FrancophonIA/ELRC3.0 huggingface dataset:
English: In 2013, following a review of the risk of kidney injury and mortality related to hydroxyethyl starch (HES) solutions for infusion when administered in patients with sepsis or critical illness, the Pharmacovigilance and Risk Assessment Committee (PRAC) recommended risk minimisation measures such as restrictions in use of these medicinal products.
Danish: Efter en gennemgang i 2013 af risikoen for nyreskade og dødelighed med sammenhæng med hydroxyethylstivelse (HES), infusionsvæske, opløsning, ved administration til patienter med sepsis eller kritisk sygdom anbefalede Udvalget for Risikovurdering inden for Lægemiddelovervågning (PRAC) risikominimeringsforanstaltninger såsom begrænsninger af anvendelsen af sådanne lægemidler.
English: The training materials should be distributed to all relevant HCPs intended to prescribe/administer HES solutions for infusion (e.g. anaesthiologists, intensive care physicians, nurses…).
Danish: Oplysningsmaterialet distribueres til alle relevante sundhedspersoner, der er tiltænkt at skulle ordinere/administrere HES-infusionsvæske, opløsning (f.eks. anæstesiologer, intensivafdelingernes læger og sygeplejersker ...).
English: In light of this, the PRAC recommendation and CMDh position were referred back to the Agency by the European Commission for further consideration of any possible unmet medical need that could result from the suspension of the marketing authorisations for the medicinal products concerned by the referral, as well as the feasibility and likely effectiveness of additional risk minimisation measures.
Danish: På denne baggrund blev PRAC's anbefaling og CMDh's udtalelse sendt tilbage til agenturet af Europa-Kommissionen med henblik på yderligere overvejelse af et eventuelt udækket medicinsk behov, der måtte opstå som følge af suspenderingen af markedsføringstilladelserne for lægemidlerne omfattet af henvisningen, samt muligheden for yderligere risikominimeringsforanstaltninger og disses forventede effektivitet.
English: As result of the reviews, the PRAC recommended that use of HES solutions for infusion should be restricted to the treatment of hypovolaemia due to acute blood loss when crystalloids alone are not considered sufficient.
Danish: Efter gennemgangene anbefalede PRAC, at anvendelsen af HES-infusionsvæske, opløsning, bør begrænses til behandling af hypovolæmi ved akut blodtab, når krystalloider alene skønnes at være insufficiente.
English: With regards to efficacy, PRAC considered that there is no new significant information related to the approved indication.
Danish: Med hensyn til effekt vurderer PRAC, at der ikke foreligger nye signifikante oplysninger, hvad angår den godkendte indikation.
English: These reviews were triggered by the results from large randomised clinical studies3,4,5 which showed an increased risk of mortality in patients with sepsis and an increased risk of kidney injury requiring dialysis in critically ill patients following treatment with HES solutions for infusion.
Danish: Disse gennemgange blev udløst af resultaterne fra store randomiserede kliniske studier3,4,5, der viste en øget risiko for død hos patienter med sepsis og en øget risiko for dialysekrævende nyreskade hos kritisk syge patienter efter behandling med HES-infusionsvæske, opløsning.
English: On 17 October 2017, Sweden triggered an urgent Union procedure under Article 107i of Directive 2001/83/EC, and requested the PRAC to assess the impact of the above non-adherence to the product information on the benefit-risk balance of hydroxyethyl starch (HES) solutions for infusion and issue a recommendation on whether the marketing authorisations of these products should be maintained, varied, suspended or revoked.
Danish: Den 17. oktober 2017 indledte Sverige en hasteprocedure i henhold til artikel 107i i direktiv 2001/83/EF og anmodede PRAC om at vurdere betydningen af ovennævnte manglende overholdelse af produktresuméet vedrørende benefit/risk-forholdet for hydroxyethylstivelse (HES), infusionsvæske, opløsning, og fremsætte en anbefaling om, hvorvidt markedsføringstilladelserne for disse lægemidler bør opretholdes, ændres, suspenderes eller tilbagekaldes.
English: Acknowledging the need of increasing the compliance to the indication and contraindications, the CMDh is of the position that a targeted communication through DHPC would be effective to this aim.
Danish: CMDh erkender nødvendigheden af at øge overholdelsen af indikationen og kontraindikationerne og finder, at målrettet kommunikation gennem et direkte brev til sundhedspersoner vil være effektivt til dette formål.
English: The results indicate that the implemented restrictions in use are not adhered to.
Danish: Resultaterne viser, at de indførte anvendelsesbegrænsninger ikke overholdes.
English: The PRAC also considered views from individual PRAC members on the benefit/risk balance of HES solutions for infusion as well as on the use of these products at the national level.
Danish: PRAC tog også hensyn til synspunkter fra individuelle PRAC-medlemmer, hvad angår benefit/riskforholdet for HES-infusionsvæske, opløsning, og anvendelsen af disse lægemidler på nationalt niveau.
English: In view of the overall exposure to HES solutions for infusion in the EU, estimated to about 1.5 to 2 million patients per year since 2014 and the reported extent of usage in patients with sepsis from the two DUSs, the estimated level of continued usage in populations where serious harm has been demonstrated raises important public health concerns, including a potentially increased mortality.
Danish: På baggrund af den generelle eksponering for HES-infusionsvæske, opløsning, i EU, der skønnes at omfatte ca. 1,5-2 millioner patienter om året siden 2014, og den rapporterede grad af brug hos patienter med sepsis fra de to studier af lægemiddelanvendelse, giver det skønnede niveau for fortsat anvendelse hos populationer, hvor der er påvist alvorlig skade, anledning til væsentlige bekymringer for den offentlige sundhed, herunder potentielt øget dødelighed.
English: (2) Addition of a prominent warning at the top of the SmPC and PL.
Danish: (2) Tilføjelse af en iøjnefaldende advarsel øverst i produktresuméet og indlægssedlen.
English: The results indicate that the implemented restrictions in use are not sufficiently adhered to.
Danish: Resultaterne viser, at de indførte anvendelsesbegrænsninger ikke overholdes tilstrækkeligt.
English: Most of the arguments refer to the use of HES solutions for infusion outside the terms of the MA or to claimed benefits that are not clinically significant or supported by robust data.
Danish: De fleste af argumenterne henviser til brugen af HES-infusionsvæske, opløsning, uden for betingelserne i markedsføringstilladelsen eller til påberåbte fordele, der ikke har klinisk betydning eller understøttes af robuste data.
English: In conclusion, no risk minimisation measures or combination of measures have been identified which would be sufficiently effective or feasible to implement in a reasonable timeframe, when an important number of patients at high risk for serious harm, would continue to be exposed.
Danish: Som konklusion er der ikke fundet risikominimeringsforanstaltninger eller kombinationer heraf, som ville være tilstrækkeligt effektive eller gennemførlige på rimelig tid, når et stort antal patienter med stor risiko for alvorlig skade fortsat ville blive udsat.
English: • It will allow targeting HCPs in charge of the administration of the medicinal product who have an important role in ensuring adherence to the adequate use of HES solutions for infusion.
Danish: • Den vil muliggøre målretning mod sundhedspersoner, der har ansvar for administration lægemidlet og har en vigtig rolle i at sikre overholdelse af korrekt anvendelse af HESinfusionsvæske, opløsning.
English: • With regards to the efficacy, PRAC considered that there is no new significant information related to the approved indication.
Danish: • Med hensyn til effekt vurderede PRAC, at der ikke foreligger nye signifikante oplysninger hvad angår den godkendte indikation.
English: Revision of PRAC recommendation
Danish: Revision af PRAC's anbefaling
English: The details of the controlled access program, the modalities of its implementation and the final training materials, including communication media and distribution modalities should be agreed with the National Competent Authorities.
Danish: De nærmere detaljer i programmet for kontrolleret adgang, den måde, det gennemføres på, og det endelige oplysningsmateriale, herunder kommunikationsmedier og fordelingsmetoder, aftales med de nationale kompetente myndigheder.
English: The CMDh noted the concerns raised by PRAC on some models of controlled access program for HES solutions for infusion, in particular regarding feasibility due to the difficulty to define relevant prescribers / departments / hospitals and their effectiveness.
Danish: CMDh noterede sig PRAC's betænkeligheder vedrørende nogle modeller af et program til kontrolleret adgang til HES-infusionsvæske, opløsning, herunder deres gennemførlighed som følge af vanskeligheden af at definere relevante ordinerende læger/afdelinger/hospitaler, og modellernes effektivitet.
English: A restricted distribution system to accredited hospitals or physicians would raise serious feasibility concerns and would be unlikely to be effective considering the particular type of distribution and usage of HES solutions for infusion.
Danish: Et system med begrænset distribution til akkrediterede hospitaler eller læger ville medføre alvorlige problemer vedrørende gennemførligheden og ville næppe være effektivt i betragtning af den særlige distribution og anvendelse af HES-infusionsvæske, opløsning.
English: Treatment of hypovolemia should replace lost blood volume in order to restore tissue perfusion and oxygenation to ultimately prevent renal injury and death.
Danish: Ved behandling af hypovolæmi bør det nedsatte blodvolumen genoprettes for at genetablere vævsperfusionen og iltningen og dermed i sidste instans forhindre nyreskade og død.
English: The CMDh noted the PRAC conclusions that no new safety data was provided that would change the conclusions on the safety profile established in the previous referrals for HES solutions for infusion.
Danish: CMDh noterede sig PRAC's konklusioner om, at der ikke var forelagt nye sikkerhedsdata, som ville kunne ændre de konklusioner om sikkerhedsprofilen, der er draget ved de tidligere indbringelser for HES-infusionsvæske, opløsning.
English: In the light of the above information, the PRAC confirmed at its May 2018 plenary meeting, its previous scientific conclusions that the benefit risk of HES solutions for infusion is negative and recommended to suspend the marketing authorisations of these medicinal products.
Danish: På baggrund af ovenstående oplysninger bekræftede PRAC på sit plenarmøde i maj 2018 sine tidligere videnskabelige konklusioner om, at benefit/risk-forholdet for HES-infusionsvæske, opløsning, er negativt, og anbefalede at suspendere markedsføringstilladelserne for disse lægemidler.
English: In view of the above, the PRAC concluded that pursuant to Article 116 of Directive 2001/83/EC the risks related to the use of HES outweigh their benefits and thus the benefit-risk balance of HES solutions for infusion is no longer favourable.
Danish: På baggrund af ovenstående konkluderede PRAC, jf. artikel 116 i direktiv 2001/83/EF, at risiciene ved brug af HES er større end fordelene, og at benefit/risk-forholdet for HES-infusionsvæske, opløsning, derfor ikke længere er gunstigt.
English: With regards to the safety data related to these products, the PRAC reviewed all available evidence since the last referral and concluded that the previous conclusions that HES solutions for infusion is associated with an increased risk of mortality and renal failure in patients with sepsis or critical illness were confirmed and that the available information, including more recently submitted clinical data, do not change the established risk in these patient populations.
Danish: Hvad angår sikkerhedsdataene for disse lægemidler, gennemgik PRAC al tilgængelig evidens siden forrige indbringelsesprocedure og konkluderede, at de tidligere konklusioner om, at HES-opløsninger til infusion er forbundet med en øget risiko for død og nyresvigt hos patienter med sepsis eller kritisk sygdom, blev bekræftet, og at de tilgængelige oplysninger, herunder nytilkomne kliniske data, ikke ændrer den fastslåede risiko hos disse patientpopulationer.
English: • With regards to the two separate DUSs conducted to assess the effectiveness of the risk minimisation measures imposed as an outcome of the 2013 referral, PRAC concluded that these studies, despite limitations due to possible misclassification, are representative of the clinical usage in the European Union and that key results are reliable.
Danish: • Hvad angår de to separate studier af lægemiddelanvendelsen til vurdering af effekten af de risikominimerende foranstaltninger, der blev pålagt som følge af indbringelsesproceduren i 2013, konkluderede PRAC, at disse studier, trods begrænsninger som følge af mulig fejlklassificering, er repræsentative for den kliniske anvendelse i EU, og at hovedresultaterne er pålidelige.
English: The CMDh noted that eight EU Member States have shared concerns about a medical need created in case of suspension of the marketing authorisation for HES solutions for infusion.
Danish: CMDh noterede sig, at otte EU-medlemsstater deler betænkeligheder vedrørende det medicinske behov, der opstår i tilfælde af suspendering af markedsføringstilladelsen for HES-infusionsvæske, opløsning.
English: Med 2008; 358(2):125-39 5 Myburgh J, Finder S, Bellomo R et al. Hydroxyethyl starch or saline for fluid resuscitation in intensive care.
Danish: 5 Myburgh J, Finder S, Bellomo R et al. Hydroxyethyl starch or saline for fluid resuscitation in intensive care.
English: The DUS protocol to be submitted by the MAHs should include clear objectives, focusing on prescribing decisions, especially adherence to indications and contraindications.
Danish: Den protokol til et studie af lægemiddelanvendelse, der skal forelægges af markedsføringstilladelsesindehaverne, skal indeholde klare målsætninger rettet mod ordinationsbeslutninger, navnlig overholdelse af indikationer og kontraindikationer.
English: HES solutions for infusion are authorised worldwide for the treatment of hypovolaemia associated with various conditions.
Danish: HES-infusionsvæske, opløsning, er godkendt verden over til behandling af hypovolæmi ved diverse sygdomme.
English: A more pronounced hypovolemia requires a greater volume (dose) of HES solutions for infusion and is also associated with a greater risk for renal injury and death.
Danish: Mere udtalt hypovolæmi kræver større volumen (dosis) af HES-infusionsvæske, opløsning, og er også forbundet med en større risiko for nyreskade og død.
English: Eight EU Member States have mentioned that a suspension of the marketing authorisations for HES solutions for infusion would have an impact in the national clinical practice as HES solutions for infusion fulfils currently a medical need in their territory.
Danish: Otte EU-medlemsstater har angivet, at en suspendering af markedsføringstilladelserne for HES-infusionsvæske, opløsning, ville få betydning for den nationale kliniske praksis, da HES-infusionsvæske, opløsning, på nuværende tidspunkt opfylder et medicinsk behov på deres område.
English: - The MAH should ensure that HES solutions for infusion are only delivered to accredited hospitals/centres.
Danish: - Indehaveren af markedsføringstilladelsen sikrer, at HES-infusionsvæske, opløsning, kun leveres til akkrediterede hospitaler/centre.
English: The CMDh discussed whether measures to mitigate the risks associated with HES solutions for infusion, including in particular the risk of increased mortality and renal failure in critically ill patients and patients with sepsis would be effective and feasible, taking into account new elements provided by the MAHs and Member States.
Danish: CMDh drøftede, om foranstaltninger til afbødning af risiciene forbundet med HES-infusionsvæske, opløsning, herunder især risikoen for øget dødelighed og nyresvigt hos kritisk syge patienter og patienter med sepsis, ville være effektive og gennemførlige i betragtning af nye elementer, der er forelagt af indehaverne af markedsføringstilladelse og medlemsstaterne.
English: These data raise serious concerns as they showed use of HES solutions for infusion in patient populations which are contraindicated such as those who are critically ill, or with sepsis3,4,5.
Danish: Disse data er meget bekymrende, da de viser, at HES-infusionsvæske, opløsning, anvendes hos kontraindicerede patientpopulationer som f.eks. kritisk syge patienter og patienter med sepsis3,4,5.
English: PRAC confirmed that the available information, including more recent submitted clinical data, do not change the established risk of increased mortality and renal failure related to the use of HES solutions for infusion in these patients.
Danish: PRAC bekræftede, at de tilgængelige oplysninger, herunder mere nytilkomne kliniske data, ikke ændrer den fastslåede risiko for øget dødelighed og nyresvigt ved brug af HES-opløsninger til infusion hos disse patienter.
English: In order to optimise the uptake by HCPs and their adherence to the adequate conditions of use of HES solutions for infusion, the learned societies should be involved in the development and distribution of such training materials.
Danish: For at optimere materialets anvendelsen hos sundhedspersoner og deres overholdelse af betingelserne for korrekt anvendelse af HES-infusionsvæske, opløsning, bør de videnskabelige samfund inddrages i udarbejdelsen og distributionen af det pågældende oplysningsmateriale.
English: Due to the serious public health impact, Sweden was considering suspending the marketing authorisations for the above mentioned medicinal products, and therefore requested an urgent review of the matter at the European level, and asked the PRAC to assess the impact of the above concerns on the benefit-risk balance of HES solutions for infusion and issue a recommendation on whether the marketing authorisations of these products should be maintained, varied, suspended or revoked.
Danish: På grund af den alvorlige risiko for den offentlige sundhed overvejede Sverige at suspendere markedsføringstilladelserne for ovennævnte lægemidler og anmodede derfor om en hastegennemgang af sagen på europæisk plan og bad PRAC om at vurdere betydningen af ovennævnte problemstilling, hvad angår benefit/risk-forholdet for HES-infusionsvæske, opløsning, og fremsætte en anbefaling om, hvorvidt markedsføringstilladelserne for disse lægemidler bør opretholdes, ændres, suspenderes eller tilbagekaldes.
English: In view of the seriousness of the safety issues and that the proportion of patients who are exposed to these risks in the absence of effective risk minimisation measures could have important public health consequences including a potentially increased mortality, the PRAC concluded that the benefit risk balance of hydroxyethyl starch solutions for infusion is no longer favourable and recommended the suspension of the marketing authorisations.
Danish: I lyset af andelen af patienter, der eksponeres for disse risici i fravær af effektive risikominimerende foranstaltninger, og da der er tale om alvorlige sikkerhedsmæssige betænkeligheder, der kan have alvorlige konsekvenser for den offentlige sundhed, herunder potentielt øget risiko for død, konkluderede PRAC, at benefit/risk-forholdet for HES-opløsninger til infusion ikke længere er gunstigt, og anbefalede, at markedsføringstilladelserne suspenderes.
English: As an overall conclusion, the CMDh considered that the risk minimisation described above would be feasible and effective and will have a synergistic effect as they allow targeting specific HCPs at all the steps of the prescription and administration of HES solutions for infusion.
Danish: Som overordnet konklusion vurderede CMDh, at den ovenfor beskrevne risikominimering ville være gennemførlig og effektiv og vil have synergistisk virkning, da den er målrettet mod bestemte sundhedspersoner i alle trin af ordination og administration af HES-infusionsvæske, opløsning.
English: Besides, the CMDh acknowledged the PRAC's concern that non-adherence would not only be due to a lack of awareness by prescribers of the restrictions imposed to HES solutions for infusion.
Danish: CMDh noterede sig i øvrigt PRAC's betænkelighed ved, at manglende overholdelse ikke alene skyldtes manglende bevidsthed hos de ordinerende om de begrænsninger, der er pålagt HES-infusionsvæske, opløsning.
English: • The PRAC further acknowledged that the current clinical experience suggests that it is difficult to clearly separate patient populations where randomised clinical trials have shown serious harm from populations targeted by the approved indication.
Danish: • PRAC anerkendte også, at den aktuelle klinisk erfaring viser, at det er vanskeligt at skelne mellem de patientpopulationer, hvor der i randomiserede kliniske studier er set alvorlig skade, og de populationer, der er omfattet af den godkendte indikation.
English: • This controlled access program is a key measure to ensure adherence of HCPs to the terms of the MA by increasing both the awareness of the relevant HCPs to the risks associated to the use of HES solutions for infusions and ensuring that they have received appropriate training before they can use HES solutions for infusion.
Danish: • Dette program for kontrolleret adgang er en nøgleforanstaltning til at sikre, at sundhedspersoner overholder betingelserne i markedsføringstilladelsen, både ved at øge de pågældende sundhedspersoners opmærksomhed om risiciene ved brug af HES-infusionsvæske, opløsning, og ved at sikre, at de har modtaget tilstrækkelig oplæring, før de kan bruge HESinfusionsvæske, opløsning.
English: Amongst other data related to safety, the PRAC reviewed the results from two separate DUSs conducted to assess the effectiveness of the risk minimisation measures imposed as an outcome of the 2013 referral, and concluded that these studies despite a potential limitation of possible misclassification, are representative of the clinical usage in the European Union and that key results are reliable.
Danish: Blandt de andre sikkerhedsrelaterede data gennemgik PRAC resultaterne fra to separate studier af lægemiddelanvendelsen til vurdering af effektiviteten af de risikominimerende foranstaltninger, der blev pålagt som følge af indbringelsesproceduren i 2013, og konkluderede, at disse studier, trods en potentiel begrænsning gennem mulig fejlklassificering, er repræsentative for den kliniske anvendelse i EU, og at hovedresultaterne er pålidelige.
English: In particular, the CMDh took into consideration the additional details from the MAHs on the proposed controlled access program.
Danish: Herunder tog CMDh i betragtning de supplerende detaljer fra indehaverne af markedsføringstilladelse om det foreslåede program til kontrolleret adgang.
English: In addition, the CMDh is of the view that the MAHs shall perform a Drug Utilisation Study, in order to assess the effectiveness of the new measures recommended.
Danish: CMDh er derudover af den opfattelse, at indehaverne af markedsføringstilladelse bør udføre et studie af lægemiddelanvendelse for at vurdere effektiviteten af de nye foranstaltninger, der anbefales.
English: Communication measures
Danish: Formidlingstiltag
English: On the contrary, the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) and five Scandinavian learned societies supported the suspension of the marketing authorisations for HES solutions for infusion.
Danish: Intensive Care Medicine (SSAI) og fem skandinaviske videnskabelige samfund suspenderingen af markedsføringstilladelserne for HES-opløsninger til infusion.