FrancophonIA/ELRC3.0 huggingface dataset:
English: ANNEX III CONDITION FOR THE LIFTING OF THE SUSPENSION
Danish: BILAG III BETINGELSER FOR OPHÆVELSE AF SUSPENDERINGEN
English: In addition, in some member states it had been both difficult and time-consuming to collate the relevant data for the purposes of the Article 31 referral, and it would be impractical and, in the medium term, unfeasible to monitor the effectiveness of risk minimization activities in these countries.
Danish: Desuden havde det i nogle medlemsstater været både vanskeligt og tidskrævende at indsamle de nødvendige data til artikel 31-indbringelsen, og det ville være upraktisk og på mellemlang sigt umuligt at overvåge virkningen af risikonedsættende foranstaltninger i disse lande.
English: dextropropoxyphene/ paracetamol/ caffeine
Danish: Styrke/ dextropropoxyfen/ paracetamol/ koffein
English: Intramuscular, intravenous use
Danish: Intramuskulær anvendelse, Intravenøs anvendelse
English: For the suspension to be lifted the Marketing Authorisation Holders would need to provide the National Competent Authorities with the following:
Danish: For ophæve suspenderingen skal indehaverne af markedsføringstilladelse fremlægge følgende for de nationale kompetente myndigheder:
English: A group of MAHs disagreed with the opinion recommending the withdrawal of the Marketing Authorisations and requested a re-examination of the opinion.
Danish: En gruppe indehavere af markedsføringstilladelse var uenige i udtalelsen, hvori det blev anbefalet at tilbagekalde markedsføringstilladelserne, og anmodede om en revurdering af den.
English: ANNEX II SCIENTIFIC CONCLUSIONS AND GROUNDS FOR SUSPENSION OF THE MARKETING AUTHORISATIONS PRESENTED BY THE EUROPEAN MEDICINES AGENCY
Danish: BILAG II FAGLIGE KONKLUSIONER OG BEGRUNDELSE FOR SUSPENDERING AF MARKEDSFØRINGSTILLADELSERNE FREMLAGT AF DET EUROPÆISKE LÆGEMIDDELAGENTUR
English: Since the benefit/risk reviews of dextropropoxyphene containing products were carried out in the UK, Sweden, France, and Ireland in 2005 - following which the fixed dose combination product (paracetamol + dextropropoxyphene) was withdrawn from the market in the UK, Sweden, and Ireland - a substantial body of important new safety information has become available.
Danish: Siden 2005, hvor benefit/risk-vurderingerne af lægemidler indeholdende dextropropoxyfen blev gennemført i Det Forenede Kongerige, Sverige, Frankrig og Irland - og hvorefter fastdosiskombinationsproduktet (paracetamol og dextropropoxyfen) blev trukket tilbage fra markedet i Det Forenede Kongerige, Sverige og Irland - er der fremkommet en stor mængde oplysninger om sikkerheden.
English: Risk Minimisation Measures
Danish: Risikonedsættende foranstaltninger
English: - The Committee assessed the grounds for re-examination submitted by a group of MAHs on 15 July 2009, the information provided by the MAHs at an oral explanation on 20 October 2009 and the scientific discussion within the Committee;
Danish: - Udvalget bedømte begrundelserne for revurdering, som blev fremlagt af en gruppe af indehavere af markedsføringstilladelse den 15. juli 2009, oplysningerne fremlagt af indehaverne af markedsføringstilladelse i forbindelse med de mundtlige redegørelser den 20. oktober 2009, og de faglige drøftelser i udvalget.
English: The narrow therapeutic index means that accidental overdose is a real possibility under normal conditions of use, particularly for patients on certain concomitant medications or when combined with even a small amount of alcohol.
Danish: Det snævre terapeutiske indeks betyder, at utilsigtet overdosis er en reel mulighed under normale anvendelsesbetingelser, navnlig for patienter, som samtidig behandles med visse andre lægemidler, eller når det kombineres med selv en lille mængde alkohol.
English: - The Committee considered the referral made under article 31 of Directive 2001/83/EC, as amended for medicinal products containing dextropropoxyphene;
Danish: - Udvalget behandlede indbringelsen i henhold til artikel 31 i direktiv 2001/83/EF, med senere ændringer, for lægemidler indeholdende dextropropoxyfen.
English: GROUNDS FOR SUSPENSION OF THE MARKETING AUTHORISATIONS
Danish: BEGRUNDELSE FOR SUSPENDERING AF MARKEDSFØRINGSTILLADELSERNE
English: On the basis of evidence of harm from reports of fatal overdose, of divergent safety reviews and previous regulatory action taken in several Member States, the European Commission initiated a referral under Article 31(2) of Directive 2001/83/EC, as amended, to address this public health issue for medicinal products containing dextropropoxyphene and paracetamol, and therefore referred the matter to the CHMP on 30 November 2007.
Danish: På baggrund af dokumentation for skader fra rapporter om dødelige overdoser, divergerende sikkerhedsundersøgelser og tidligere indgriben fra myndighederne i flere medlemsstater indbragte EuropaKommissionen en sag i henhold til artikel 31, stk. 2, i direktiv 2001/83/EF, med senere ændringer, for at behandle dette folkesundhedsrelaterede problem i forbindelse med lægemidler indeholdende dextropropoxyfen og paracetamol, og henviste derfor sagen til CHMP den 30. november 2007.
English: - The Committee concluded that the risks associated with the use of parenteral dextropropoxyphene medicinal products in the treatment of symptomatic pain outweigh the potential benefit as the efficacy has not been demonstrated.
Danish: - Udvalget konkluderede, at risiciene forbundet med brug af parenterale lægemidler indeholdende dextropropoxyfen til behandling af symptomatiske smerter opvejer de potentielle fordele, da virkningen ikke er fastslået.
English: Benefit-Risk
Danish: Benefit/risk-forhold
English: However no consideration was given to the need for national mortality data, and in particular forensic pathology data, to ensure that any risk minimisation measures are working: it is not possible to use routinely-collected (spontaneous) data to assess the effectiveness of the risk minimisation measures, because of the significant under-reporting of even serious adverse events, including death.
Danish: Der blev dog ikke taget hensyn til behovet for nationale dødelighedsdata, især retsvidenskabelige patologiske data, for at sikre, at de risikonedsættende foranstaltninger virker: det er ikke muligt at anvende rutineindsamlede (spontane) data til at vurdere virkningen af de risikonedsættende foranstaltninger på grund af den betragtelige underrapportering af selv alvorlige hændelser, herunder dødsfald.
English: - The Committee considered the risk of fatal overdose with dextropropoxyphene.
Danish: - Udvalget behandlede risikoen for dødelige overdoser med dextropropoxyfen.
English: The most frequently reported adverse reactions with fatal outcome involved hepatobiliary disorders, skin disorders, general disorders, blood and lymphatic disorders, nervous system disorders, gastrointestinal disorders and cardiac disorders.
Danish: De hyppigst indberettede bivirkninger med dødelig udgang omfattede sygdomme i lever og galdeveje, hudsygdomme, almene sygdomme, sygdomme i blod- og lymfesystemet, sygdomme i nervesystemet, gastrointestinale sygdomme samt hjertesygdomme.
English: Ibuprofen has also shown to be more effective, as a single dose, in the management of severe postoperative pain; tramadol being equally effective in this setting.
Danish: Ibuprofen har også vist sig at være mere effektivt som enkeltdosis til behandling af postoperative smerter, og tramadol har samme virkning under disse forhold.
English: Similarly in Ireland, analysis in 2009 of further data from the Alcohol and Drug Research Unit of the Health Research Board revealed significant under-reporting of deaths associated with dextropropoxyphene-containing products - indicating fatality rates fifteen-fold higher than previously reported.
Danish: Også i Irland viste analyser i 2009 af yderligere data fra alkohol- og narkotikaforskningsenheden ved det irske sundhedsforskningsorgan (Health Research Board) en betragtelig underrapportering af dødsfald, som var forbundet med lægemidler indeholdende dextropropoxyfen, - femten gange flere dødsfald end tidligere indberettet.
English: In chronic pain, other combinations of paracetamol and an opioid (such as a fixed-dose combination of paracetamol and codeine phosphate), or a combination of a non-steroidal anti-inflammatory drug (NSAID) and an opioid other than dextropropoxyphene have been shown to be at least as effective as the fixed combination of dextropropoxyphene and paracetamol.
Danish: Mod kroniske smerter har andre kombinationer af paracetamol og et opioid (såsom en fastdosiskombination af paracetamol og kodeinfosfat) eller en kombination af et non-steroidt antiinflammatorisk lægemiddel (NSAID) og et andet opioid end dextropropoxyfen vist sig at være mindst lige så effektivt som den faste kombination af dextropropoxyfen og paracetamol.
English: Based on the limited efficacy and the significant risk of fatal overdose (in particular accidental overdose), the CHMP was of the opinion that the benefit/risk balance of dextropropoxyphene containing medicinal products was negative.
Danish: På baggrund af den begrænsede virkning og den signifikante risiko for dødelig overdosering (især utilsigtet overdosering) var CHMP af den opfattelse, at benefit/risk-forholdet for lægemidler indeholdende dextropropoxyfen var negativt.
English: Also, research in the UK demonstrated the benefits of the withdrawal of dextropropoxyphene from the market - with clear evidence of a fall in number of deaths associated with dextropropoxyphene, but without any rise in mortality from poisoning with other common analgesics.
Danish: Undersøgelser i Det Forenede Kongerige viste også fordele ved at trække dextropropoxyfen tilbage fra markedet - med et tydeligt fald i antallet af dødsfald forbundet med dextropropoxyfen, dog uden nogen stigning i antallet af dødsfald som følge af forgiftning med almindelige smertestillende midler.
English: For the equivalent dose of dextropropoxyphene combined with paracetamol 650 mg the NNT was 4.4 (3.5 to 5.6) when compared with placebo, indicating higher efficacy.
Danish: For den tilsvarende dosis dextropropoxyfen i kombination med paracetamol 650 mg var det påkrævede antal til gavnlig behandling 4,4 (3,5 til 5,6) sammenlignet med placebo, hvilket angiver, at dette har en bedre virkning.
English: Risk Minimisation measures proposed by the MAHs included restriction of the use of the product (i.e. changes in SPC to restrict the population; pack size reduction), modification of the posology (e.g. reduction of posology in elderly population) and addition of further safety warnings (e.g. on concomitant use with alcohol, dependence and tolerance, combination with other central acting analgesics and overdose in children).
Danish: De risikonedsættende foranstaltninger, som blev foreslået af indehaverne af markedsføringstilladelse, bestod bl.a. i begrænsning af brugen af produktet (dvs. ændringer i produktresuméerne for at begrænse patientpopulationen, mindre pakningsstørrelser), ændring af doseringen (f.eks. en mindre dosering til ældre) samt tilføjelse at yderligere sikkerhedsadvarsler (f.eks. om brug sammen med alkohol, afhængighed og tolerance, brug i kombination med andre centralt virkende smertestillende midler, og overdosering hos børn).
English: Apart from the strengthened warnings, and more extensive contra-indications, proposed by several MAHs, the other proposals for changes in the SPCs and PLs - for example, in relation to indication - reflected the existing variations across Europe and were often not internally consistent.
Danish: Bortset fra de yderligere advarsler og mere omfattende kontraindikationer, som blev foreslået af indehaverne af markedsføringstilladelse, afspejlede forslagene om ændring af produktresuméer og indlægssedler - f.eks. med hensyn til indikationer - de eksisterende forskelle i Europa, og de var ofte ukonsekvente hver for sig.
English: Available efficacy data are limited due to methodological shortcomings such as the absence of a sample size calculation in the majority of the double-blind studies in acute pain and the lack of long term efficacy data to support the use of the fixed combination of dextropropoxyphene and paracetamol as a prolonged treatment.
Danish: De tilgængelige data om virkningen er begrænsede som følge af metodologiske mangler, såsom manglende beregning af prøvestørrelsen i størstedelen af de dobbeltblindede undersøgelser af akutte smerter, og manglende data om den langsigtede virkning til at understøtte anvendelsen af den faste kombination af dextropropoxyfen og paracetamol som længevarende behandling.
English: The availability of a parenteral formulation might be viewed as providing a further therapeutic option, since it would arguably reduce the risk of an accidental overdose (by the patient taking more, because of lack of efficacy) and of intentional overdose (depending on where supplies were held).
Danish: Tilstedeværelsen af en parenteral formulering kan ses som en yderligere terapeutisk mulighed, da det formentlig vil reducere risikoen for utilsigtet overdosering (af patienter, der tager mere, fordi virkningen udebliver) og for tilsigtet overdosering (afhængig af, hvor forsyningerne blev opbevaret).
English: - Evidence of a patient population in which the benefit-risk balance of parenteral dextropropoxyphene medicinal products is positive.
Danish: - Dokumentation for en patientpopulation, i hvilken benefit/risk-forholdet for parenterale lægemidler indeholdende dextropropoxyfen er positivt.
English: In view of the complex context in which cases of fatal overdose occurred under normal conditions of use and in view of the narrow therapeutic index and the potential for rapid death, the CHMP was of the opinion that the above proposed risk minimisation activities of narrowing the indication, reducing the pack sizes and/or introducing further safety warnings and contraindications (including those beyond the Product Information) would not be able to reduce the risks to an acceptable level.
Danish: Set i lyset af den komplekse sammenhæng, hvori de dødelige overdoseringer fandt sted under normale anvendelsesbetingelser, samt det snævre terapeutiske indeks og risikoen for hurtig død, mente CHMP ikke, at de ovennævnte foreslåede tiltag for at mindske risikoen, såsom indsnævring af indikationen, reduktion af pakningernes størrelse og/eller flere sikkerhedsadvarsler og kontraindikationer (ud over dem, der findes i produktinformationen), ville nedbringe risikoen til et acceptabelt niveau.
English: Furthermore, the lack of long term efficacy data did not allow any definite conclusions to be drawn on the efficacy of the dextropropoxyphene medicinal products as a long-term treatment.
Danish: Manglen på data om den langsigtede virkning gjorde det desuden umuligt at træffe endegyldige konklusioner om virkningen af lægemidler indeholdende dextropropoxyfen som langtidsbehandling.
English: The CHMP reviewed the data submitted by the MAHs to address the above-mentioned concerns as well as the available data from Member States in relation to drug poisoning that involves dextropropoxyphene and the investigation of suspicious deaths in their countries.
Danish: CHMP vurderede de oplysninger, der var blevet indsendt af indehaverne af markedsføringstilladelsen som svar på de ovennævnte betænkeligheder, samt de tilgængelige data fra medlemsstaterne om forgiftninger, hvor dextropropoxyfen indgik, og undersøgelser af mistænkelige dødsfald i de pågældende lande.
English: In addition, the CHMP considered other known risks associated with the use of parenteral opioids such as the risk of abuse and dependence.
Danish: CHMP behandlede desuden andre kendte risici forbundet med brugen af parenterale opioider, f.eks. risiko for misbrug og afhængighed.
English: However, the key safety concern with dextropropoxyphene is that it has a very narrow therapeutic index under normal conditions of use: following overdose, cardiac arrhythmias (which cannot be reversed using naloxone) and opioid side effects (such as respiratory depression) are rapid in onset and often fatal - there is evidence that the case fatality rate is higher than, for example, for tricyclic antidepressants.
Danish: De største betænkeligheder vedrørende dextropropoxyfen er dog, at det har et meget snævert terapeutisk indeks under normale anvendelsesbetingelser: efter overdosis, viser hjertearytmier (som ikke kan standses med naloxon) og bivirkninger ved opioider (som f.eks. respirationshæmning) sig hurtigt og er ofte dødelige - det er dokumenteret, at dødeligheden er højere end eksempelvis for tricykliske antidepressive midler.
English: However, the CHMP considered that parenteral opioids carry further significant risks in themselves, such as abuse/dependence and diversion which are also of major concern.
Danish: CHMP vurderede dog, at parenterale opioider medfører yderligere betydelige risici i sig selv, herunder misbrug/afhængighed og diversion, hvilket også er et stort problem.
English: Although available meta-analyses mostly included single dose studies, these data also provided further insights in the efficacy of the dextropropoxyphene containing medicinal products.
Danish: Selv om de tilgængelige metaanalyser hovedsageligt omfattede enkeltdosisundersøgelser, gav disse data alligevel yderligere indsigt i virkningen af lægemidler indeholdende dextropropoxyfen.
English: Available data showed only limited efficacy of the dextropropoxyphene medicinal products in the symptomatic treatment of pain.
Danish: De tilgængelige data viste kun en begrænset virkning af lægemidler indeholdende dextropropoxyfen til symptomatisk behandling af smerter.
English: Though a parenteral formulation of dextropropoxyphene might be viewed as providing a further therapeutic option, parenteral opioids carry further significant risks in themselves, such as abuse/dependence and diversion, which would appear difficult to justify in this instance given the lack of evidence of efficacy.
Danish: Selv om en parenteral formulering af dextropropoxyfen kan ses som en yderligere terapeutisk mulighed, medfører parenterale opioider yderligere betydelige risici i sig selv, såsom misbrug/afhængighed og diversion, hvilket det er vanskeligt at retfærdiggøre i dette tilfælde på grund af manglen på dokumentation for virkningen.
English: For the suspension to be lifted, the Marketing Authorisation Holders would need to provide evidence of a patient population in which the benefit-risk balance of parenteral dextropropoxyphene medicinal products is positive.
Danish: For at ophæve suspenderingen skal indehaverne af markedsføringstilladelse fremlægge dokumentation for en patientpopulation, i hvilken benefit/risk-forholdet for parenterale lægemidler indeholdende dextropropoxyfen er positivt.
English: In particular, more comprehensive mortality data at a national level from France, notably forensic toxicology results, provided evidence of a significantly greater number of deaths associated with the use of dextropropoxyphene-containing products than had previously been estimated.
Danish: Navnlig viste mere omfattende data fra Frankrig om dødstal på nationalt plan, især retsvidenskabelige toksikologiske resultater, at der skete langt flere dødsfald i forbindelse med brugen af lægemidler indeholdende dextropropoxyfen end før antaget.
English: The Committee noted that this risk is limited for the parenteral dextropropoxyphene medicinal products, given the administration under hospital setting (given by healthcare professionals) and the classification of these medicinal products as narcotic prescription (in the Member State where the product is authorised).
Danish: Udvalget bemærkede, at risikoen er begrænset for de parenterale lægemidler indeholdende dextropropoxyfen, da de indgives i hospitalsregi (af sundhedspersonalet), og at disse lægemidler er klassificeret som receptpligtige narkotika (i den medlemsstat, hvor lægemidlet er godkendt).
English: A substantial proportion of the fatal overdoses are accidental - occurring under normal conditions of use, for the licensed indication of painand there is a significant public health impact in relation to these cases alone.
Danish: En betragtelig del af de dødelige overdoser under normale anvendelsesbetingelser til den godkendte indikation smerter er utilsigtede - og disse tilfælde alene har en væsentlig indvirkning på folkesundheden.
English: Although spontaneous reporting suggested that the safety signal concerning the overdose was not significant, other more complete data, particularly from forensic centres and national mortality statistics confirmed that the risk of accidental fatal overdose under normal conditions of use associated with dextropropoxyphene containing products is of major concern, mainly due to their narrow therapeutic index and high case fatality.
Danish: Selv om spontane rapporter antydede, at sikkerhedsrisikoen i forbindelse med overdosering ikke var signifikant, bekræftede andre mere udførlige data, især fra retsmedicinske centre og nationale dødsstatistikker, at risikoen for utilsigtet dødelig overdosering, der kan sammenkædes med lægemidler indeholdende dextropropoxyfen, er et stort problem, hovedsageligt på grund af deres snævre terapeutiske indeks og høje dødsrate.
English: Having considered the detailed grounds for re-examination provided by the group of MAHs in writing and in an oral explanation, the CHMP considered that the design of the proposed clinical study to demonstrate the superior efficacy for combination of dextropropoxyphene and paracetamol versus paracetamol alone was flawed, and even a well-designed study would not change the benefit-risk balance of the dextropropoxyphene medicinal products in view of the narrow therapeutic index.
Danish: Efter en gennemgang af den detaljerede skriftlige begrundelse for revurdering og den mundtlige redegørelse fra indehaverne af markedsføringstilladelse fandt CHMP, at udformningen af den foreslåede kliniske undersøgelse til påvisning af, at kombinationen af dextropropoxyfen og paracetamol havde bedre virkning end paracetamol alene, var mangelfuld, og selv en veludformet undersøgelse ville ikke ændre benefit/risk-forholdet for lægemidler indeholdende dextropropoxyfen i lyset af dets snævre terapeutiske indeks.
English: While some patients find these products helpful in managing pain, results from clinical trials do not provide evidence for the superior efficacy of dextropropoxyphene alone or in combination with paracetamol, when compared with normal therapeutic doses of simple analgesics.
Danish: Nogle patienter oplever, at disse lægemidler er effektive til smertebehandling, men resultater fra kliniske undersøgelser giver ikke dokumentation for større virkning af dextropropoxyfen alene eller i kombination med paracetamol sammenlignet med normale terapeutiske doser af simple smertestillende lægemidler.
English: Whilst there is a risk of fatal overdose, the CHMP considered that it is limited for the parenteral dextropropoxyphene medicinal products, given the administration under hospital setting (given by healthcare professionals) and the classification of these medicinal products as narcotic prescription (in the Member State where the product is authorised) and the lack of evidence of fatal overdose particularly of accidental overdose.
Danish: Selvom der er risiko for en dødelig overdosis, fandt CHMP, at denne er begrænset for parenterale lægemidler indeholdende dextropropoxyfen, da de indgives i hospitalsregi (af sundhedspersonalet), at disse lægemidler er klassificeret som receptpligtige narkotika (i den medlemsstat, hvor lægemidlet er godkendt), og da der savnes dokumentation for dødelig overdosering, navnlig utilsigtet overdosering.
English: However, the CHMP took note of the narrow therapeutic index of dextropropoxyphen containing products.
Danish: CHMP noterede sig det snævre terapeutiske indeks for lægemidler indeholdende dextropropoxyfen.