FrancophonIA/ELRC3.0 huggingface dataset:
English: Having noted the BSWP assessment, the CHMP concluded that there are serious concerns regarding the appropriateness of the statistical methodology used for the pooled analyses, mainly because they have been based on fixed effects models in the presence of evident heterogeneity but in particular because the main grounds for the refusal of the evidence relate to the lack of compliance with the key criteria detailed in the CHMP Points to consider document (CPMP/EWP/2330/99).
Slovenian: Ob upoštevanju ocene BSWP je sklenil, da obstajajo resni pomisleki glede ustreznosti statistične metodologije, ki se je uporabila za združene analize, predvsem ker so temeljile na modelu fiksnih učinkov v prisotnosti očitne heterogenosti, zlasti pa zato, ker se glavni razlogi za zavrnitev dokazov nanašajo na pomanjkanje skladnosti s ključnimi merili, podrobno določenimi v dokumentu CHMP Points to consider (CPMP/EWP/2330/99).
English: Analysis of spontaneous reports suggests that hypersensitivity reactions are more frequent in women, patients with previous or current allergic disease or those using NSAIDs or other analgesics concomitantly.
Slovenian: Analiza spontanih poročil je razkrila, da so preobčutljivostne reakcije pogostejše pri ženskah, bolnikih s preteklimi ali trenutnimi alergijskimi boleznimi in pri ljudeh, ki istočasno jemljejo nesteroidna protivnetna zdravila (NSAID) ali druge analgetike.
English: A causal relationship with tolperisone was assessed as at least possible in 90% of all hypersensitivity reactions.
Slovenian: Podane so bile ocene, da je bila vzročna povezava s tolperizonom vsaj možen vzrok za 90 % vseh preobčutljivostnih reakcij.
English: Van Denburg et al. (2008) have found a 33% change in the Ashworth Scale to correlate with a 1-point change in the Physician's global assessment score in patients with post-stroke spasticity, indicating clinical relevance.
Slovenian: Van Denburg et al. (2008) so ugotovili, da 33-odstotno izboljšanje na Ashworthovi lestvici sovpada z izboljšanjem za 1 točko pri zdravnikovi splošni oceni bolnika s spastičnostjo, ki je posledica možganske kapi, kar kaže na klinično pomembnost zdravila.
English: Gedeon Richter PLC proposed to restrict the indication to “Short-term treatment of muscle spasms in adult patients with acute non-specific low back pain”, with a maximum duration of treatment of 7 days.
Slovenian: Družba Gedeon Richter PLC je predlagala, naj se indikacija omeji na „kratkoročno zdravljenje mišičnih spazmov pri odraslih bolnikih z akutno nespecifično bolečino v križu“, pri čemer zdravljenje traja največ sedem dni.
English: It can therefore be concluded that of the four main studies in this indication, which became available after the initial marketing authorisation was granted, one suffers from substantial deficiencies and the remaining 3 failed to demonstrate an effect on the efficacy outcome.
Slovenian: Zaključimo lahko, da je izmed štirih glavnih študij v zvezi z navedeno indikacijo, ki so postale dostopne po izdaji prvotnega dovoljenja za promet z zdravilom, ena študija precej pomanjkljiva, preostale tri pa niso uspele dokazati vpliva zdravila na rezultate učinkovitosti.
English: The SAG was also of the opinion that it is not possible to derive any conclusion regarding the efficacy of tolperisone, nor was it possible to identify any specific patient subgroups that could benefit from treatment with tolperisone compared to other treatments.
Slovenian: Prav tako je menila, da ni mogoče niti izpeljati nobenega zaključka glede učinkovitosti tolperizona niti opredeliti nobenih podskupin bolnikov, ki bi lahko imeli koristi od zdravljenja s tolperizonom v primerjavi z drugimi zdravljenji.
English: There are no GCPcompliant studies, there is 1 actively-controlled trial and a few observational studies.
Slovenian: Izvedena ni bila nobena študija, ki bi bila skladna z dobro klinično prakso, obstajajo pa ena aktivno nadzorovana preiskava in nekaj opazovalnih študij.
English: The CHMP has considered the totality of the available data on the safety and efficacy of tolperisone.
Slovenian: CHPM je upošteval vse razpoložljive podatke glede varnosti in učinkovitosti tolperizona.
English: The chemical structure of tolperisone is similar to that of lidocaine and, similarly to lidocaine, tolperisone has membrane stabilising effects.
Slovenian: Kemijska zgradba tolperizona je podobna zgradbi lidokaina, poleg tega pa tako kot lidokain tudi tolperizon sodeluje pri stabilizaciji membrane.
English: The improvement in Ashworth scale was accompanied by a statistically significant difference in the investigator's overall assessment of efficacy in favour of tolperisone.
Slovenian: Poleg izboljšanja na Ashworthovi lestvici velja omeniti tudi statistično pomembno razliko pri raziskovalčevi splošni oceni učinkovitosti, ki je bila v korist tolperizona.
English: The Struck 2002 study failed to demonstrate a significant improvement in the primary endpoint, and the two secondary parameters for which a statistically significant improvement could be seen are subjective, and not considered clinically meaningful given that they were not accompanied by commensurate improvements in clinically relevant parameters such as pain intensity, pain at movement and motility.
Slovenian: Študija, ki jo je leta 2002 izvedel Struck, ni pokazala nobenega omembe vrednega izboljšanja pri primarnem opazovanem dogodku, dva sekundarna parametra, kjer je bilo opaženo statistično pomembno izboljšanje, pa sta subjektivna in klinično nepomembna, saj bi morala biti zabeležena tudi ustrezna izboljšanja pri klinično pomembnih parametrih, kot so intenzivnost bolečin, bolečine pri gibanju in gibljivost.
English: However, efficacy results of the subgroup treated with a daily tolperisone dose of up to 450 mg/day were consistent with the results of the whole ITT population.
Slovenian: Vendar pa so bili rezultati učinkovitosti pri podskupini, ki je prejemala dnevni odmerek do 450 mg, skladni z rezultati pri celotni populaciji vključenih bolnikov (ITT).
English: Very limited information exists on the efficacy of tolperisone in this indication.
Slovenian: O učinkovitosti tolperizona v zvezi s to indikacijo je na voljo zelo omejeno število informacij.
English: • The variation to the terms of the marketing authorisation for the oral formulations of medicinal products referred to in Annex I, for which the relevant sections of the summary of product characteristics and package leaflet are set out in Annex III to the opinion.
Slovenian: • spremembo pogojev dovoljenja za promet z zdravilom za peroralne oblike zdravil iz Priloge I, za katere so zadevni razdelki povzetka glavnih značilnosti zdravila in navodilo za uporabo navedeni v Prilogi III k mnenju;
English: Further functional secondary parameters (i.e. the modified Barthel Index (assessing activities of daily living), capacity to perform routine activities and walking endurance) consistently favoured tolperisone over placebo.
Slovenian: Tudi drugi funkcionalni sekundarni parametri (npr. spremenjen Barthelov indeks (instrument za ocenjevanje dnevnih aktivnosti), zmožnost opravljanja rutinskih dejavnosti in vzdržljivost pri hoji) so dosledno kazali na večjo učinkovitost tolperizona v primerjavi s placebom.
English: Finally, the Hodinka 2001 study also failed to demonstrate a relevant difference in the primary endpoint, and the only transient significant difference observed was in the Roland-Morris Disability Scale at day 7, having disappeared at day 14.
Slovenian: Tudi študija, ki jo je leta 2001 izvedel Hodinka, ni pokazala omembe vrednih sprememb pri primarnem opazovanem dogodku, kratkotrajno izboljšanje pa je 7. dan sicer bilo opaženo na Roland-Morrisovi lestvici prizadetosti, vendar so učinki 14. dan izginili.
English: However, the Committee considered the proposed study to be inadequate to provide conclusive evidence regarding the potential efficacy of tolperisone in the proposed indication, in particular due to the short treatment duration proposed.
Slovenian: Vendar je odbor menil, da predlagana študija ne zadostuje za zagotovitev prepričljivih dokazov o možni učinkovitosti tolperizona v zvezi s predlagano indikacijo, zlasti zaradi predlaganega kratkega trajanja zdravljenja.
English: In the Melka study (1997), the reduction in muscle tone (as measured by the Ashworth scale) was accompanied by a consistent improvement in functional parameters indicative of clinical relevance.
Slovenian: Študija Melke (1997) je poleg znižanja mišičnega tonusa (glede na Ashworthovo lestvico) zabeležila tudi sistematično izboljšanje funkcionalnih parametrov, kar kaže na klinično pomembnost zdravila.
English: However, as hypersensitivity is a characteristic of the active substance rather than of the formulation, the concerns identified with the oral formulations are also relevant for the parenteral formulation.
Slovenian: Ker pa je preobčutljivost bolj značilnost zdravilne učinkovine kot formulacije zdravila, so pomisleki, ki so se pojavili v zvezi s peroralnimi oblikami, pomembni tudi za parenteralne oblike.
English: Germany considered that the numerous reports of hypersensitivity reactions received in the post authorisation phase are indicative of a safety concern which is not balanced by the limited evidence of efficacy.
Slovenian: Nemčija je menila, da številna poročila o preobčutljivostnih reakcijah, ki jih je prejela po odobritvi zdravila, kažejo na nekatera varnostna tveganja, ki niso uravnotežena z omejenim številom dokazov o učinkovitosti zdravila.
English: While only a small number of reports of hypersensitivity reactions were observed in the studies submitted, they represent more than half of all spontaneous reports.
Slovenian: V predloženih študijah so namreč zabeležili majhno število poročil o preobčutljivostnih reakcijah, medtem ko je med spontanimi poročili takih več kot polovica.
English: It possesses high affinity for nervous tissue, reaching the highest concentrations in the brain stem, spinal cord and peripheral nerve tissue.
Slovenian: Tolperizon ima veliko afiniteto do živčnega tkiva, najvišje koncentracije pa doseže v možganskem deblu, hrbtenjači in perifernem živčevju.
English: Following the adoption of the CHMP opinion and recommendations during the June 2012 CHMP meeting, re-examination requests were received from Gedeon Richter PLC and PP Nature Balance Lizenz GmbH, as they considered that there is adequate data supporting the efficacy of tolperisone in the “treatment of muscular hypertonicity and muscle spasms associated with locomotor diseases” indication.
Slovenian: Po sprejetju mnenja CHMP in priporočil na sestanku CHMP junija 2012 sta družbi Gedeon Richter PLC in PP Nature Balance Lizenz GmbH poslali zahtevka za ponovni pregled, saj po njunem mnenju obstajajo zadostni podatki, ki potrjujejo učinkovitost tolperizona pri indikaciji „zdravljenje mišične hipertonije in mišičnih spazmov, povezanih z obolenji lokomotornega sistema“.
English: The Struck 2004 study also failed to demonstrate a significant improvement in the primary endpoint.
Slovenian: Študija, ki jo je Struck opravil leta 2004, prav tako ni pokazala omembe vrednega izboljšanja pri primarnem opazovanem dogodku.
English: Mean maximum walking distance per 2 minutes at final visit was approx. 70 meters in the tolperisone and 40 meters in the placebo group.
Slovenian: Povprečna najdaljša prehojena razdalja v 2 minutah pri zadnjem obisku je znašala približno 70 metrov pri bolnikih, ki so prejemali tolperizon, in 40 metrov pri bolnikih, ki so prejemali placebo.
English: In the Stamenova study, patients could be titrated up to 900 mg per day, thus only a subgroup (35%) of tolperisone patients was treated within the dose range currently approved in the SPC (150-450 mg).
Slovenian: Študija Stamenove je dopuščala titracijo dnevnih odmerkov do 900 mg, tako da je samo podskupina (35 %) bolnikov, zdravljenih s tolperizonom, dobivala odmerek, ki je v povzetku glavnih značilnosti zdravila trenutno naveden kot odobren (150-450 mg).
English: In both studies, tolperisone is given to a very heterogeneous population as part of a rehabilitation program, so it is not possible to isolate the effect of tolperisone from the effect of other interventions and therefore this data does not support the evidence of efficacy in this particular indication.
Slovenian: V obeh študijah je tolperizon prejemala izredno heterogena populacija bolnikov, vključenih v rehabilitacijski program, zato je nemogoče ločiti učinke tolperizona od učinkov drugih dejavnikov, kar pomeni, da podatki študij ne morejo podpreti dokazov o učinkovitosti v zvezi z omenjeno indikacijo.
English: Tolperisone reduces the reticulo-spinal facilitation in the brainstem and has been shown to be effective in alleviating experimental gamma-rigor of reticular origin.
Slovenian: Tolperizon zmanjša retikulospinalni spodbujevalni vpliv v možganskem deblu in dokazano učinkovito lajša okorelost receptorjev gama retikularnega izvora.
English: In the only study in this indication where superiority of tolperisone over placebo in the primary outcome was shown (Pratzel 1995), this was achieved using a new parameter in the formula for calculation which was not pre-determined but rather introduced in post-hoc efficacy analysis.
Slovenian: Primarni rezultati edine študije (Pratzel 1995), opravljene v zvezi s to indikacijo, ki so pokazali večjo učinkovitost tolperizona v primerjavi s placebom, so bili pridobljeni z uporabo novega parametra v formuli za izračun, ki ni bil predhodno določen, temveč je bil vpeljan v post hoc analizi učinkovitosti.
English: • Peripheral level - stabilises the membrane of neurons, and consequently supresses the amplitude and frequency of the action potentials.
Slovenian: • Periferno živčevje - stabilizira membrano živčnih celic ter s tem zmanjša obseg in pogostost akcijskih potencialov.
English: Parenteral formulation
Slovenian: Parenteralna oblika
English: • The revocation of the marketing authorisation for the parenteral formulations of medicinal products referred to in annex I.
Slovenian: • preklic dovoljenja za promet z zdravilom za parenteralne oblike zdravil iz Priloge I.
English: For the remaining indications (rehabilitation after orthopaedic and trauma surgery, treatment of obliterative vascular diseases as well as syndromes due to impaired vascular innervation, and Little's disease and other encephalopaties accompanied by dystonia) there is extremely limited evidence of efficacy, mainly based on small studies with inadequate design and including a heterogeneous population.
Slovenian: O učinkovitosti zdravila v zvezi z ostalimi indikacijami (rehabilitacija po ortopedskih in travmatoloških operacijah, zdravljenje obliterativnih žilnih bolezni ter sindromov, ki so posledica motenj krvnega pretoka, cerebralna paraliza in druge encefalopatije, ki jih spremlja distonija) je na voljo zelo malo dokazov, ki pretežno temeljijo na majhnih študijah, ki so imele pomanjkljivo zasnovo in so zajele heterogeno populacijo bolnikov.
English: Hypotheses include tolperisone metabolites as hapten formations activating the patient's immune system through covalent modification of proteins, or structural similarity to the local anaesthetic lidocaine.
Slovenian: Dve od hipotez sta, da se presnovki tolperizona obnašajo kot hapteni, ki prek kovalentne modifikacije beljakovin sprožijo bolnikov obrambni sistem, oziroma, da obstaja strukturna podobnost z lokalnim anestetikom lidokainom.
English: The Feher study (1985) used the Rivermead scale, which has shown high validity and reliability in assessment of motor function in stroke patients.
Slovenian: V Feherjevi študiji (1985) je bila uporabljena Rivermeadska lestvica, ki se je izkazala za izredno zanesljiv in verodostojen instrument za ocenjevanje motoričnih funkcij pri bolnikih po možganski kapi.
English: The only study in this indication with a positive outcome contains significant methodological deficiencies which preclude any conclusion on the efficacy of the product.
Slovenian: V edini študiji v zvezi s to indikacijo, ki je odkrila pozitivne rezultate, je bila uporabljena precej pomanjkljiva metodologija, zato je na podlagi te študije nemogoče podati kakršnekoli zaključke o učinkovitosti izdelka.
English: It is therefore not plausible how the reduction of a triggered PPT could have been translated into a clinically relevant effect in patients with painful reflex muscle spasm.
Slovenian: Zato ni utemeljeno, kakšne klinično pomembne učinke bi lahko imelo znižanje števila sproženih PPT-jev na bolnike z bolečimi reflektornimi mišičnimi spazmi.
English: These are mostly observational and extremely limited documentation is available.
Slovenian: Večinoma gre za opazovalne študije z zelo skopo dokumentacijo.
English: • Treatment of muscular hypertonicity and muscle spasms associated with locomotor diseases (e.g. spondylosis, spondylarthrosis, cervical and lumbar syndromes, arthrosis of large joints)
Slovenian: • zdravljenje mišične hipertonije in mišičnih spazmov, povezanih z obolenji lokomotornega sistema (npr. spondiloza, spondilartroza, cervikalni in lumbalni sindrom ter artroza velikih sklepov);
English: Hypersensitivity can be a significant event and cases of anaphylactic reactions/anaphylactic shock have been reported.
Slovenian: Preobčutljivost je lahko nezanemarljiv dogodek, zabeleženi pa so bili tudi primeri anafilaktičnih reakcij oziroma anafilaktičnega šoka.
English: In this respect, the CHMP took note of the fact that the marketing authorisation holder of the products for which these indications are approved concluded that the evidence of efficacy is insufficient to balance the risks associated to the product and proposed that the indications be deleted.
Slovenian: Pri tem je CHMP upošteval dejstvo, da je imetnik dovoljenj za promet z zdravili, za katera so bile odobrene omenjene indikacije, sam ocenil, da je dokazov o učinkovitosti premalo, da bi lahko odtehtali tveganja, povezana s tem zdravilom, in predlagal, da se indikacije izbrišejo.
English: • Central-reticular level - An imbalance between supraspinal facilitatory and inhibitory control can also lead to an enhanced reflex activity and an increased muscle tone.
Slovenian: • Osrednje živčevje - retikularna formacija: neravnovesje med spodbujevalnimi in zaviralnimi supraspinalnimi mehanizmi lahko prav tako povzroči povečano delovanje refleksov in povišan mišični tonus.
English: The CHMP endorsed a communication i.e. ‘Dear Healthcare Professional Communication (DHPC)' to communicate the outcome of the present review.
Slovenian: CHMP je odobril t. i. „Neposredno obvestilo zdravstvenim delavcem”, v katerem so zapisani izsledki tega pregleda zdravila.
English: • Treatment of obliterative vascular diseases as well as syndromes due to impaired vascular innervation (e.g. acrocyanosis, dysbasia angioneurotica intermittens)
Slovenian: • zdravljenje obliterativnih žilnih bolezni ter sindromov, ki so posledica motenj krvnega pretoka (npr. akrocianoza, intermitentna angionevrotična disbazija);
English: The MAHs also disagreed with the CHMP assessment of the safety profile of tolperisone.
Slovenian: Imetnika dovoljenj za promet z zdravilom se prav tako nista strinjala z oceno varnostnega profila tolperizona, ki jo je opravil CHMP.
English: • The Committee is also of the opinion that there is evidence of clinically significant efficacy of tolperisone in the symptomatic treatment of post-stroke spasticity in adults.
Slovenian: • da je odbor tudi mnenja, da obstajajo dokazi o klinično pomembni učinkovitosti tolperizona pri simptomatskem zdravljenju spastičnosti, ki je posledica možganske kapi pri odraslih;
English: In addition, the improvement in PPT was not accompanied by a corresponding improvement in the mobility of patients.
Slovenian: Razen izboljšanja števila PPT študija ni zabeležila tudi ustreznega izboljšanja gibalnih sposobnosti bolnikov.
English: • Acute or chronic treatment of pathologically elevated skeletal muscle tone in organic neurological disorders
Slovenian: • akutno ali kronično zdravljenje patološko povišanega tonusa skeletnih mišic pri organskih nevroloških motnjah;
English: Whereas
Slovenian: Ob upoštevanju:
English: • The Committee also concluded that, in the absence of relevant data to support the efficacy in the dosing recommendations approved, the potential benefit of tolperisone-containing parenteral formulations is outweighed by the identified risk of hypersensitivity.
Slovenian: • da je odbor sklenil tudi, da glede na pomanjkanje relevantnih podatkov, ki bi podprli učinkovitost odobrenih priporočil za odmerjanje, ugotovljena tveganja za preobčutljivostne reakcije odtehtajo morebitne koristi parenteralnih oblik zdravil, ki vsebujejo tolperizon.
English: As a result, the CHMP considered that none of the provided pooled analyses could be considered as supportive to demonstrate the efficacy of tolperisone in the “treatment of muscular hypertonicity and muscle spasms associated with locomotor diseases” indication, nor in the proposed restricted indication.
Slovenian: Zato po njegovem mnenju za nobeno od predloženih združenih analiz ni mogoče šteti, da dokazuje učinkovitost tolperizona pri indikaciji „zdravljenje mišične hipertonije in mišičnih spazmov, povezanih z obolenji lokomotornega sistema,“ niti pri predlagani omejeni indikaciji.
English: Tolperisone reduces the sodium influx through the isolated nerve membrane in a dose dependent way, thus amplitude and frequency of action potentials are reduced.
Slovenian: Tolperizon glede na velikost odmerka zmanjša prehajanje natrija skozi izolirano membrano živčnih celic, s čimer se zmanjšata obseg in pogostost akcijskih potencialov.
English: Grounds for the variation/revocation to the terms of the marketing authorisation
Slovenian: Podlaga za spremembo pogojev/preklic dovoljenja za promet z zdravilom
English: In this randomised, double-blind, placebo controlled, multicentre study efficacy of tolperisone has been shown in the symptomatic treatment of patients with spasticity following cerebral stroke.
Slovenian: Randomizirana, dvojno slepa, s placebom nadzorovana, multicentrična študija je pokazala, da je tolperizon učinkovit pri simptomatskem zdravljenju bolnikov s spastičnostjo, ki je posledica možganske kapi.
English: Furthermore, inhibitory effects on voltage dependent Ca2+ channels have been demonstrated, suggesting that tolperisone might also reduce the transmitter release in addition to its membrane stabilising effect.
Slovenian: Poleg tega tudi dokazano zavira napetostno regulirane kalcijeve (Ca2+) kanale, kar pomeni, da bi lahko poleg tega, da pomaga pri stabilizaciji membrane, tudi zmanjšal sproščanje živčnih prenašalcev.
English: The Melka study can only be considered as providing supportive evidence of efficacy in the treatment of spasticity caused by neurological diseases.
Slovenian: Študija Melke lahko tako zgolj ponudi dodatne dokaze o učinkovitosti pri zdravljenju spastičnosti, ki je posledica nevroloških motenj.
English: The SAG stated that it did not consider the results of the 4 pooled analyses to be supportive of the efficacy of tolperisone.
Slovenian: Po mnenju te skupine rezultati štirih združenih analiz ne potrjujejo učinkovitosti tolperizona.
English: • Central-spinal level - tolperisone reduces the increased mono- and polysynaptic reflex activity in a dose-dependent manner to the physiological level.
Slovenian: • Osrednje živčevje - hrbtenjača: tolperizon glede na količino odmerka zmanjša pojav monosinaptičnih in polisinaptičnih refleksov na fiziološko raven.
English: The CHMP also noted the MAH proposal to conduct a clinical study to collect additional evidence of the efficacy of tolperisone in the proposed restricted low back pain indication, as a post-referral commitment, as well as the related draft study synopsis.
Slovenian: Upošteval je tudi predlog imetnika dovoljenja za promet z zdravilom za izvedbo klinične študije za pridobitev dodatnih dokazov o učinkovitosti tolperizona v zvezi s predlagano omejeno indikacijo za križ kot obveze po napotitvi ter s tem povezan povzetek osnutka študije.