv leversygdom som følge af mipomersen-induceret steatohepatitis.
English: This was not considered applicable either, even if possible within the scope of Article 2 of Commission Regulation (EC) No. 507/2006, as the requirements as defined in Article 4 of the said Regulation were not met, in particular the demonstration by the applicant of a positive risk-benefit balance of the medicinal product and the likelihood to provide comprehensive clinical data by way of specific obligations.
Danish: Artikel 2 i Kommissionens forordning (EF) nr. 507/2006 åbner mulighed herfor, men dette fandtes ikke at kunne komme i betragtning på grund af manglende opfyldelse af kravet i forordningens artikel 4, dvs. ansøgeren skal påvise, at forholdet mellem fordele og risici er positivt, og at det er sandsynligt, at ansøgeren er i stand til at fremskaffe fuldstændige kliniske data gennem nærmere bestemte forpligtelser.
English: Though such liver disease could develop after long-term treatment, and thus patients could have experienced CVS benefit, hepatotoxicity could also develop as sequel to liver enzyme elevations following only short term treatment, even if patients are discontinued early.
Danish: Skønt en sådan leversygdom måske først opstår efter langvarig behandling, og patienten således har haft kardiovaskulære sikkerhedsfordele, kan hepatotoksicitet også tænkes at udvikles som sequela til leverenzymforhøjelsen efter kort tids behandling, uanset tidlig seponering.
English: • The rates of discontinuation from mipomersen treatment (taking into account the patient's consented length of treatment) are similar to those observed with statins and other lipid-lowering therapies and with other approved SC injectable therapies studied in similar long-term studies, although, due to a lack of placebo control in the long-term extension study, the true adherence rate in this study is not possible to assess.
Danish: • Andelen af seponeringer af mipomersen (i henhold til den behandlingsvarighed, patienten har samtykket i) svarer til, hvad der er set med statiner og andre lipidsænkende midler og med andre subkutane injektionspræparater i tilsvarende langsigtede undersøgelser, skønt den faktiske retentionsandel ikke kan fastlægges på grund af manglende placebokontrolgruppe i den langsigtede forlængede undersøgelse.
English: Focusing on the targeted HoFH population, the CHMP noted that the withdrawal rate for HoFH patients who had been enrolled in the pivotal 6 months DB study CS5 and consented to further participate in the OL extension study CS6 (for one or two years, including the time in CS5), was approximately 60% (23/38) within the first two years.
Danish: Vedrørende HoFH-målpopulationen konstaterede CHMP, at der i løbet af de første to år var en udtrædelsesrate på ca. 60 % (23/38) af de HoFH-patienter, der deltog i den dobbeltblindede seks måneders undersøgelse CS5 og samtykkede i også at deltage i den åbne forlængelse CS6 (i et eller to år inkl.
English: Mipomersen exhibits adverse effect on liver and other mechanisms of liver damage beyond fat accumulation cannot be excluded.
Danish: Mipomersen har negativ virkning på leveren, og det kan ikke udelukkes, at der er andre mekanismer for leverbeskadigelse end fedtakkumulering.
English: CHMP position on ground 1
Danish: CHMP's stillingtagen til begrundelse 1
English: • Within the context of the small number of patients tested, the 6-month treatment time of placebo-controlled studies, and the 6-month follow-up time, final conclusions regarding CVS adverse effects as demonstrated in the clinical studies cannot be reached at this time; however, the results of analyses performed to date do not provide support for a difference in the rate of MACE between treatment groups.
Danish: • Med det lille antal testede patienter giver de placebokontrollerede undersøgelser af seks måneders varighed og med seks måneders opfølgningsperiode ikke på nuværende tidspunkt grundlag for konklusioner om kardiovaskulære bivirkninger; de hidtil foretagne analyser giver imidlertid ikke grund til at antage, at der er forskel mellem behandlingsgrupperne i andelen af større utilsigtede kardiale hændelser.
English: Concern remains about the potential progression of fatty liver disease to steatohepatitis and fibrosis, for which monitoring of patients at risk of developing inflammatory and fibrotic changes includes repeated liver biopsy.
Danish: Der er fortsat betænkelighed ved den potentielle progression af fedtleversygdom til steatohepatitis og fibrose, der indebærer gentagne leverbiopsier som led i overvågningen af patienter, som har risiko for udvikling af inflammatoriske og fibrotiske ændringer.
English: This corresponds to a reduction by 21% and 48% with mipomersen when corrected with placebo (for HoFH and HeFH, respectively).
Danish: Efter korrektion for placebo svarer dette til en reduktion på 21 % og 48 % med mipomersen for henholdsvis HoFH og HeFH.
English: In case of the pivotal study in HoFH patients (ISIS 301012-CS5) patients with a documented history of hepatic disease, liver cirrhosis, or liver steatosis were also excluded.
Danish: Hovedundersøgelsen med HoFH-patienter (ISIS 301012-CS5) ekskluderede ligeledes patienter med dokumenteret leversygdom, levercirrose eller leversteatose i anamnesen.
English: CHMP position on ground 3
Danish: CHMP's stillingtagen til begrundelse 3
English: - a median increase in hepatic fat fraction of 9.6% in mipomersen treated patients versus 0.02% in placebo-treated patients was observed,
Danish: - Den mediane stigning i hepatisk fedtfraktion var 9,6 % med mipomersen, mod 0,02 % med placebo.
English: In the clinical development programme increases in hepatic transaminases (ALT, AST) and liver fat were observed frequently in patients who received mipomersen therapy.
Danish: I det kliniske udviklingsprogram sås ofte stigninger i levertransaminaser (ALT, AST) og leverens fedtindhold hos patienter i behandling med mipomersen.
English: • CHMP ground 3: The high overall withdrawal rate with mipomersen after 2-3 years, even in the restricted HoFH population, remains a major concern, thus severely limiting the number of patients that may obtain a potential benefit from its lipid-lowering effect.
Danish: • CHMP's begrundelse 3: Der er alvorlig betænkelighed ved den høje samlede udtrædelsesrate med mipomersen efter 2-3 år, selv i den begrænsede HoFHpopulation, idet dette stærkt begrænser det antal patienter, der potentielt kan få gavn af dets lipidsænkende virkning.
English: The applicant presented an updated proposed SmPC and RMP, and the postauthorisation safety study (PASS) and believes that mipomersen would serve as an important therapeutic option to help address the significant unmet medical need of patients with HoFH.
Danish: Ansøgeren fremlagde forslag til et opdateret produktresumé og til en opdateret risikostyringsplan samt en sikkerhedsundersøgelse efter godkendelse (PASS), og vedkommende mener, at mipomersen vil være et middel til at imødekomme et uopfyldt behandlingsbehov hos patienter med HoFH.
English: Liver enzyme increase
Danish: Stigning i leverenzymer
English: On the other hand, given the absence of events in the placebo arms of the combined pivotal phase 3 studies in patients at very high cardiovascular risk, the relatively small sample size and short study duration, this finding might also be attributed to a chance.
Danish: Dette resultat kan dog også skyldes en tilfældighed på baggrund af de manglende hændelser i placeboarmen i de kombinerede fase 3-hovedundersøgelser hos patienter med meget høj kardiovaskulær risiko, den relativt lille stikprøvestørrelse og undersøgelsernes korte varighed.
English: There was an association between the higher increases in hepatic fat content and greater percent reductions in apo B consistent with the mipomersen mechanism of action, suggesting a direct relationship between the degree of mipomersen lipidlowering effect and the degree of steatosis, which the CHMP considers to be a concern still not adequately addressed.
Danish: Dette er i overensstemmelse med mipomersens virkningsmekanisme og tyder på en direkte sammenhæng mellem graden af mipomersens lipidsænkende virkning og graden af steatose, hvilket CHMP anser for at være et problem, som fortsat ikke er løst på tilfredsstillende måde.
English: The high overall withdrawal rate with mipomersen after 2-3 years, even in the restricted HoFH population, remains a concern, thus severely limiting the number of patients that may obtain a potential benefit from its lipid-lowering effect.
Danish: Selv i den begrænsede HoFH-population er der en høj samlet udtrædelsesrate med mipomersen efter 2-3 år, hvilket er betænkeligt og stærkt begrænser antallet af patienter, der potentielt kan have gavn af dets lipidsænkende virkning.
English: There is no known threshold at which hepatic steatosis or liver fat fraction results in inflammation and progressive liver disease, which renders the monitoring of onset of liver related adverse events difficult.
Danish: Der er ingen kendt tærskel, ved hvilken leversteatose eller leverens fedtfraktion medfører inflammation og progressiv leversygdom.
English: The CHMP acknowledged that in a small population like that of HoFH patients, the collection of a large database is not likely; nevertheless the importance of monitoring the CVS safety data as stressed in this guidance still applies.
Danish: CHMP vedgik, at der i en lille population som HoFH-patienter ikke kan forventes indsamlet en stor database.
English: However, based on data from pivotal studies and OLE CS6 study, withdrawal rates may be as high as 50%-70% at two years and mainly due to mipomersen treatment intolerability, thus, significantly decreasing the rate of patients that may benefit from the lipid-lowering effect of the drug in the long-term, which is considered a major concern.
Danish: Data fra hovedundersøgelserne og OLE CS6undersøgelsen viser imidlertid, at udtrædelsesraterne efter to år kan være så høje som 50 % - 70 %, hovedsagelig på grund af intolerans over for mipomersen.
English: No conclusive evidence was provided to support the assumption that mipomersen-induced liver steatosis, which is associated with its mechanism of action, has a benign course.
Danish: Der er ikke konklusiv evidens for at antage et benignt forløb af den leversteatose, der induceres af mipomersen og er knyttet til dets virkningsmekanisme.
English: Therefore, pursuant to Article 12 of Regulation (EC) No 726/2004, the CHMP has recommended the refusal of the granting of the marketing authorisation for Kynamro.
Danish: CHMP anbefalede derfor afslag på ansøgning om udstedelse af markedsføringstilladelse for Kynamro i medfør af artikel 12 i forordning (EF) nr.
English: Furthermore, although the relevant risks (apart from the off label use) are identified within the RMP, the PRAC considers the RMP insufficient to adequately identify CVS risk.
Danish: Skønt risikostyringsplanen udpeger de relevante risici (bortset fra ikke-godkendt brug), finder Udvalget for Risikovurdering inden for Lægemiddelovervågning, at risikostyringsplanen ikke adækvat dækker kardiovaskulære risici.
English: In addition, it must also be considered that the estimates result from a small HoFH patient set, and though a treatment effect on LDL reduction is shown, the magnitude of this estimate is still prone to some variability.
Danish: Der er påvist virkning af behandlingen i form af reduktion af LDL, men dennes anslåede størrelse er underkastet nogen variabilitet.
English: A similar or even higher event rate might be expected for MACE (including acute myocardial infarction, stroke or CVA, unstable angina, PCI, and CABG) in a patient population such as the one enrolled in the pivotal phase 3 studies (HoFH and severe HeFH patients).
Danish: Hos en population som i fase 3hovedundersøgelserne (patienter med HoFH og svær HeFHD) kan der muligvis forventes samme eller en endnu højere hændelsesrate af større utilsigtede kardiale hændelser (MACE) (herunder akut myokardieinfarkt, apopleksi eller cerebrovaskulært attak, ustabil angina, perkutan koronar intervention og koronar bypassoperation).
English: Statistically significant percent reductions with mipomersen compared to placebo were also observed for apo B, TC, and non HDL-C from baseline to PET.
Danish: Også for apo-B, totalkolesterol (TC) og non-HDL-C medførte mipomersen statistisk signifikant reduktion fra baseline til PET sammenlignet med placebo.
English: 26, week 52 and week 72 is too small to draw firm conclusions regarding long-term effects on liver fat accumulation with mipomersen treatment.
Danish: I OLE-undersøgelsen var der for få patienter med tilgængelige data ved baseline og i uge 26, 52 og 72 til, at der kan drages faste konklusioner om de langsigtede virkninger af mipomersen på fedtakkumulering i leveren.
English: In particular, the numerical imbalance in overall CV events, MACE and CV hospitalisations is of concern.
Danish: Navnlig er der betænkelighed ved den numeriske ubalance i det samlede antal kardiovaskulære hændelser, større utilsigtede kardiale hændelser (MACE) og indlæggelser af kardiovaskulære årsager.
English: Twenty two (15.6%) patients experienced increases in ALT and AST that met protocol-defined monitoring/safety rules for liver chemistry; for 8 (5.7%) of these patients, dosing with mipomersen was stopped.
Danish: Hos 22 (15,6 %) af patienterne modsvarede stigningerne i ALT og AST de protokoldefinerede overvågnings- og sikkerhedsregler for leverkemi.
English: Furthermore, in the placebo arm of the pooled phase 2 and 3 trial population including patients at somewhat lower CVS risk (as compared with the very high CV risk in HoFH patients), a higher number of MACE was noted, again potentially indicating that the absence of MACE in the placebo arms of the pivotal studies of overall small size might be a chance finding.
Danish: Der var desuden et højere antal større utilsigtede kardiovaskulære hændelser i placeboarmen af den poolede fase 2- og 3-undersøgelsespopulation bestående af patienter med noget lavere kardiovaskulær risiko (end den meget høje kardiovaskulære risiko hos patienter med HoFH).
English: CHMP position on ground 2:
Danish: CHMP's stillingtagen til begrundelse 2
English: Potential negative effects, in particular inflammatory effects, immunological reactivity, increase in blood pressure and renal toxicity (as shown by proteinuria) on other cardiovascular risk factors may counteract the potential beneficial effect on CV outcome due to reduction in LDL-C;
Danish: Den potentielt gavnlige virkning på det kardiovaskulære udfald gennem reduktion i LDL-C vil muligvis modvirkes af potentielle negative virkninger, navnlig inflammatoriske effekter, immunologisk reaktivitet, blodtryksstigninger og renal toksicitet (der viser sig som proteinuri).
English: Potential negative effects, in particular inflammatory effects, immunological and renal toxicity (as shown by proteinuria) on other cardiovascular risk factors may counteract the potential beneficial effect on CVS outcome due to reduction in LDL-C.
Danish: Den potentielt gavnlige virkning på kardiovaskulært udfald gennem reduktion i LDL-C kan tænkes at modvirkes af potentielle negative virkninger på andre kardiovaskulære risikofaktorer, navnlig inflammatoriske virkninger, immunologisk toksicitet og renal toksicitet (som viser sig ved proteinuri).
English: Clinical studies have not been prospectively planned nor adjudicated for CVS safety outcomes so that only limited conclusions can be drawn from the presented data.
Danish: Der kan derfor kun drages begrænsede konklusioner af de forelagte data.
English: Further information can be found in the summary of the risk management plan.
Danish: Yderligere oplysninger fremgår af sammendraget af risikostyringsplanen.
English: In addition, panobinostat works in a different way to existing treatments.
Danish: Derudover virker panobinostat på en anden måde end ved eksisterende behandlinger.
English: This is a summary of the European public assessment report (EPAR) for Farydak.
Danish: Dette dokument er et sammendrag af den europæiske offentlige vurderingsrapport (EPAR) for Farydak.
English: It will also provide a final analysis from the main study on how long patients who have been treated with the medicine survive.
Danish: Virksomheden vil endvidere levere en endelig analyse fra hovedundersøgelsen vedrørende overlevelseslængden for patienter, som er blevet behandlet med lægemidlet.
English: The Agency's Committee for Medicinal Products for Human Use (CHMP) considered the increase in progression free survival to be clinically significant although it noted that a benefit in overall survival had not yet been shown.
Danish: Agenturets Udvalg for Lægemidler til Mennesker (CHMP) konkluderede, at forøgelsen af progressionsfri overlevelse var klinisk signifikant, selvom det blev bemærket, at generel længere overlevelse endnu ikke var påvist.
English: Other information about Farydak
Danish: Andre oplysninger om Farydak