FrancophonIA/ELRC3.0 huggingface dataset:
English: On the efficacy side for the indication “prophylaxis of migraine headache” data derive from a few randomised, double-blind, placebo-controlled studies or double-blind non placebo-controlled and open label studies, the majority of which was conducted after the granting of the initial marketingauthorisation.
Danish: Data vedrørende virkningen ved indikationen “forebyggelse af migræne” er baseret på nogle få randomiserede, dobbeltblindede, placebokontrollerede undersøgelser eller dobbeltblindede ikkeplacebokontrollerede undersøgelser samt åbne undersøgelser, hvoraf størstedelen blev udført efter udstedelsen af den oprindelige markedsføringstilladelse.
English: Some symptoms related to ergotism may be confounded with migraine symptoms and thus not reported as an adverse drug reaction.
Danish: Nogle af symptomerne ved ergotisme kan forveksles med migrænesymptomer og bliver derfor ikke indberettet som en bivirkning.
English: In the acute treatment of migraine, it is administered parenterally or in the form of a nasal spray because of the low bioavailability of the unchanged drug by the oral route.
Danish: Til akut behandling af migræne administreres det parenteralt eller som nasalspray, da den orale biotilgængelighed af det uændrede stof er lav.
English: The efficacy of dihydroergotamine in the acute treatment of migraine attack is not within the scope of this referral and will not be discussed.
Danish: Virkningen af dihydroergotamin til akut behandling af migræneanfald er ikke omfattet af denne indbringelse og vil ikke blive gennemgået.
English: From the approved indications of the dihydroergotamine containing medicinal products the ones that are in the scope of this referral procedure and are approved in at least one Member State are the following (specific wording of the indication may vary from product to product):
Danish: For lægemidler indeholdende dihydroergotamin omfatter denne indbringelsesprocedure følgende indikationer, som er godkendt i mindst én medlemsstat (den konkrete ordlyd af indikationen kan være forskellig for forskellige produkter):
English: Therefore, other mechanisms inducing fibrosis cannot be excluded, which suggests a causal link between fibrosis and agonism of 5-HT2A and 5-HT1B receptors and also plausible effect on serotonin transporter.
Danish: Andre fibrosefremkaldende mekanismer kan således ikke udelukkes, hvilket tyder på en årsagssammenhæng mellem fibrose og agonistisk påvirkning af 5-HT2A- og 5-HT1B-receptorer og sandsynligvis også en virkning på serotonintransporteren.
English: The frequency of attacks of migraine (the primary efficacy criteria) was not statistically significant (dihydroergotamine group (-1.84 ± 1.55) vs. placebo group (-1.67 ± 1.49) (p=0.220)).
Danish: Hyppigheden af migræneanfald (det primære kriterium for virkning) var ikke statistisk signifikant forskelligt i dihydroergotamin-gruppen (-1,84 ± 1,55) fra placebogruppen (-1,67 ± 1,49) (p=0,220).
English: Likewise, the efficacy of dihydroergotamine administered by subcutaneous, intramuscular or intravenous injection or intranasal spray is not within the scope of this referral and will be not discussed.
Danish: Virkningen af dihydroergotamin ved subkutan, intramuskulær eller intravenøs injektion eller som intranasal spray er heller ikke omfattet af denne indbringelse og vil ikke blive gennemgået.
English: For all products the concomitant use of CYP3A inhibitors is contraindicated with dihydroergotamine (section 4.5) and for others the concomitant use of vasonconstrictive agent is also contraindicated.
Danish: For alle produkterne er CYP3A-hæmmere kontraindiceret sammen med dihydroergotamin (punkt 4.5), og for nogle er også vasokonstringerende midler kontraindiceret sammen med dihydroergotamin.
English: In addition, given that fibrosis is a serious life threatening reaction, observed after long duration of treatment with dihydroergotamine (a drug used in indications requiring long duration of treatment) this has an impact on the benefit-risk balance of the products.
Danish: Da fibrose er en livstruende reaktion, som ses efter langtidsbehandling med dihydroergotamin (et lægemiddel, der anvendes ved indikationer, som kræver langtidsbehandling), har dette endvidere betydning for benefit/risk-forholdet for produkterne.
English: In addition, a scientific advisory group (SAG) was convened in December 2012 at the request of the CHMP during which the experts discussed, based on their clinical experience, whether this substance plays a role in the treatment of orthostatic hypotension.
Danish: Desuden blev der på anmodning af CHMP i december 2012 indkaldt en videnskabelig rådgivende gruppe, hvor eksperterne ud fra deres kliniske erfaring drøftede, om dette stof har en plads i behandlingen af ortostatisk hypotension.
English: Moreover, given the seriousness of ergotism and its consequences (sequelae, need for surgery, amputation), the young age of the patients with symptoms of ergotism and the short time to onset of the reaction, the safety profile of dihydroergotamine is highly questionable.
Danish: På baggrund af de alvorlige konsekvenser af ergotisme (sequelae, behov for operationer, amputation), den unge alder af patienter med symptomer på ergotisme og den korte tid til indsætten af reaktioner er sikkerhedsprofilen af dihydroergotamin højst problematisk.
English: Therefore, even if it is highly pharmacologically plausible that ergot derivatives acting as 5HT2B receptor agonists may induce "serotonergic" valve disease similar to that induced by carcinoid tumours or fibrotic lesions of other tissues, it must be remembered that some ergot derivatives are not 5-HT2B receptor agonists.
Danish: Skønt det farmakologisk er stærkt sandsynligt, at ergotderivater gennem deres virkning som 5-HT2B-receptoragonister kan fremkalde “serotonerg” klapsygdom svarende til den, der fremkaldes af carcinoidtumorer eller fibrotiske forandringer i andre væv, må man derfor være opmærksom på, at visse ergotderivater ikke er 5-HT2B-receptoragonister.
English: The literature data indicate a possible efficacy of oral dihydroergotamine in migraine prophylaxis, but definite scientific proof remains weak.
Danish: Litteraturdata tyder på en mulig virkning af oral indtagelse af dihydroergotamin til forebyggelse af migræne, men der er fortsat kun svag videnskabelig evidens herfor.
English: Moreover, the number of cases reported with a contraindicated concomitant drug reveals that information in the SmPC is not sufficient to avoid an exposition of the patient to the serious risk of ergotism.
Danish: Det indberettede antal tilfælde med et kontraindiceret samtidigt anvendt lægemiddel viser desuden, at oplysningerne i produktresuméet ikke er tilstrækkelige til at undgå, at patienterne eksponeres for den alvorlige risiko for ergotisme.
English: The CHMP also stated that the study population, consisting only of drug induced orthostatic hypotension patients, is not representative to conclude on the efficacy of dihydroergotamine in the total population of orthostatic hypotension patients.
Danish: CHMP anførte desuden, at den undersøgte population, der udelukkende bestod af patienter med lægemiddelinduceret ortostatisk hypotension, ikke er repræsentativ for virkningen af dihydroergotamin hos hele populationen af patienter med ortostatisk hypotension.
English: Only one study, Thulesius (1986), demonstrated a significant decrease of immediate drop in blood pressure after standing up with 10mg per day dihydroergotamine compared to placebo, in patients with hypotension induced by treatment with psychotropic drugs and it became available after the initial marketing authorisation was granted.
Danish: Kun én undersøgelse, Thulesius (1986), viste signifikant reduceret momentant blodtryksfald ved overgang til stående stilling ved en dosis på 10 mg af dihydroergotamin dagligt i forhold til placebo hos patienter med hypotension fremkaldt af psykoaktive lægemidler.
English: The relationship between fibrosis and serotoninergic receptor activation, particularly 5-HT2B receptors by ergot derivatives is extensively described in the literature.
Danish: Sammenhængen mellem fibrose og ergotderivaters aktivering af serotoninerge receptorer, navnlig 5-HT2B-receptorer, er udførligt beskrevet i litteraturen.
English: However, a total of 134 cases of ergostim or symptoms potentially related to ergotism have been reported by the MAHs.
Danish: Der blev imidlertid af markedsføringstilladelsesindehaverne indberettet 134 tilfælde af ergotisme eller symptomer med potentiel sammenhæng med ergotisme.
English: • Ancillary treatment of visual acuity decrease and visual field disturbances presumably of vascular origin
Danish: • supplerende behandling af synsnedsættelse og synsfeltforstyrrelser af formodet vaskulær årsag
English: There is little evidence from double-blind, placebo-controlled clinical trials and no uniform picture of the efficacy of oral ergotamine compared to placebo or other substances in the prevention of migraine emerges from these studies since studies reported both positive and negative results.
Danish: Der er kun ringe evidens fra dobbeltblindede, placebokontrollerede kliniske undersøgelser, og undersøgelserne tegner ikke noget ensartet billede af virkningen af oralt ergotamin sammenholdt med placebo eller andre stoffer til forebyggelse af migræne, da de gav både positive og negative resultater.
English: In the only recent, large study with appropriate design (double-blind, placebo-controlled, 5-month treatment study) (PROMISE study) that became available after the granting of the initial marketing authorisation, the evidence for efficacy of dihydroergotamine in the prevention of migraine has not been demonstrated as there was no statistically significant difference between dihydroergotamine and placebo.
Danish: I den eneste nyere, store undersøgelse med hensigtsmæssigt design (dobbeltblindet, placebokontrolleret med 5-måneders behandlingsvarighed) (PROMISE-undersøgelsen), der blev stillet til rådighed efter udstedelsen af den oprindelige markedsføringstilladelse, fandtes der ikke evidens for virkningen af dihydroergotamin til forebyggelse af migræne, da der ikke var statistisk signifikant forskel mellem det aktive stof og placebo.
English: In addition, a scientific advisory group (SAG) was convened in December 2012 at the request of the CHMP during which the experts discussed, based on their clinical experience, whether this substance plays a role in the prophylaxis of migraine headache.
Danish: Desuden blev der på anmodning af CHMP i december 2012 indkaldt en videnskabelig rådgivende gruppe, hvor eksperterne ud fra deres kliniske erfaring drøftede, om dette stof har en plads i forebyggelse af migræne.
English: However, given the number of cases reported with dihydroergotamine, with symptoms related to ergotism (despite probable lacking cases) even when dihydroergotamine is used as recommended (no overdosage, no contraindicated drug, and short time treatment), the high pharmacological plausibility and a suggestive chronology in most of the cases, it is considered that patients are exposed to a high risk of ergotism when treated with dihydroergotamine.
Danish: På baggrund af de indberettede antal tilfælde med dihydroergotamin, hvor der forekom symptomer relateret til ergotisme (trods sandsynlig manglende indberetning af tilfælde), selv når dihydroergotamin blev anvendt i henhold til anbefalingerne (ingen overdosering, intet kontraindiceret lægemiddel og kort behandlingsperiode), den høje farmakologiske plausibilitet og i de fleste tilfælde en påfaldende tidsmæssig sammenhæng findes behandling med dihydroergotamin at udsætte patienterne for høj risiko for ergotisme.
English: The efficacy of dihydroergotamine in the prevention of migraine in this study has not been demonstrated taking into account that there was no statistically significant difference between dihydroergotamine and placebo with respect to the reduction of the frequency of migraine attacks (the primary efficacy criterion) in the overall population.
Danish: Undersøgelsen dokumenterer ikke virkning af dihydroergotamin til forebyggelse af migræne i betragtning af, at der ikke var statistisk signifikant forskel mellem dihydroergotamin og placebo i reduktion af hyppigheden af migræneanfald (det primære kriterium for virkning) hos den samlede population.
English: The CHMP noted the position of several MAHs that there is not enough evidence to support an indication of oral dihydroergotamine in the symptomatic treatment of veno-lymphatic insufficiency and was of the opinion that no scientific conclusion can be drawn regarding the efficacy of dihydroergotamine based on these study results.
Danish: CHMP bemærkede, at flere markedsføringstilladelsesindehavere fandt, at der ikke er tilstrækkelig evidens for indikationerne for oralt dihydroergotamin til symptomatisk behandling af venolymfatisk insufficiens, og var af den opfattelse, at disse undersøgelser ikke giver grundlag for videnskabelige konklusioner om virkningen af dihydroergotamin.
English: Although significant reduction in venous capacity, capillary flow of erythrocytes and peak flow of reactive hyperemia were demonstrated, due to a very small study group, the uncontrolled design and other methodological limitations, the CHMP could not draw any conclusion on the efficacy of dihydroergotamine.
Danish: Skønt der var signifikant reduktion i venekapacitet, erytrocytgennemstrømning i kapillærerne og peakflow af reaktiv hyperæmi, kunne CHMP ikke drage nogen konklusion om virkningen af dihydroergotamin på grund af den meget lille patientgruppe, det ukontrollerede design og andre metodologiske begrænsninger.
English: With regard to the risk of ergotism, the review of cases provided by the MAHs was not exhaustive and the methodology used to retrieve cases of ergotism was unclear for most of the MAHs.
Danish: Markedsføringstilladelsesindehavernes gennemgang var ikke udtømmende hvad angår risikoen for ergotisme, og for størstedelens vedkommende var det uklart, hvilken metode de havde anvendt til at finde tilfælde af ergotisme.
English: To conclude, given the cases reported for a reaction difficult to diagnose early (delayed symptoms) and probably under reported, the use of the drug at an approved dosage, added to a plausible pharmacological profile, dihydroergotamine is considered to be strongly associated with a risk of fibrotic reactions.
Danish: På baggrund af, at de indberettede tilfælde vedrører en reaktion, der er vanskelig at diagnosticere tidligt (forsinket opståen af symptomer) og antagelig er underindberettet, og på baggrund af dihydroergotamins plausible farmakologiske profil konkluderes det, at dihydroergotamin i den godkendte dosering har stærk sammenhæng med risiko for fibrotiske reaktioner.
English: • Ancillary treatment of intermittent claudication in symptomatic peripheral arterial occlusive disease
Danish: • supplerende behandling af claudicatio intermittens ved symptomatisk perifer arteriel okklusiv sygdom (PAOD stadium II)
English: • Symptomatic treatment of chronic pathological cognitive and neurosensorial impairment in elderly
Danish: • symptomatisk behandling af kronisk patologisk kognitiv og neurosensorisk funktionsnedsættelse hos ældre (bortset fra Alzheimers sygdom og anden form for demens)
English: For the percentage of responders (61.1% in the dihydroergotamine group vs. 55.9% in the placebo group) the difference was not statistically significant.
Danish: Der var ikke statistisk signifikant forskel i procentdelen af responderende patienter (61,1 % i dihydroergotamin-gruppen mod 55,9 % i placebogruppen).
English: Overall, the varying affinity for serotoninergic receptors with the different ergot derivatives and the therapeutic doses used may explain the differences observed for notification rates for the fibrotic reactions.
Danish: Overordnet kan de iagttagne forskelle i indberetningshyppigheden for fibrotiske reaktioner muligvis forklares af den varierende affinitet for serotoninerge receptorer af de forskellige ergotderivater og de anvendte terapeutiske doser.
English: − Symptomatic treatment of veno-lymphatic insufficiency.
Danish: • symptomatisk behandling af venolymfatisk insufficiens.
English: Based on the clinical experience the group considered that no special population exists that could benefit from the treatment with this active substance in the prophylaxis of migraine headache.
Danish: På grundlag af de kliniske erfaringer fandt gruppen, at der ikke findes nogen nærmere bestemt population, der vil kunne have fordel af behandling med dihydroergotamin til forebyggelse af migræne.
English: In the preventive treatment of migraine, dihydroergotamine is administered orally for long term.
Danish: Dihydroergotamin anvendes til forebyggelse af migræne som oral langtidsbehandling.
English: No significant improvement over placebo was observed in the subset of patients with unaffected QOL.
Danish: For den undergruppe af patienter, der ikke havde nedsat livskvalitet, iagttoges ikke signifikant bedring i forhold til placebo.
English: • The variation to the terms of the marketing authorisation for dihydroergotamine containing medicinal products referred to in Annex I, to delete the below indications from the Product Information (specific wording of the indication may vary from product to product and from country to country) as well as any relevant reference to these indications in the Product Information, when there are other therapeutic indications approved as part of their marketing authorisation:
Danish: • ændring af betingelserne for markedsføringstilladelsen for de i bilag I anførte lægemidler indeholdende dihydroergotamin, således at nedenstående indikationer i produktinformationen slettes (den konkrete ordlyd af indikationen kan variere fra produkt til produkt og fra land til land),
English: The CHMP also noted the position of several MAHs that there is not enough evidence to support an indication of oral dihydroergotamine in orthostatic hypotension.
Danish: CHMP bemærkede desuden, at flere markedsføringstilladelsesindehavere fandt, at der ikke er tilstrækkelig dokumentation for indikationen ortostatisk hypotension ved oral indgift af dihydroergotamin.
English: Overall, the CHMP was of the opinion that no situation could justify exposing a patient to risk of fibrosis and ergotism considering the very limited data on efficacy.
Danish: På baggrund af de meget begrænsede data om virkning fandt CHMP overordnet, at ingen situation kan berettige, at en patient udsættes for risiko for fibrose og ergotisme.
English: In the only recent, large study with appropriate design (PROMISE study) there was no statistically significant difference between dihydroergotamine and placebo with respect to the reduction of the frequency of migraine attacks (the primary efficacy criterion) in the overall population.
Danish: Det inkluderede antal patienter var lille, og behandlingsvarigheden var for kort. I den eneste nyere, større undersøgelse med fyldestgørende design (PROMISE-undersøgelsen) var der ingen statistisk signifikant forskel mellem dihydroergotamin og placebo i reduktion af hyppigheden af migræneanfald (det primære kriterium for virkning) i den samlede population.
English: • Symptomatic treatment of veno-lymphatic insufficiency
Danish: forebyggelse af migræne ortostatisk hypotension symptomatisk behandling af venolymfatisk insufficiens
English: What does the black triangle mean?
Danish: Hvad betyder den sorte trekant?
English: For more information, visit www.ema.europa.eu
Danish: Yderligere information finder du ved at besøge www.ema.europa.eu
English: It does not mean that the medicine is unsafe.
Danish: Det betyder ikke, at lægemidlet ikke er sikkert at anvende.
English: They may have other diseases and they may be taking other medicines.
Danish: De kan have andre sygdomme og kan tage andre lægemidler.
English: This ensures that patients can access the treatments they need without being exposed to unacceptable side effects.
Danish: Derved sikres det, at patienterne har adgang til den behandling, de har behov for, uden at de udsættes for uacceptable bivirkninger.
English: Why are medicines monitored after they are approved?
Danish: Hvorfor overvåges lægemidler, efter de er godkendt?
English: How to report side effects
Danish: Sådan indberetter du bivirkninger
English: However, medicines with the black triangle are being monitored even more closely than others.
Danish: Lægemidler med den sorte trekant overvåges dog endnu tættere end de andre.
English: It is therefore vital that the safety of all medicines continues to be monitored while they are on the market.
Danish: Det er derfor afgørende, at sikkerheden af alle lægemidler fortsat overvåges, mens de er på markedet.
English: This is generally because there is less information available about them compared with other medicines, for example because they are new on the market.
Danish: Sædvanligvis skyldes dette, at man har færre oplysninger om dem end om andre lægemidler, f.eks. fordi de er nye på markedet.
English: The European Union (EU) has introduced a new way of identifying medicines that are being monitored particularly closely.
Danish: Den Europæiske Union (EU) har indført en ny mærkning af lægemidler, der er under særlig tæt overvågning.
English: European regulatory authorities decide to authorise medicines after assessing the results of laboratory tests and clinical trials.
Danish: De europæiske lægemiddelmyndigheder træffer beslutning om godkendelse af lægemidler efter at have vurderet resultaterne af laboratorieundersøgelser og kliniske undersøgelser.
English: Clinical trials usually involve a limited number of patients for a defined time period in controlled conditions.
Danish: Kliniske undersøgelser omfatter sædvanligvis kun et begrænset antal patienter, der deltager i et bestemt tidsrum under kontrollerede betingelser.
English: Examples of medicines under additional monitoring include new medicines authorised since the start of 2011 and medicines for which regulators require more studies to be carried out, e.g. on long-term use or on rare side effects seen in clinical trials.
Danish: Som eksempler på lægemidler, der er under supplerende overvågning, kan nævnes nye lægemidler, der er godkendt siden begyndelsen af 2011, og lægemidler, for hvilke myndighederne har stillet krav om yderligere undersøgelser, f.eks. vedrørende langvarig anvendelse eller sjældne bivirkninger, der er iagttaget i de kliniske undersøgelser.
English: Some less common side effects may only be apparent when a medicine has been used for a long time by a large number of people.
Danish: Visse mindre almindelige bivirkninger vil muligvis først vise sig, efter at lægemidlet har været anvendt i lang tid af et stort antal mennesker.
English: These medicines have a black inverted triangle displayed in their package leaflet, together with a short sentence that reads:
Danish: Disse lægemidler har en omvendt sort trekant på indlægssedlen sammen med følgende korte sætning:
English: By reporting side effects, you can help medicines regulators assess whether the benefits of a medicine remain greater than its risks.
Danish: Ved at indberette bivirkninger kan du hjælpe lægemiddelmyndighederne med at vurdere, om fordelene ved et lægemiddel stadig overstiger risiciene.
English: You should report any suspected side effects with a medicine you are taking, particularly if it displays the black triangle.
Danish: Du skal indberette alle formodede bivirkninger med de lægemidler, du tager, navnlig hvis lægemidlet har den sorte trekant.
English: In a real-life setting, a larger and more diverse group of patients will use the medicine.
Danish: I praksis vil lægemidlet blive anvendt af en større og mere uensartet gruppe af patienter.
English: Only medicines whose benefits have been shown to be greater than their risks can be marketed.
Danish: Lægemidler kan kun markedsføres, hvis deres fordele er påvist at være større end risiciene.
English: Information on how to do this can be found in the package leaflet of your medicine or on your national medicines regulator's website.
Danish: Hvordan du gør dette, kan du se i indlægssedlen for dit lægemiddel og på Sundhedsstyrelsens websted.
English: You can report side effects to your doctor, pharmacist or nurse.
Danish: Du kan melde bivirkninger til lægen, på apoteket eller til sundhedspersonale.