FrancophonIA/ELRC3.0 huggingface dataset:
English: It was noted that there was a small excess of cases of heart failure (cilostazol: 2.9%, vs. placebo: 2.4%) and hypotension (cilostazol: 0.7%, vs. placebo: 0.1%) in the CASTLE study.
Danish: I CASTLE-undersøgelsen bemærkedes en lille overhyppighed af hjertesvigt (cilostazol: 2,9 %, mod placebo: 2,4 %) og af hypotension (cilostazol: 0,7 %, mod placebo: 0,1 %).
English: In the CASTLE trial, a lower bleeding event rate was observed in the cilostazol arm than in the placebo arm and the use of concomitant aspirin did not increase the frequency of bleeding in the sub-group treated with cilostazol.
Danish: I CASTLE-undersøgelsen var der færre blødningsepisoder i cilostazolarmen end i placeboarmen, og samtidig brug af acetylsalicylsyre øgede ikke blødningsfrekvensen i den undergruppe, der fik cilostazol.
English: The first DUS' will obtain baseline data with the objective to describe the characteristics of new users of cilostazol and the duration of the use of cilostazol and discontinuation patterns.
Danish: I den første undersøgelse indhentes baseline-data til karakterisering af nye brugere af cilostazol og mønsteret for anvendelsesvarighed og seponering.
English: Overall, the group was of the view that for a small group of patients with low risk of cardiovascular co-morbidities, limiting intermittent claudication who cannot manage initial exercise rehabilitation, or who are unsuitable for revascularisation, this drug may have a role.
Danish: Overordnet var det gruppens opfattelse, at dette lægemiddel kan have berettigelse hos en lille patientgruppe, som har lav risiko for kardiovaskulær komorbiditet, som lider af begrænsende claudicatio intermittens, og som ikke kan klare den indledende rehabilitering med motion eller er uegnede til revaskularisering.
English: The CHMP was therefore of the opinion that cilostazol has a statistically significant, albeit modest effect on walking distances in patients with IC and that some patients may benefit to a clinically relevant degree.
Danish: CHMP fandt derfor, at cilostazol har en statistisk signifikant, omend moderat virkning på gangdistancen hos patienter med claudicatio intermittens, og at nogle patienter kan have klinisk relevant gavn heraf.
English: Cilostazol is associated with a modest but statistically significant increase in walking distance compared with placebo in patients with IC, and this has also been demonstrated using quality of life measurements.
Danish: Cilostazol medfører en beskeden, men statistisk signifikant forøgelse i gangdistance i forhold til placebo hos patienter med claudicatio intermittens, og dette er også påvist ved livskvalitetsvurderinger.
English: The hazard ratio for mortality (cilostazol vs. placebo) was 0.94, 95% CI [0.63-1.39].
Danish: Hazard ratio for dødelighed (cilostazol mod placebo) var 0,94 med 95 % SI
English: In view of this, the CHMP considered that cilostazol should be contraindicated in patients with a history of severe tachyarrhythmia and that additional warnings should be introduced in the PI.
Danish: På denne baggrund fandt CHMP, at cilostazol bør være kontraindiceret hos patienter med svær takyarytmi i anamnesen, og at der bør indsættes yderligere advarsler i produktinformationen.
English: However, concomitant aspirin and clopidogrel treatment together increased the risk of bleeding in the cilostazol group compared with the placebo patients.
Danish: Ved samtidig behandling med både acetylsalicylsyre og clopidogrel var der imidlertid større blødningsrisiko i gruppen på cilostazol end i placebogruppen.
English: Also, cilostazol should only be initiated by physicians experienced in the management of intermittent claudication after suitability of treatment with cilostazol has been carefully considered, alongside other treatment options such a revascularisation.
Danish: Ligeledes bør behandlingen med cilostazol kun iværksættes af læger med erfaring i behandling af claudicatio intermittens, og kun efter forudgående nøje overvejelse af egnetheden af behandling med cilostazol sammenlignet med andre behandlingsmuligheder såsom revaskularisering.
English: The study will also aim to quantify off-label use, describe dosage patterns and identify the medical specialties of physicians prescribing cilostazol.
Danish: Undersøgelsen skal desuden søge at kvantificere ikke godkendt anvendelse, beskrive doseringsmønstrene og kortlægge, inden for hvilke specialer der ordineres cilostazol.
English: In all efficacy trials cilostazol showed a higher percentage improvement in ACD when compared with placebo and this was statistically significant in 6 of the 9 trials.
Danish: I alle undersøgelser af virkning medførte cilostazol procentuelt større forbedring af ACD end placebo, og forskellen var statistisk signifikant i seks af de ni undersøgelser.
English: It was noted by the CHMP that the increase in walking distance on flat ground is likely to be greater than the increase measured on the treadmill - which is set on an incline.
Danish: CHMP bemærkede, at der må forventes større forskel i gangdistance på vandret underlag end i trædemøllensom svarer til en opadskrånende flade.
English: In addition, considering its anti-platelet activity, cilostazol is expected to increase the risk of bleeding.
Danish: I betragtning af sine trombocytfunktionshæmmende egenskaber forventes cilostazol desuden at øge blødningsrisikoen.
English: In view of this, the CHMP considered that patients treated concomitantly with two or more additional antiplatelet or anticoagulant agents (e.g. aspirin acetylsalicylic acid, clopidogrel, heparin, warfarin, acenocoumarol, dabigatran, rivaroxaban or apixaban) should not be treated with cilostazol-containing products.
Danish: På denne baggrund fandt CHMP, at patienter, der er i samtidig behandling med to eller flere yderligere trombocytfunktionshæmmende midler eller antikoagulantia (f.eks. acetylsalicylsyre, clopidogrel, heparin,
English: The primary analysis, pre-specified in the protocols, demonstrated a statistically significant longer walking distance in patients receiving cilostazol 100mg bid over placebo.
Danish: Den primære analyse, der var prædefineret i protokollerne, viste statistisk signifikant større gangdistance med cilostazol, 100 mg to gange dagligt, end med placebo.
English: The Committee concluded that the benefit-risk balance of cilostazol products for the improvement of the maximal walking distance and maximal pain-free walking distances in patients with intermittent claudication (IC), who do not have rest pain and who do not have evidence of peripheral tissue necrosis (peripheral arterial disease Fontaine stage II) remains positive under normal conditions of use, subject to restrictions, warning, changes to the product information and risk minimisation measures agreed.
Danish: Udvalget konkluderede, at benefit/risk-forholdet under normale omstændigheder fortsat er positivt for produkter indeholdende cilostazol til forbedring af maksimal gangdistance og maksimal smertefri gangdistance ved claudicatio intermittens uden hvilesmerter og uden tegn på perifer vævsnekrose (perifer arteriel sygdom Fontaine stage II), forudsat at der gennemføres de vedtagne begrænsninger, advarsler, ændringer i produktinformationen og risikominimeringsforanstaltninger.
English: The results from clinical trials did not generate any signal of serious cardiac arrhythmic events, but a small number of serious events (ventricular tachycardia, electrocardiogram QT prolongation (including Torsade de Pointes)) were received from spontaneous sources/non-interventional studies and some of these were considered compatible with the chronotropic effects of cilostazol.
Danish: I de spontane indberetninger/ikke-interventionelle undersøgelser var der imidlertid enkelte alvorlige hændelser (ventrikulær takykardi, QT-forlængelse i EKG (herunder Torsade de Pointes)), hvoraf nogle blev anset for forenelige med de kronotrope virkninger af cilostazol.
English: The increase in walking distance over baseline walking distance with cilostazol treatment was 35% higher than with placebo.
Danish: Cilostazol øgede gangdistancen i forhold til baseline 35 % mere end placebo.
English: In terms of safety, clinical trial data showed that the most commonly-reported adverse events are headaches, diarrhoea, dizziness, palpitations, peripheral oedema and tachycardia, and these adverse events were listed in the product information.
Danish: Hvad sikkerheden angår, er de hyppigst indberettede bivirkninger i de kliniske undersøgelser hovedpine, diarré, svimmelhed, palpitationer, perifert ødem og takykardi, som i forvejen var nævnt i produktinformationen.
English: Although a post-hoc analysis, the demonstration that the current accepted CV MACE in studies of new drugs (CV death, non-fatal MI and stroke) was statistically significantly lower in the treatment group was felt to give strong reassurance on CV safety.
Danish: Vedrørende den kardiovaskulære sikkerhed fandt de det meget betryggende, at den gældende vedtagne CV MACE for undersøgelse af nye lægemidler (kardiovaskulære dødsfald, ikke-fatalt myokardieinfarkt og apopleksi) var signifikant lavere i behandlingsgruppen, selv om dette var fundet ved post hoc-analyse.
English: Cilostazol is a dihydro-quinolinone derivative that belongs to the pharmacotherapeutic group antithrombotic agents, platelet aggregation inhibitor excluding heparin.
Danish: Cilostazol er et dihydroquinolinonderivat i den farmakoterapeutiske klasse antitrombotiske midler, trombocytfunktionshæmmende midler, andre trombocytaggregationshæmmere end heparin.
English: The proposal from the MAHs to recommend a reduction to 50mg bid in some patient sub-groups was welcomed by the group.
Danish: Gruppen tilsluttede sig anbefalingen om dosisnedsættelse til 50 mg to gange dagligt til visse patientundergrupper som foreslået af indehaveren af markedsføringstilladelsen.
English: Point estimates in all nine trials favoured cilostazol 100mg bid over placebo and the analysis demonstrated statistical superiority of cilostazol over placebo in six of the nine trials.
Danish: I alle ni undersøgelser var punktestimaterne til fordel for cilostazol, 100 mg to gange dagligt, sammenlignet med placebo, og i seks af de ni undersøgelser påvistes statistisk superioritet af cilostazol, 100 mg to gange dagligt, over placebo.
English: The second DUS will have the objective to evaluate the effectiveness of the proposed SmPC changes, educational initiatives and other implemented risk minimisation measures in terms of the mitigation of off-label use and adherence of prescribers to the SmPC, in comparison with baseline data.
Danish: Den anden undersøgelse skal gennem sammenholdelse med baseline-data vurdere effektiviteten af de foreslåede ændringer af produktresuméet, efteruddannelsestiltagene og de øvrige gennemførte risikominimeringsforanstaltninger på undgåelse af ikke-godkendt brug og på de ordinerende lægers overholdelse af produktresuméet.
English: Whereas
Danish: CHMP
English: The anti-platelet activity of cilostazol also raised a concern for haemorrhagic events.
Danish: Den trombocytfunktionshæmmende aktivitet af cilostazol gav desuden anledning til betænkelighed vedrørende blødningsepisoder.
English: A greater proportion of ‘completers' treated with cilostazol were classified as ‘responders' than those treated with placebo (39.6%, vs. 26.3% ) with ‘responders' defined as those patients whose walking distance had improved by 50% or more from baseline.
Danish: Af de patienter, der gennemførte, var der flere respondenter blandt de cilostazol-behandlede end blandt de placebobehandlede (39,6 % mod 26,3 %).
English: Data relating to quality of life assessments and responder analyses was considered in the assessment as these data give some insight into the issue of the clinical relevance of the treatment effect, which is complicated by the fact that patients are likely to have different levels of benefit depending on the severity of their intermittent claudication (IC) symptoms.
Danish: I vurderingen blev der taget hensyn til livskvalitets- og responderanalyse, da disse data giver nogen indsigt i den kliniske relevans af behandlingsvirkningen.
English: Finally The Committee agreed to drug utilisation studies to describe the characteristics of new users of cilostazol and the duration of the use of cilostazol and discontinuation patterns, and thereby to evaluate the effectiveness of the implemented risk minimisation measures;
Danish: CHMP vedtog desuden foranstaltninger til at sikre, at sundhedspersoner informeres om anvendelsesbetingelserne for produktet, Endelig godkendte udvalget to undersøgelser af lægemiddelanvendelse, der skal karakterisere nye brugere af cilostazol og mønsteret i anvendelsen af cilostazol og dets seponering for derigennem at vurdere effektiviteten af de gennemførte risikominimeringsforanstaltninger,
English: A pooled meta-analysis of these trials using the ratio of geometric means for LOG (ACD at last visit/ACD at baseline) for cilostazol vs. placebo demonstrated a treatment effect of 1.15 (95% CI: 1.11 - 1.19) for ACD.
Danish: Analysen viste en behandlingsvirkning på 1,15 (95 % SI for ACD: [1,11; 1,19].
English: Other adverse events of interest such as myocardial ischemia (myocardial infarction, angina pectoris, coronary artery disease), congestive heart failure and hypotension, were also identified during the mid-term efficacy clinical trials, with a higher incidence in the cilostazol group compared to placebo.
Danish: I de mellemlange kliniske undersøgelser af virkning var der desuden andre bivirkninger af interesse, som forekom hyppigere med cilostazol end med placebo: myokardieiskæmi (myokardieinfarkt, angina pectoris, koronararteriesygdom), venstresidigt hjertesvigt og hypotension.
English: The experts considered that the included patients were a reasonable representation of real-life and it was hard to argue that the study was not reassuring and agreed that cilostazol has shown a consistent trend for being as safe as placebo across the major cardiovascular endpoints.
Danish: Eksperterne fandt, at de inkluderede patienter var rimeligt repræsentative for praksis, og at undersøgelsen måtte anses for at være betryggende.
English: 5 x 1 bottle (unit pack)
Danish: 5 x 1 flaske (enkeltpakning)
English: In all three media, both products released more than 85% or close to 85% of the drug substance within 15 minutes and more than 95% in 20 minutes.
Danish: I alle tre medier frigav begge lægemidler over 85 % eller tæt ved 85 % af lægemiddelstoffet inden for 15 minutter, og over 95 % i løbet af 20 minutter.
English: The study will therefore be repeated, with the final results expected to be ready by the end of June 2013.
Danish: Undersøgelsen vil derfor blive gentaget, hvorefter de endelige resultater ventes at foreligge ved udgangen af juni 2013.
English: Overall summary of the scientific evaluation of Cilazapril Teva and associated names (see Annex I)
Danish: Samlet resumé af den videnskabelige vurdering af Cilazapril Teva og relaterede navne (se bilag I)
English: The report covers the period 1st January 2009 to 31st December 2011 and identified two case reports, both of which were medically confirmed reports describing non-serious adverse reactions.
Danish: Rapporten omfatter perioden fra den 1. januar 2009 til den 31. december 2011 og henviser til to caserapporter, der begge er lægeligt bekræftede indberetninger af ikkealvorlige bivirkninger.
English: • The Committee considered the procedure under Article 31 of Directive 2001/83/EC for Cilazapril Teva and associated names.
Danish: • udvalget behandlede proceduren i henhold til artikel 31 i direktiv 2001/83/EF for Cilazapril Teva og relaterede navne,
English: The EMA, CMD(h) and CHMP initiated a process to identify and assess all medicinal product dossiers that include studies conducted at the above mentioned facility during the identified time period.
Danish: EMA, CMD(h) og CHMP indledte en identifikation og vurdering af alle lægemiddeldossierer, der omfatter undersøgelser udført på ovennævnte afdeling i den pågældende periode.
English: Finally the MAH noted that the periodic safety update report (PSUR) no. 383/01/12, dated February 13th 2012, reported no increased number of safety concerns with cilazapril.
Danish: Endelig konstaterede indehaveren af markedsføringstilladelsen, at den periodiske opdaterede sikkerhedsindberetning (PSUR) nr. 383/01/12 af 13. februar 2012 ikke viste et øget antal betænkeligheder med hensyn til sikkerheden af cilazapril.
English: Cilazapril Teva is available as 0.5 mg, 1 mg and 2.5 mg and 5 mg tablets.
Danish: Cilazapril Teva leveres som tabletter i styrkerne 0,5 mg, 1 mg, 2,5 mg og 5 mg.
English: Only minor deficiencies were identified, which were not considered to influence the outcome of the clinical bioequivalence (e.g. exact EDTA matrix not specified, validated batch size not given, no influence of haemolytic or lipidaemic plasma shown, matrix effect in 4 different plasma batches shown).
Danish: Der blev kun fundet mindre mangler, som ikke blev anset for at have betydning for resultatet, hvad angår klinisk bioækvivalens (f.eks. ingen eksakt angivelse af EDTA-matrix, ingen størrelsesangivelse på den validerede batch, ingen påvist indflydelse af hæmolytisk eller lipidæmisk plasma, matrixeffekt påvist i fire forskellige plasmabatcher).
English: Cilazapril Teva contains cilazapril, a pyridazine angiotensin-converting enzyme inhibitor (ACE inhibitor) used for the treatment of hypertension and congestive heart failure.
Danish: Cilazapril Teva indeholder cilazapril, en angiotensinkonverterende enzym-hæmmer (ACE-hæmmer) i pyridazingruppen, der anvendes til behandling af hypertension og kongestiv hjerteinsufficiens.
English: The quality of the bio-analytical report was checked internally by the MAH and was considered to be of good quality, based on the guideline applicable at that time (“Guideline for Industry - Bioanalytical Method Validation”, May 2001).
Danish: Den bioanalytiske rapport blev kontrolleret internt af indehaveren af markedsføringstilladelsen og bedømt til at være af god kvalitet på grundlag af de daværende gældende retningslinjer (“Guideline for Industry - Bioanalytical Method Validation”, maj 2001).
English: The CHMP considered that these results could not be extrapolated to confirm the reliability of the pivotal bioequivalence study 2005-980.
Danish: CHMP vurderede, at disse resultater ikke kunne ekstrapoleres til bekræftelse af pålideligheden af bioækvivalenshovedundersøgelse 2005-980.
English: The MAH also referred to comparative dissolution data for the Cilazapril Teva tablets and the reference product, using three different dissolution media (0.1 N HCl, pH 4.5 acetate buffer and pH 6.8 phosphate buffer).
Danish: Indehaveren af markedsføringstilladelsen henviste endvidere til de sammenlignende opløsningsdata for Cilazapril Teva-tabletter og referencelægemidlet, hvor der blev anvendt tre forskellige opløsningsmedier (0,1 N HCl, acetatbuffer med pH 4,5, og fosfatbuffer med pH 6,8).
English: The CHMP also noted the PSUR data, which did not indicate any safety concerns; however this is insufficient to confirm the bioequivalence of the product.
Danish: CHMP bemærkede endvidere, at PSUR-dataene ikke viste tegn på betænkeligheder med hensyn til sikkerheden, hvilket dog er utilstrækkeligt til at bekræfte lægemidlets bioækvivalens.
English: The MAH stated that the calculated f2 values indicated dissolution similarity between the drug products in all three media, and therefore considered the probability of the drug being released in the stomach to be high.
Danish: Indehaveren af markedsføringstilladelsen anførte, at de beregnede f2-værdier viste, at opløsningsegenskaberne for de to lægemidler var de samme i alle tre medier, og at lægemiddelstoffet derfor med stor sandsynlighed ville blive frigivet i mavesækken.
English: • The Committee considered that the available data gave rise to serious doubts as to the evidence of the bioequivalence of Cilazapril Teva and associated names with the EU reference product in view of concerns on the reliability of the data, due to the findings of the inspection of the Cetero Research facilities.
Danish: • udvalget fandt, at de foreliggende data gav anledning til alvorlig tvivl om dokumentationen for bioækvivalensen af Cilazapril Teva og relaterede navne med EU-referencelægemidlet på baggrund af betænkeligheder med hensyn til pålideligheden af dataene som følge af inspektionsresultaterne for Cetero Research,
English: The CHMP also noted the MAH review of study 2005-980 and the quality of the bio-analytical report and the reported similarity between the results generated by Cetero Research and those found from repeated studies/analysis for other drug products.
Danish: CHMP noterede sig endvidere indehaveren af markedsføringstilladelsens gennemgang af undersøgelse 2005-980, kvaliteten af den bioanalytiske rapport og den rapporterede lighed mellem resultaterne fra Cetero Research og resultaterne af gentagelser af undersøgelser/analyser for andre lægemidler.
English: Therefore, given the serious doubts regarding the reliability and the correctness of the data from the critical pivotal bioequivalence study 2005-980, submitted in support of the marketing authorisation, and in the absence of a reliable bioequivalence study specifically designed to establish the bioequivalence of Cilazapril Teva to its EU reference product, the CHMP was unable to conclude on the bioequivalence of Cilazapril Teva.
Danish: På baggrund af den alvorlige tvivl om pålideligheden og korrektheden af dataene fra den afgørende bioækvivalenshovedundersøgelse 2005-980, der var forelagt til støtte for markedsføringstilladelsen, og i mangel af en pålidelig bioækvivalensundersøgelse, der er udformet specifikt med henblik på at fastslå, hvorvidt Cilazapril Teva er bioækvivalent med det tilsvarende EU-referencelægemiddel, var CHMP ude af stand til at drage konklusioner om bioækvivalensen for Cilazapril Teva.
English: Therefore, and in the absence of a reliable bioequivalence study specifically designed to establish the bioequivalence of Cilazapril Teva to its EU reference product, the benefit-risk balance of Cilazapril Teva cannot be considered to be favourable.
Danish: Som følge heraf og i mangel af en pålidelig bioækvivalensundersøgelse, der er udformet specifikt med henblik på at fastslå, hvorvidt Cilazapril Teva er bioækvivalent med det tilsvarende EU-referencelægemiddel, kan benefit/risk-forholdet for Cilazapril Teva ikke anses for tilfredsstillende.
English: The MAH considered that the data described in this PSUR did not impact the benefit-risk balance of Cilazapril Teva.
Danish: Indehaveren af markedsføringstilladelsen fandt, at data i denne PSUR ikke berørte benefit/risk-forholdet for Cilazapril Teva.
English: The MAH was therefore of the view that the formulation of this immediate-release product will have only little influence on the bioavailability, which is supported by good point estimates for AUC and Cmax in study 2005-980.
Danish: Indehaveren af markedsføringstilladelsen mente derfor, at biotilgængeligheden af dette lægemiddel med øjeblikkelig frigivelse kun i ringe grad afhænger formuleringen, hvilket underbygges af de gode punktestimater for AUC og Cmax i undersøgelse 2005-980.
English: Having assessed the available data, the CHMP retained serious doubts due to the findings of the inspection of the Cetero Research facilities in Houston (Texas, USA), regarding the reliability and the correctness of the data from the critical pivotal bioequivalence study submitted in support of the marketing authorisation.
Danish: Efter at have vurderet de foreliggende data og på baggrund af inspektionsresultaterne for Cetero Research-afdelingen i Houston (Texas, USA) var CHMP fortsat stærk i tvivl om pålideligheden og korrektheden af dataene fra den afgørende bioækvivalenshovedundersøgelse, der var forelagt til støtte for markedsføringstilladelsen.