FrancophonIA/ELRC3.0 huggingface dataset:
English: Having reviewed the PRAC recommendation, the CHMP agrees with the PRAC overall conclusions and grounds for recommendation.
Danish: Efter gennemgang af PRAC's henstilling tilslutter CHMP sig PRAC's overordnede konklusioner og begrundelse for henstillingen.
English: This is the rationale that justifies the mandatory liver monitoring within the first 2 treatment courses, while during later courses, monitoring is recommended as clinically indicated.
Danish: Dette er rationalet for den obligatoriske leverovervågning i løbet af de første 2 behandlingsforløb, mens der under efterfølgende forløb anbefales monitorering som klinisk indiceret.
English: The PRAC also considered the views expressed by experts at an ad hoc expert group meeting.
Danish: PRAC tog desuden i betragtning de synspunkter, der blev udtrykt af eksperter på et ad hoc-møde.
English: Hysterectomy is a very common curative surgical procedure within gynaecology associated with a low mortality (mortality figures quoted range from 0.02% to 0.17%) and a low risk of intra- or postoperative complications (quoted from 5% to 8%).
Danish: Hysterektomi er en meget almindelig kurativ gynækologisk operation, der er forbundet med lav dødelighed (dødelighedsfrekvensen angives til mellem 0,02 % og 0,17 %) og lav risiko for intra- eller postoperative komplikationer (angivet til 5 % til 8 %).
English: The MAH should implement these questionnaires and their results should be discussed in future periodic safety update reports (PSURs).
Danish: Indehaveren af markedsføringstilladelsen bør implementere disse spørgeskemaer, og resultaterne af dem bør diskuteres i fremtidige periodiske opdaterede sikkerhedsrapporter (PSUR'er).
English: In addition, patients who develop transaminase levels (ALT or AST) > 3 x ULN during treatment should stop treatment and be closely monitored.
Danish: Patienter, der får transaminaser (ALT eller AST) > 3 x ULN i løbet af behandlingen, bør desuden tages ud af behandlingen og overvåges tæt.
English: This last indication was authorised based on results from another study providing data for up to 4 intermittent treatment courses of 3 months each with ulipristal acetate along with data for repeated treatment courses from the previous studies.
Danish: Denne sidste indikation blev godkendt på grundlag af resultaterne af en anden undersøgelse, der tilvejebragte data for op til 4 forløb med intermitterende behandling med ulipristalacetat på hver 3 måneder, i tilslutning til data fra de tidligere undersøgelser med forløb med gentagen behandling.
English: Uterine fibroids are the single most common indication for hysterectomy1.
Danish: Uterusfibromer er den hyppigst forekommende indikation for hysterektomi1.
English: Other surgical treatments such as myomectomy and uterine artery embolisation are also valid alternatives to hysterectomy, but they are not suitable for all cases and are also associated with a higher rate for complications than hysterectomy.
Danish: Andre operative behandlinger som myomektomi og embolisering af arteria uterina er ligeledes valide alternativer til hysterektomi, men er ikke egnede i alle tilfælde og er desuden forbundet med højere komplikationsfrekvens end hysterektomi.
English: • The PRAC considered the procedure under Article 20 of Regulation (EC) No 726/2004 resulting from pharmacovigilance data for Esmya (ulipristal acetate).
Danish: • PRAC behandlede den procedure i henhold til artikel 20 i forordning (EF) nr. 726/2004, der var foranlediget af lægemiddelovervågningsdata for Esmya (ulipristalacetat).
English: Usually, DILI events occur within the first 6 months after starting a new medication2.
Danish: Sædvanligvis forekommer hændelser med medikamentel leverskade inden for de første 6 måneder efter initiering af ny medicinering2.
English: However, there is sufficient information from these cases to conclude that there is at least a reasonable possibility that Esmya may infrequently contribute to hepatic injury.
Danish: Oplysningerne fra disse tilfælde er dog tilstrækkelige til at konkludere, at der i det mindste er en rimelig mulighed for, at Esmya i sjældne tilfælde kan bidrage til leverskade.
English: However, due to exclusion criteria covering patients with elevated transaminases, or other signs of liver disease, as well as the limited size of the safety database in these studies, the absence of findings in clinical trials has to be interpreted with caution.
Danish: På grund af eksklusionskriterier for patienter med forhøjede transaminaser eller andre tegn på leversygdom, foruden den begrænsede størrelse af sikkerhedsdatabasen i disse undersøgelser, må fraværet af fund i kliniske undersøgelser dog fortolkes med forsigtighed.
English: Although uterine fibroids are benign, moderate to severe forms are often associated with significant morbidity, such as heavy bleeding, anaemia, pain, discomfort and reduced quality of life.
Danish: Skønt uterusfibromer er benigne, er moderate til svære former ofte forbundet med betydelig morbiditet såsom svær blødning, anæmi, smerter, ubehag og nedsat livskvalitet.
English: Data from clinical trials, non-clinical studies including in vitro testing were also reviewed.
Danish: Der blev ligeledes gennemgået data fra kliniske og ikke-kliniske undersøgelser, herunder in vitro-testning.
English: Taking into account the experts' views on the topic, and after a thorough review of the available data, PRAC considered that the following risk minimisation measures should be recommended.
Danish: Efter at have taget hensyn til eksperternes holdning til spørgsmålet og efter en grundig gennemgang af de foreliggende data fandt PRAC, at der bør anbefales følgende risikominimeringsforanstaltninger.
English: It was noted that no signal of hepatic toxicity was identified from non-clinical or clinical studies on Esmya.
Danish: Det bemærkedes, at der ikke er konstateret signaler om hepatisk toksicitet i de ikke-kliniske eller kliniske undersøgelser med Esmya.
English: Also, due to hormonal differences between rodents and humans, the toxicological liver safety findings obtained in rodents were assessed as less relevant for humans.
Danish: Som følge af hormonelle forskelle mellem gnavere og mennesker er de toksikologiske sikkerhedsresultater vedrørende leveren hos gnavere desuden vurderet som mindre relevante for mennesker.
English: The PRAC considers it appropriate to also monitor liver function 2 to 4 weeks after the treatment has stopped, since for some of the reported cases, liver injury was reported a few weeks after the discontinuation of the treatment.
Danish: PRAC anser det for hensigtsmæssigt også at overvåge leverfunktionen 2 til 4 uger efter at behandlingen er ophørt, da der i nogle af de indberettede tilfælde er indberettet leverskade et par uger efter behandlingens ophør.
English: Furthermore, measures to minimise a risk for liver injury should be implemented.
Danish: Derudover bør der træffes foranstaltninger til minimering af risikoen for leverskade.
English: The pre-operative treatment may be considered of least benefit as it reflects a situation when surgery is planned; however reductions in myoma size as well as reductions in blood loss and anaemia are considered of clinical significance.
Danish: Den præoperative behandling kan betragtes som den mindst gavnlige, da den afspejler en situation, hvor der planlægges operation; reduktionen i myomstørrelse samt reduktion af blodtab og anæmi anses dog for at have klinisk betydning.
English: Three cases of serious liver injury leading to a hepatic transplantation were reported between the marketing authorisation of Esmya (ulipristal acetate) and November 2017.
Danish: Der er indberettet tre tilfælde af alvorlig, transplantationskrævende leverskade i tidsrummet mellem udfærdigelsen af markedsføringstilladelsen for Esmya (ulipristalacetat) og november 2017.
English: Treatment should be stopped in patients showing signs or symptoms compatible with liver injury and the patient should be investigated immediately.
Danish: Behandlingen bør seponeres hos patienter, der viser tegn eller symptomer svarende til leverskade, og patienten bør straks undersøges.
English: In particular, there was a consensus among hepatologists that in at least 2 cases reported, a relation with the use of Esmya could be observed.
Danish: Særligt var hepatologerne enige om, at der i mindst 2 af de indberettede tilfælde kunne iagttages en sammenhæng med anvendelse af Esmya.
English: Given the estimated exposure to Esmya of approximately 200,000 to 275,000 patient-years, the number of cases of serious liver injury leading to liver transplantation appears higher than expected, although background incidence on drug induced liver injury is uncertain.
Danish: Da den skønnede eksponering for Esmya modsvarer ca. 200 000 til 275 000 patientår, forekommer antallet af alvorlige transplantationskrævende leverskader højere end forventet, skønt baggrundsincidensen for medikamentel leverskade er usikker.
English: • The PRAC concluded that Esmya (ulipristal acetate) may carry a risk for serious liver injury.
Danish: • PRAC konkluderede, at Esmya (ulipristalacetat) måske medfører risiko for alvorlig leverskade.
English: In the view of the remaining uncertainties, the PRAC is of the view that further data on Esmya and liver injury should be collected.
Danish: I betragtning af de tilbageværende usikkerheder er det PRAC's opfattelse, at der bør indsamles yderligere data om Esmya og leverskade.
English: Since a possible causal relationship between Esmya and acute liver failure could not be ruled out, these cases prompted an in-depth investigation of this risk and its impact on the benefit risk balance of Esmya.
Danish: Da der ikke kunne udelukkes en mulig kausal sammenhæng mellem Esmya og akut leversvigt, har disse tilfælde foranlediget en tilbundsgående undersøgelse af denne risiko og dens indvirkning på benefit/risk-forholdet for Esmya.
English: The PRAC was also of the view that the reported cases of liver injury should be closely monitored; to this effect a targeted follow up questionnaire has been included in a revised risk management plan (RMP).
Danish: PRAC var endvidere af den opfattelse, at de indberettede tilfælde af leverskader bør overvåges tæt; til dette formål indeholder den reviderede risikostyringsplan et spørgeskema med henblik på målrettet opfølgning.
English: • The PRAC was also of the opinion that mechanistic studies should be conducted, to further investigate a possible mechanism for hepatic toxicity.
Danish: • PRAC var desuden af den opfattelse, at der burde udføres mekanistiske studier med henblik på yderligere undersøgelse af en mulig virkningsmekanisme for levertoksicitet.
English: The available data raise serious concerns, and warrant risk minimisation measures to be taken.
Danish: De foreliggende data giver anledning til alvorlige betænkeligheder og kræver, at der træffes foranstaltninger til risikominimering.
English: Of note, the development of drug induced liver injury generally tends to be a gradual phenomenon, developing over 1-4 weeks.
Danish: Det bør bemærkes, at medikamentelt induceret leverskade sædvanligvis er gradvist indsættende og opstår i løbet af 1-4 uger.
English: In addition, the PRAC considers that warnings regarding monitoring and stopping criteria should be implemented, in order to identify a hepatic injury of any origin before the patient experiences symptoms, which could reduce the risk of developing serious injury.
Danish: Desuden finder PRAC, at der bør implementeres advarsler vedrørende overvågnings- og stopkriterier for at identificere en leverskade uanset oprindelse, inden patienten oplever symptomer, hvorved risikoen for alvorlig skade kan mindskes.
English: Patients should inform physicians on any liver problems they may have, and be also aware of the liver function monitoring tests to be performed before the treatment, during the treatment and after its discontinuation.
Danish: Patienterne bør oplyse lægen om eventuelle leverproblemer, de måtte have, og bør desuden være opmærksomme på, at der skal tages leverfunktionsprøver før behandlingen, under behandlingen og efter seponering.
English: The existing educational material (physician's guide) should also be updated with these recommendations, and the issuing of a Direct Healthcare Professional Communication (DHPC) is also considered appropriate, to inform healthcare professionals of the recommendations of the present review.
Danish: Disse anbefalinger bør ligeledes indgå i det eksisterende oplysningsmateriale (lægevejledningen), og der bør udsendes en direkte meddelelse til fagfolk i sundhedssektoren (DHPC), hvor de oplyses om anbefalingerne i nærværende gennemgang.
English: • The PRAC also found it necessary to introduce a patient card to be provided in each package of Esmya, to ensure that patients are adequately informed on the possible risks of liver injury and the implemented risk minimisation measures.
Danish: • PRAC fandt det desuden nødvendigt at indføre et patientkort, der skal være indeholdt i hver pakning med Esmya, for at sikre, at patienterne informeres tilstrækkeligt om de mulige risici for leverskader og de indførte risikominimeringsforanstaltninger.
English: • The PRAC reviewed the totality of the data regarding the risk for liver injury with Esmya provided by the marketing authorisation holder and National Competent Authorities on cases of liver injury and liver transplantation reported since the initial marketing authorisation of the product.
Danish: • PRAC gennemgik samtlige data vedrørende risikoen for leverskade med Esmya, som var fremlagt af indehaveren af markedsføringstilladelsen og de nationale kompetente myndigheder vedrørende tilfælde af leverskade og levertransplantation, der var indberettet siden den oprindelige markedsføringstilladelse for produktet.
English: Uterine fibroids are the most common female pelvic tumour.
Danish: Uterusfibromer er den hyppigste pelvistumor hos kvinder.
English: Acknowledging the uncertainty regarding background incidence and the information in the reported cases, the seriousness of the reported cases raises concern.
Danish: Trods usikkerheden vedrørende baggrundsincidens og oplysningerne om de indberettede tilfælde giver de indberettede tilfældes alvorlige karakter anledning til betænkelighed.
English: However, it is recognised that a surgical treatment is not suitable for all women, due to their medical history, co-morbidities or willingness to preserve fertility.
Danish: Det vedgås dog, at operativ behandling ikke er velegnet til alle kvinder, enten som følge af anamnesen, komorbiditet eller patientens ønske om at bevare fertiliteten.
English: PRAC considered all the data submitted by the MAH, as well as data provided by the National Competent Authorities including follow-up information on cases of liver transplantation.
Danish: PRAC tog hensyn til alle data indgivet af indehaveren af markedsføringstilladelsen samt data fra de nationale kompetente myndigheder, herunder opfølgende oplysninger om tilfælde af levertransplantation.
English: Based on the safety findings and possible mechanism of action, the experts of the ad hoc experts group were of the view that a causal association between Esmya and severe liver injury is plausible.
Danish: På baggrund af sikkerhedsresultaterne og den mulige virkningsmekanisme var eksperterne i ad hocekspertgruppen af den opfattelse, at der er sandsynlighed for en årsagssammenhæng mellem Esmya og svær leverskade.
English: In addition, observational studies should be performed to further characterise the hepatic risk and to evaluate the effectiveness of implemented risk minimisation measures.
Danish: Derudover bør der udføres observationsundersøgelser til nærmere karakterisering af den hepatiske risiko og evaluering af effektiviteten af de indførte risikominimeringsforanstaltninger.
English: The Committee, as a consequence, recommends the variation to the terms of the marketing authorisations for Esmya (ulipristal acetate).
Danish: Udvalget anbefaler derfor ændring af betingelserne for markedsføringstilladelsen for produkter indeholdende Esmya (ulipristalacetat).
English: Through a pronounced reduction of bleeding, reducing anaemia and related symptoms, Esmya has been demonstrated to rapidly contribute to the improvement of the quality of life in patients who did not undertake a surgical treatment.
Danish: Esmyas udtalte reduktion af blødning og reduktion af anæmi og relaterede symptomer er påvist hurtigt at medvirke til forbedret livskvalitet hos patienter, som ikke har fået operativ behandling.
English: In view of the above, the Committee considers that the benefit-risk balance of Esmya (ulipristal acetate) remains favourable subject to the agreed amendments to the product information and the additional risk minimisation measures.
Danish: På ovenstående baggrund finder udvalget, at benefit/risk-forholdet for Esmya (ulipristalacetat) fortsat er positivt under forudsætning af, at der foretages de vedtagne ændringer af produktinformationen og træffes de supplerende risikominimeringsforanstaltninger.
English: • The PRAC further concluded that Esmya should be contraindicated in patients with underlying hepatic disorder.
Danish: • PRAC konkluderede yderligere, at Esmya bør være kontraindiceret hos patienter med underliggende leversygdom.
English: In order to ensure that decisions on the initiation and continuation of the treatment are made by physicians who are familiar with diagnosis of uterine fibrosis, the PRAC also recommends that the initiation and supervision of treatment with Esmya should be restricted to physicians experienced in the diagnosis and treatment of uterine fibroids.
Danish: For at sikre, at beslutninger om initiering og fortsættelse af behandlingen træffes af læger, der er fortrolige med diagnosticering af uterusfibrom, anbefaler PRAC desuden, at initiering af og tilsyn med behandlingen med Esmya begrænses til læger med erfaring i diagnose og behandling af uterusfibrom.
English: Therefore, liver function tests should be performed before starting treatment with Esmya, monthly during the first two courses of treatment as well as two to four weeks after the discontinuation of the treatment.
Danish: Der bør derfor udføres leverfunktionstests inden behandling med Esmya en gang om måneden under de to første behandlingsforløb samt to til fire uger efter seponering af behandlingen.
English: Taking into account the clinical utility of Esmya in the intermittent treatment indication, where no other long-term pharmacological alternative is authorised, this indication should be limited to adult women of reproductive age who are not eligible for surgery.
Danish: Idet der tages hensyn til den kliniske værdi af Esmya til den intermitterende behandlingsindikation, hvor der ikke er godkendt noget andet farmakologisk langtidsdækkende alternativ, bør denne indikation begrænses til voksne kvinder, som er i den reproduktive alder og ikke er egnede til operation.
English: PRAC considered that it should be clarified in in the wording of the indication that in line with the current posology Esmya is to be used for a single treatment course in pre-operative setting.
Danish: PRAC fandt, at det i ordlyden af indikationen bør præciseres, at Esmya er beregnet til anvendelse i ét enkelt præoperativt behandlingsforløb i overensstemmelse med den nuværende dosering.
English: In view of the existing concerns on recently reported cases of serious liver injury and acknowledging that the magnitude of the benefit differs for different clinical situations, the PRAC considered that the use of Esmya should be limited.
Danish: I lyset af de eksisterende betænkeligheder ved nyligt indberettede tilfælde af alvorlig leverskade og i erkendelse af, at fordelen afhænger af den kliniske situation, fandt PRAC, at anvendelsen af Esmya bør begrænses.
English: and assuming that all such cases are due to Esmya, regardless of causality, the peak time to onset of liver injury is around 140 days and the vast majority of the reported potential drug induced liver injuries occurring between 1 and 8 months (2 treatment cycles including 2 months pause).
Danish: Baseret på de indberettede tilfælde af potentiel leverskade med Esmya - og forud at alle sådanne tilfælde er forårsaget af Esmya uanset årsagssammenhæng - er tiden til maksimal indsætten af leverskade ca. 140 dage, og langt størstedelen af de indberettede potentielt medikamentelt inducerede leverskader indtræder ved mellem 1 og 8 måneder (2 behandlingscyklusser inkl.
English: In post marketing settings, all of the reported cases lack information hampering causality assessment, and causal relationship with Esmya and serious hepatic injury is therefore not firmly established.
Danish: I alle tilfælde, der er indberettet efter markedsføring, mangler der oplysninger, hvilket vanskeliggør vurdering af kausalitet, og der har derfor ikke med sikkerhed kunnet fastslås en kausal sammenhæng mellem Esmya og alvorlig leverskade.
English: Patients should be informed of potential adverse reactions related to liver that could be caused by the use of Esmya, as well as on the need to warn their physicians on any liver problems they may have.
Danish: Patienterne bør informeres om potentielle leverrelaterede bivirkninger, som Esmya måske kan forårsage, og om nødvendigheden af at underrette lægen om eventuelle leverproblemer, de måtte have.
English: The temporary measure recommended by the PRAC in February 2018, to not treat any new patients is superseded by these new recommendations.
Danish: Disse nye henstillinger erstatter den midlertidige foranstaltning, der er indebar at undlade at behandle nye patienter, som PRAC anbefalede i februar 2018.
English: Balancing this to the benefits of Esmya treatment of moderate to severe symptoms of uterine fibroids, the PRAC concluded that the indicated population should be restricted for safety reasons.
Danish: Som afvejning heraf i forhold til fordelene ved Esmya til behandling af moderate til svære symptomer på uterusfibromer konkluderede PRAC, at den indicerede population bør begrænses af sikkerhedshensyn.
English: In conclusion, the PRAC considered that the benefit-risk balance of Esmya remained favourable subject to the amendments of the terms of the marketing authorisations.
Danish: Sammenfattende fandt PRAC, at benefit/risk-forholdet for Esmya fortsat var positivt, forudsat at der foretages ændringer i betingelserne for markedsføringstilladelserne.
English: In addition, the PRAC recommended the performance of liver function tests before starting each treatment course with Esmya, during treatment as well as two to four weeks after the discontinuation of treatment.
Danish: Derudover anbefalede PRAC, at der foretages leverfunktionstests før initiering af hvert behandlingsforløb med Esmya, under behandlingen samt to til fire uger efter ophør af behandlingen.
English: Although the general characteristics of Esmya do not support it to be a typical DILI causing agent, based on the current review, and taking experts views into consideration, the PRAC concluded that Esmya (ulipristal acetate) may carry a risk for serious liver injury.
Danish: Skønt Esmyas generelle egenskaber ikke svarer til et typisk leverskadeligt lægemiddel, konkluderede PRAC på grundlag af den aktuelle gennemgang og under hensyn til eksperternes synspunkter, at Esmya (ulipristalacetat) kan indebære risiko for alvorlig leverskade.
English: No information on hepatic events was at that time included in the Product Information of Esmya.
Danish: Produktinformationen for Esmya indeholdt på daværende tidspunkt ingen oplysninger om hepatiske hændelser.