FrancophonIA/ELRC3.0 huggingface dataset:
English: Another group of experts supported the view that macrocyclic agents are more stable and are preferable as first line contrast agents.
Croatian: Druga skupina stručnjaka podržala je mišljenje da su makrociklička sredstva stabilnija te da bi trebala biti prvi odabir pri primjeni kontrastnih sredstava.
English: Hypersensitivity or anaphylactoid reactions with GdCAs can manifest as a range of clinical signs and symptoms.
Croatian: Preosjetljivost ili anafilaktičke reakcije nakon primjene GdCA-ova mogu se pokazati kao niz kliničkih znakova i simptoma.
English: Gadolinium containing contrast agents (GdCAs) are complexes of paramagnetic gadolinium (III) with different types of organic chelators.
Croatian: Gadolinij koji sadrži kontrastna sredstva (GdCA-ovi) složeni je spoj paramagnetskog gadolinija (III) s različitim vrstama organskih kelatora.
English: • To complement the information in the SmPC with evidence-based educational programs;
Croatian: • nadopuna informacija o sažetku opisa svojstava lijeka pomoću edukativnih programa koji se temelje na dokazima;
English: The approved indications for GdCAs are general and relate to the whole body scanning/imaging, which includes all organs, with the exception of GdCAs with targeted indications related to the specific physicochemical properties that allow the enhancement of specific features.
Croatian: Odobrene indikacije za GdCA-ove općenite su i odnose se na skeniranje/snimanje cijelog tijela i svih organa, uz iznimku GdCA-ova s ciljanim indikacijama povezanima s određenim fizikalno-kemijskim svojstvima koja omogućuju poboljšanje određenih značajki.
English: Toxicity has been seen in other tissues where it accumulates (including NSF, skin plaques) and in non-clinical data.
Croatian: Toksičnost je primijećena u drugim tkivima u kojima se taloži (uključujući NSF, kožne plakove) i u nekliničkim podacima.
English: In a previous referral under Article 31 of Directive 20010/83/EC finalised in 2010, the Committee for Medicinal Products for Human Use (CHMP) concluded that the use of GdCAs was associated with the risk of nephrogenic systemic fibrosis (NSF), a serious and life-threatening syndrome involving fibrosis of the skin, joints and internal organs in patients with renal impairment.
Croatian: U prethodnom upućivanju na temelju članka 31. Direktive 20010/83/EZ koje je dovršeno 2010., Odbor za lijekove za humanu uporabu (CHMP) zaključio je da je uporaba GdCA-ova povezana s rizikom od nefrogene sistemske fibroze (NSF), ozbiljnog sindroma opasnog po život koji uključuje fibrozu kože, zglobova i unutarnjih organa u bolesnika s oštećenjem bubrega.
English: PRAC considered that it is highly unlikely that the release of Gd from gadodiamide is slower in vivo than in vitro.
Croatian: PRAC smatra da je malo vjerojatno da je otpuštanje gadolinija iz gadodiamida sporije in vivo nego in vitro.
English: Therefore, data shows that linear agents are deposited in the brain and are retained and persist for up to one year or longer.
Croatian: Stoga podaci pokazuju da se linearna sredstva talože u mozgu u kojem se zadržavaju do jedne godine ili duže.
English: Thus, PRAC considered that the McDonald study did not change their previous conclusions and noted that this view is also supported by the ad-hoc expert group held on the 19th of June.
Croatian: Stoga PRAC smatra da McDonaldovo ispitivanje ne može promijeniti prethodne zaključke te je napomenuo da je to mišljenje poduprla ad hoc stručna skupina na sastanku održanom 19. lipnja.
English: Also the restriction of the number of doses administered during the lifetime of a patient raises practical difficulties and therefore would not be effective.
Croatian: I ograničenje broja doza koje se primjenjuju tijekom cijelog života bolesnika nije praktično te stoga neće biti djelotvorno.
English: In view of available observational data which did not confirm a risk related to Gd accumulation in the brain so far, the PRAC considered that:
Croatian: Uzimajući u obzir dostupne promatračke podatke koji dosad nisu potvrdili rizik povezan s taloženjem gadolinija u mozgu, PRAC je donio sljedeće mišljenje:
English: The study also found that changes in signal intensity were strongly correlated with the amount of gadolinium detected by ICP-MS.
Croatian: U ispitivanju je također utvrđeno da su promjene u intenzitetu signala snažno povezane s količinom gadolinija primijećenog putem tehnike ICP-MS.
English: • the delayed phase that relies on selective uptake of a GdCA by functioning hepatocytes, which results in enhancement and visualisation of the normal hepatic parenchyma while improving the delineation and detection of lesions such as cysts and hepatocellular carcinomas.
Croatian: • odgođena faza koja se oslanja na selektivni unos GdCA-ova putem hepatocita, što dovodi do poboljšanja i vizualizacije normalnog parenhima jetre, istovremeno poboljšavajući razgraničenje i detekciju lezija kao što su ciste i hepatocelularni karcinomi.
English: Observational clinical studies will have limitations because methods for measuring adverse cognitive or motor neurological outcomes may not be captured by standard methods, or not be measured routinely, and may neither be reliable nor valid.
Croatian: Promatračka klinička ispitivanja imat će ograničenja jer se mjerenje štetnih kognitivnih ili motoričkih neuroloških ishoda možda neće zabilježiti u okviru standardnih metoda ili mjerenja neće biti rutinska.
English: It is reasonable to suppose that gadolinium can de-chelate from linear GdCAs and bind to macromolecules in human brains similarly as what is observed in rodent brains.
Croatian: Razumno je pretpostaviti da se gadolinij može dekelirati iz linearnih GdCA-ova i vezati za makromolekule u ljudskom mozgu na način sličan onom koji je primijećen u mozgu glodavaca.
English: In addition, low concentrations of linear gadolinium agents as well as macrocyclic agents were detected in non-clinical and clinical studies via mass spectrometry.
Croatian: Nadalje, niske koncentracije linearnih gadolinijskih sredstava, kao i makrocikličkih sredstava primijećene su u nekliničkim i kliničkim ispitivanjima putem masene spektrometrije.
English: With regards to the claim that virtually no Gd becomes liberated from gadodiamide in the body, PRAC noted that at 37°C in human serum Gd rapidly dissociates from its chelator in vitro (Frenzel et al. 2008).
Croatian: U pogledu tvrdnje da se gotovo nijedan oblik gadolinija ne oslobađa iz gadodiamida u tijelu, PRAC je utvrdio da se pri 37 °C u ljudskom serumu gadolinij brzo razdvaja od svojeg in vitro kelatora (Frenzel i dr. 2008.).
English: Hence, the potential risk of brain accumulation and retention in the body tissues cannot be minimised by recommendations to contraindicate use in particular groups (e.g. children, pregnant women, those with renal impairment, other groups) or by avoiding use for particular scans or clinical settings, including repeated use or by restricting re-exposure to certain agents or product classes.
Croatian: Stoga se mogući rizik od taloženja u mozgu i zadržavanja u tjelesnim tkivima ne može smanjiti preporukama za kontraindikaciju kod određenih skupina (npr. djeca, trudnice, osobe s oštećenjem bubrega, druge skupine) ili izbjegavanjem uporabe pri određenim snimanjima ili kliničkim slučajevima, uključujući ponovljenu uporabu ili ograničavanjem ponovnog izlaganja određenim sredstvima ili razredima lijekova.
English: Non-clinical data
Croatian: Neklinički podaci
English: Further studies have tried to characterise and quantify the amount of deposition of gadolinium in the brain.
Croatian: Dodatnim ispitivanjima pokušalo se karakterizirati i kvantificirati taloženje gadolinija u mozgu.
English: Enhancement of the DN and globus pallidus (GP) in unenhanced scans after previous use of linear GdCAs has been observed across multiple studies in humans.
Croatian: Poboljšanje DN-a i globus pallidusa (GP) na snimkama koje nisu poboljšane nakon prethodne uporabe linearnih GdCA-ova primijećeno je u više ispitivanja na životinjama.
English: Macrocyclic GdCAs have a very low potential for retention of gadolinium in tissues, are very stable and have a low risk of dechelation.
Croatian: Makrociklički GdCA-ovi imaju vrlo malen potencijal za zadržavanje gadolinija u tkivima, vrlo su stabilni i imaju malen rizik od dekelacije.
English: With regards to the use of Multihance in the paediatric population, it was noted that, while hepatocellular carcinoma as well as metastatic lesions are frequent in the adult population, liver diseases in children are rather diffuse than focal and tumours are rare.
Croatian: U pogledu uporabe Multihancea u pedijatrijskih bolesnika, utvrđeno je da, iako su hepatocelularni karcinom i metastatske lezije česte u odraslih bolesnika, bolesti jetre kod djece su više difuzne nego fokusne, dok su tumori rijetki.
English: The PRAC concluded that based on the available data Multihance can continue to be used in paediatric patients for delayed phase liver imaging.
Croatian: PRAC je na temelju dostupnih podataka za Multihance zaključio da se može i dalje koristiti u pedijatrijskih bolesnika za snimanje jetre u odgođenoj fazi.
English: It is not fully clear how reliable the method of Gd quantification in tissue was.
Croatian: Nije potpuno jasno koliko je pouzdana metoda određivanje količine gadolinija u tkivu.
English: • To extend the posology to lower doses in specific applications and clinical settings where the advances in technology have shown that to be appropriate.
Croatian: • izmjena doziranja radi smanjenja doza u posebnim slučajevima i kliničkim okruženjima kada tehnološki napredak ukazuje na takvu potrebu.
English: • Linear GdCAs are associated with a significant risk of NSF, although current risk minimisation measures appear to be effective based on spontaneous adverse drug reaction reporting.
Croatian: • Linearni GdCA-ovi povezuju se sa značajnim rizikom od NSF-a iako izvješćivanje o spontanim nuspojavama lijekova ukazuje na to da trenutačne mjere za smanjenje rizika djeluju.
English: Linear GdCAs are associated with a significant risk of NSF.
Croatian: Linearni GdCA-ovi povezuju se sa značajnim rizikom od NSF-a.
English: The experts also stated that it is plausible that adverse clinical consequences could be associated with gadolinium retention in the brain.
Croatian: Stručnjaci su izjavili i da se štetne kliničke posljedice vjerojatno mogu povezati sa zadržavanjem gadolinija u mozgu.
English: In view of the above, the PRAC considered that the benefits of macrocyclic agents outweigh their risks.
Croatian: Uzimajući u obzir prethodno navedeno, PRAC smatra da koristi makrocikličkih sredstava nadmašuju rizike povezane s njima.
English: It has shown clinical utility in imaging of the liver.
Croatian: Dokazana je klinička korist pri snimanju jetre.
English: Gadolinium bound to macromolecules is expected to have a higher relaxivity and would be capable of generating a T1-weighted signal at low concentration.
Croatian: Očekuje se da će gadolinij vezan za molekule imati veći relaksivitet te da će moći generirati T1-ponderirani signal pri niskim koncentracijama.
English: In summary, the PRAC considered that there are no new arguments which could convincingly challenge its previous views regarding the dechelation of Gd and hence the low stability of linear GdCA complexes playing a major role for its tissue disposition.
Croatian: Ukratko, PRAC smatra da ne postoje novi uvjerljivi argumenti koji bi doveli u pitanje prethodna mišljenja o dekeliranju gadolinija i niskoj stabilnosti linearnih GdCA kompleksa koji igraju ključnu ulogu u dispoziciji tkiva.
English: However, after the use of linear agents gadolinium is retained longer at measurable levels and persists for up to one year or more.
Croatian: Međutim, nakon uporabe linearnih sredstava, gadolinij se zadržava duže (u mjerljivim razinama), odnosno jednu godinu ili duže.
English: Therefore, a conclusion that there are significant and clinically relevant differences in diagnostic performance between two GdCAs needs to be supported by robust evidence from clinical studies including evidence on a better clinical outcome and patient management, which is currently lacking; the impact on diagnostic thinking and patient management was not proven.
Croatian: Zaključak o postojanju značajnih i klinički relevantnih razlika u dijagnostičkoj izvedbi dvaju GdCA sredstava treba biti potkrijepljen snažnim dokazima iz kliničkih ispitivanja, uključujući dokaze o boljem kliničkom ishodu i upravljanju bolesnicima koji trenutačno ne postoje; učinak na dijagnostičku izvedbu i upravljanje bolesnicima nije dokazan.
English: • the study results from the Mayo Clinic Study of Ageing (MCSA) study (McDonald et al. 2017, manuscript in preparation), are limited by small sample sizes, relatively short follow-up with regard to potential long-term effects, lack of discussion of sensitivity of the envisaged endpoints regarding detection of potential adverse effects, lack of full detailed information on statistical methods and their robustness and that they are overall too limited to provide reassurance about the safety of usage of GdCAs.
Croatian: • rezultati ispitivanja Mayo Clinic Study of Ageing (MCSA) (McDonald i dr. 2017., dokument u pripremi) ograničeni su zbog malih uzoraka, relativnog kratkog vremena praćenja mogućih dugoročnih učinaka, manjka rasprave o osjetljivosti predviđenih krajnjih točki u pogledu otkrivanja mogućih štetnih učinaka, manjka detaljnih informacija o statističkim metodama i njihovoj pouzdanosti, ograničenih podataka o sigurnosti uporabe GdCA sredstava.
English: Detailed explanation of the scientific grounds for the differences from the PRAC recommendation
Croatian: Detaljno objašnjenje znanstvene osnove za odstupanja od preporuke PRACa
English: Perfusion imaging in MRI is typically performed both at rest and during pharmacological stress (for example, with adenosine or dipyridamole), and utilizes a dynamic imaging technique in which signal intensity in the myocardium is evaluated during the passage of the contrast bolus.
Croatian: Snimanje perfuzije magnetnom rezonancijom obično se provodi pri mirovanju i tijekom farmakološkog stresa (uz primjerice adenozin ili dipiridamol) te se koristi tehnika dinamičnog snimanja u kojem se intenzitet signala u miokardu mjeri tijekom prolaza kontrastnog bolusa.
English: One group of experts (including the patient representative) supported the PRAC recommendation (i.e. suspension of linear agents besides Primovist and intraarticular Magnevist) and its rationale, with the exception of the suspension of Multihance for liver imaging in absence of macrocyclic agents for this indication and lack of availability of Primovist in one Member State.
Croatian: Jedna skupina stručnjaka (uključujući predstavnika bolesnika) podržala je preporuku PRAC-a (tj. obustavu linearnih sredstava, osim Primovista i intraartikularnog Magnevista) i njegovo obrazloženje, uz iznimku obustave Multihancea za snimanje jetre jer ne postoje makrociklička sredstva za tu indikaciju i u jednoj državi članici Primovist nije dostupan.
English: There is also a concern that gadolinium deposits in some tissues, particularly bone, could be released at a later stage for example during loss of bone density in aging or pregnancy/breastfeeding, exposing patients to further systemic distribution of gadolinium.
Croatian: Postoji zabrinutost da bi se gadolinij koji se taloži u određenim tkivima, posebno u kosti, mogao otpustiti u kasnijoj fazi, na primjer tijekom opadanja gustoće kostiju tijekom starenja ili trudnoće/dojenja, pri čemu bi bolesnici bili izloženi daljnjoj distribuciji gadolinija u sustavu.
English: The clinical finding (e.g. Radbruch et al.) that macrocyclic agents do not cause brain T1 hyperintensity was replicated by other groups and can therefore be considered to be substantiated.
Croatian: Klinička otkrića (npr. Radbruch i dr.) koja ukazuju da makrociklička sredstva ne uzrokuju hiperintenzitet T1 signala replicirale su druge skupine te se stoga mogu smatrati potkrijepljenima.
English: • Gd retention was studied rather early (one week) after cessation of treatment so that detected Gd may not represent the long-term storage form.
Croatian: • Zadržavanje gadolinija ispitivano je poprilično rano (jedan tjedan) nakon prekida liječenja tako da otkriveni gadolinij možda ne predstavlja dugoročni oblik pohrane.
English: Prolonged elimination time in patients with renal impairment and release of gadolinium from GdCAs are the main factors that contribute to the development of NSF.
Croatian: Produljeno vrijeme izlučivanja u bolesnika s oštećenjem bubrega i otpuštanje gadolinija iz GdCA-ova glavni su čimbenici koji doprinose razvoju NSF-a.
English: This is due to the range of potential outcomes of interest, the requirement for long term follow-up, and the heterogeneity of the patient population that undergoes MRI.
Croatian: Razlog tome je niz mogućih interesnih ishoda, potreba dugoročnog praćenja te heterogenost skupine bolesnika koja se podvrgava snimanju magnetskom rezonancijom.
English: • PRAC considered options for risk minimisation measures.
Croatian: • PRAC je razmotrio opcije mjera za smanjenje rizika.
English: Also PRAC was not able to define a safe threshold level for exposure to gadolinium and retention of gadolinium in the brain, or to define a period of time during which a potential adverse effect would have time to manifest.
Croatian: PRAC nije mogao ni definirati sigurnu graničnu razinu za izlaganje gadoliniju i taloženje gadolinija u mozgu ni definirati vremensko razdoblje u kojem će se mogući štetni učinak pokazati.
English: In order to address the serious concerns of the potential neurological effects, PRAC considered the feasibility of clinical safety studies, both observational and interventional, and concluded that these would not be feasible within a reasonable period of time.
Croatian: Kako bi se riješile ozbiljne zabrinutosti u vezi s mogućim neurološkim učincima, PRAC je razmotrio provedivost sigurnosnih kliničkih ispitivanja, i promatračkih i intervencijskih, te je zaključio da takva ispitivanja nisu provediva u razumnom vremenskom razdoblju.
English: It was also mentioned that there is currently little, if any, concern amongst experts specifically about the use of macrocyclic agents in clinical practice, and the current safety concern laying over all GdCAs arises from the clinical use of linear GdCAs.
Croatian: Spomenuto je i da trenutačno stručnjaci nisu skoro nimalo zabrinuti u pogledu uporabe makrocikličkih sredstava u kliničkoj praksi te da trenutačne sigurnosne zabrinutosti u pogledu GdCA-ova proizlaze iz kliničke uporabe linearnih GdCAova.
English: These conclusions are in line with the opinion of the experts expressed at the ad hoc expert meeting, i.e. that linear and macrocyclic agents can be used interchangeably for cardiac imaging and that there is no established or perceived difference in their clinical utility.
Croatian: Ti su zaključci u skladu s mišljenjem stručnjaka izraženim na ad hoc sastanku stručnjaka, odnosno da se linearna i makrociklička sredstva mogu naizmjenično koristiti za snimanje srca te da nije utvrđena razlika njihove kliničke koristi.
English: Also, according to this view, it would be important to complement this strategy by efforts to better inform healthcare professionals, particularly practitioners requesting imaging, on the choice of contrast agents depending on the different conditions and indications; to allow for increased overall awareness of risk benefit analysis.
Croatian: Isto tako, u skladu s tim mišljenjem trebalo bi nadopuniti tu strategiju boljim informiranjem zdravstvenih stručnjaka, posebno liječnika koji traže snimanja, o pravom odabiru kontrastnog sredstva ovisno o različitom stanju i indikacijama.
English: PRAC also considered limiting the number of doses for patients and concluded that there are practical difficulties for limiting the number of doses as it is not possible to ascertain which contrast agent was previously administered to patients, and it would not be possible to ensure effective restriction of number of doses administered during the lifetime of a patient.
Croatian: PRAC je također razmotrio ograničavanje broja doza za bolesnike te je zaključio da postoje praktične poteškoće za ograničavanje broja doza jer nije moguće utvrditi koje su kontrastno sredstvo bolesnici prethodno primali te ne bi bilo moguće osigurati djelotvorno ograničavanje broja doza koji bolesnik primi tijekom cijelog života.
English: However, PRAC considered the clinical utility outweighing the risks related to accumulation of gadolinium is limited to the delayed phase liver imaging and thus PRAC recommended that the indication of gadobenic acid is restricted to this use only.
Croatian: Međutim, PRAC smatra da se klinička korist koja nadmašuje rizike povezane s taloženjem gadolinija može ograničiti samo na snimanje jetre u odgođenoj fazi te je stoga PRAC preporučio da se indikacija gadobenske kiseline ograniči samo na tu uporabu.
English: The available data in humans support a conclusion that while impaired renal function is not a necessary precondition for signal hyperintensity increases in the brain, impaired renal function does increase the extent of brain accumulation and signal hyperintensity.
Croatian: Dostupni podaci o ljudima podupiru zaključak da iako oštećena bubrežna funkcija nije obvezno preduvjet za povećanje hiperintenziteta signala u mozgu, oštećena bubrežna funkcija povećava količinu taloženja u mozgu i hiperintenzitet signala.
English: • No specific patient group with less risk of accumulation in the brain can currently be identified.
Croatian: • trenutačno se ne može odrediti određena skupina bolesnika s manjim rizikom od taloženja u mozgu.
English: A restriction by number of doses may not be possible in clinical practice, because previous exposures to GdCAs may not have been recorded sufficiently with regard to the type of GdCA used.
Croatian: Ograničavanje broja doza možda neće biti moguće u kliničkoj praksi jer prethodno izlaganje GdCA sredstvima možda nije u dovoljnoj mjeri zabilježeno, kao ni vrsta primljenog GdCA sredstva.
English: Gd presence in the brain following the last administration of other linear agents, gadopentetic acid and gadobenic acid also remained at the same level after the same period.
Croatian: Prisutnost gadolinija u mozgu nakon posljednje primjene drugih linearnih sredstava, gadopentetične kiseline i gadobenske kiseline također je ostala na istoj razini nakon određenog razdoblja.
English: • Data on stability, as well as in vitro and non-clinical studies, show that linear gadolinium-containing contrast agents (GdCAs) release gadolinium from the ligand molecules to a greater extent than macrocyclic agents.
Croatian: • Podaci o stabilnosti, kao i podaci iz in vitro i nekliničkih ispitivanja pokazuju da linearna kontrastna sredstva koja sadrže gadolinij (GdCA-ovi) ispuštaju gadolinij iz molekula liganda u većoj mjeri od makrocikličkih sredstava.
English: In non-clinical studies (Robert et al. 2016 Lohrke et al. 2015; Lohrke et al. 2016; Kartamihardja et al. 2016a; Kartamihardja et al. 2016b; Smith et al. 2017; Rasschaert et al. 2016; MAH unpublished studies) the levels were typically around 10-fold higher with linear agents.
Croatian: Kartamihardja i dr. 2016.a; Kartamihardja i dr. 2016.b; Smith i dr. 2017.; Rasschaert i dr. 2016.; neobjavljena ispitivanja nositelja odobrenja za stavljanje u promet) razine su obično imale koncentraciju za 10 jedinica veću nego kod linearnih sredstava.
English: On 9 March 2016, the European Commission triggered a referral under Article 31 of Directive 2001/83/EC resulting from pharmacovigilance data and requested the PRAC to assess the impact of the above concerns on the benefit-risk balance of gadolinium containing medicinal products and to issue a recommendation on whether the relevant marketing authorisations should be maintained, varied, suspended or revoked.
Croatian: Europska komisija pokrenula je upućivanje na temelju članka 31. Direktive 2001/83/EZ, što je proizašlo iz podataka o farmakovigilanciji, te je od PRAC-a zatražila procjenu učinka gore navedenih problema na omjer koristi i rizika za lijekove koji sadrže gadolinij i izdavanje preporuke o tome treba li odgovarajuća odobrenja za stavljanje u promet zadržati, izmijeniti, obustaviti ili uskratiti.