FrancophonIA/ELRC3.0 huggingface dataset:
English: The CHMP, having considered the PRAC recommendation, is of the view that the following clarifications to the PRAC grounds and recommendation are necessary:
Slovenian: Odbor CHMP, ki je proučil priporočilo odbora PRAC, meni, da so v zvezi s priporočilom in njegovimi razlogi potrebna naslednja pojasnila:
English: The evidence strongly suggests a correlation between the potential for release of gadolinium from the ligand and the extent of retention in these tissues and organs.
Slovenian: Dokazi jasno kažejo povezavo med možnostjo sproščanja gadolinija iz liganda ter obsegom zadrževanja v teh tkivih in organih;
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.
Slovenian: Zaključek, da so med obema sredstvoma GdCA znatne in klinično pomembne razlike glede diagnostične zmogljivosti, je treba podpreti s trdnimi dokazi iz kliničnih študij, vključno z dokazi za boljši klinični izid in obravnavanje bolnika, ki zdaj niso na voljo; učinek na diagnostično razmišljanje in obravnavanje bolnika ni bil dokazan.
English: Elimination of GdCAs is therefore reduced in patient with renal dysfunction.
Slovenian: Izločanje sredstev GdCA je zato pri bolnikih s slabim delovanjem ledvic zmanjšano.
English: The experts also stated that it is plausible that adverse clinical consequences could be associated with gadolinium retention in the brain.
Slovenian: Strokovnjaki so tudi povedali, da je verjetno, da so neželene klinične posledice povezane z zadrževanjem gadolinija v možganih.
English: Hypersensitivity or anaphylactoid reactions with GdCAs can manifest as a range of clinical signs and symptoms.
Slovenian: Preobčutljivost ali anafilaktoidna reakcija na sredstva GdCA se lahko manifestira kot različni klinični znaki ali simptomi.
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.
Slovenian: Razpoložljivi podatki o ljudeh podpirajo zaključek, da motnje v delovanju ledvic niso nujno predpogoj za povečanje hiperintenzivnosti signala v možganih, vendar pa povečajo kopičenje v možganih in hiperintenzivnost signala.
English: Further studies have tried to characterise and quantify the amount of deposition of gadolinium in the brain.
Slovenian: Z nadaljnjimi študijami se je skušalo opredeliti in izmeriti količino odloženega gadolinija v možganih.
English: These observations leave the possibility that the method used for the Gd determination is unreliable under certain circumstances.
Slovenian: Zaradi teh ugotovitev je še vedno mogoče, da metoda, uporabljena za določitev gadolinija, v nekaterih primerih ni zanesljiva.
English: Enhancement after gadobenate dimeglumine (Multihance) or gadopentetate dimeglumine (Magnevist) appeared more progressively compared with gadodiamide.
Slovenian: Pokazalo se je, da je povečanje po gadobenat dimegluminu (Multihance) ali gadopentetat dimegluminu (Magnevist) v primerjavi z gadodiamidom progresivnejše.
English: Linear GdCAs are associated with a significant risk of NSF.
Slovenian: Linearna sredstva GdCA so povezana z znatnim tveganjem NSF.
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.
Slovenian: • linearna sredstva GdCA so povezana z znatnim tveganjem NSF, čeprav se na podlagi spontanega poročanja o neželenih učinkih zdravil zdajšnji ukrepi za zmanjšanje tveganja zdijo učinkoviti;
English: Therefore, the PRAC considered that the benefits of these products outweigh their risks.
Slovenian: Odbor PRAC je zato menil, da koristi teh izdelkov prevladajo nad njihovimi tveganji.
English: • Clinical studies, both observational and interventional, to fully address the serious concerns of potential neurological effects are not considered feasible within a reasonable period of time.
Slovenian: • opazovalne in intervencijske klinične študije za celovito obravnavanje resnih pomislekov glede morebitnih nevroloških učinkov v razumnem času ne bi bile izvedljive.
English: In addition, PRAC considered that it is not possible to restrict the use of intravenous linear GdCAs to certain indications or certain groups of patients as:
Slovenian: Poleg tega je odbor PRAC menil, da uporabe intravenskih linearnih sredstev GdCA ni mogoče omejiti na nekatere indikacije ali skupine bolnikov, ker:
English: Lanthanide ions such as gadolinium can bind to Ca2+ binding enzymes and interfere with calcium channels, due to competition with Ca2+ in cellular and biochemical processes, which can lead to adverse biological effects (Sherry et al. 2009).
Slovenian: Lantanoid, kot je gadolinij, se lahko veže na encime, ki vežejo Ca2+, in zaradi tekmovanja s Ca2+ v celičnih in biokemičnih procesih interferira s kalcijevimi kanalčki, kar lahko povzroči neželene biološke učinke (Sherry idr., 2009).
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.
Slovenian: V zvezi z uporabo sredstva Multihance pri pediatrični populaciji je bilo poudarjeno, da so hepatocelični karcinomi in metastatične lezije pogoste pri odrasli populaciji, bolezni jeter pri otrocih pa prej razpršene kot zgoščene, tumorji pa redki.
English: • Gadolinium has been measured in the brain, both indirectly by studies showing signal intensity increases, and directly by studies measuring gadolinium concentrations with mass spectrometry, including methods that allow localisation in the brain (LA-ICP-MS) and separation of Gd species (GPC-MS).
Slovenian: • opravljene so bile meritve gadolinija v možganih, neposredno s študijami, ki dokazujejo povečanje intenzivnosti signala, in posredno s študijami, ki koncentracije gadolinija merijo z masno spektrometrijo, vključno z metodami, ki omogočajo lokalizacijo v možganih (LA-ICP-MS) in razločevanje vrst gadolinija (GPC-MS);
English: • To update the SmPC to make the physician aware of the accumulation in the brain and to reduce exposure and communicate about such update;
Slovenian: • posodobitev povzetka glavnih značilnosti zdravila za ozaveščanje zdravnikov o kopičenju v možganih in zmanjšanje izpostavljenosti ter obveščanje o tej posodobitvi;
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.
Slovenian: • rezultati iz študije klinike Mayo o staranju (MCSA) (McDonald idr., 2017, rokopis v pripravi) so omejeni zaradi majhnih vzorcev, sorazmerno kratkotrajnega nadaljnjega spremljanja morebitnih dolgotrajnih učinkov, odsotnosti razprave o občutljivosti predvidenih končnih točk pri ugotavljanju morebitnih neželenih učinkov, pomanjkanja popolnih in podrobnih informacij o statističnih metodah in njihovi zanesljivosti ter na splošno prevelike omejenosti, da bi lahko potrdili varnost uporabe sredstev GdCA.
English: The MAHs provided several proposals for risk minimization measures with regards the accumulation and retention of GdCA in the brain of patients exposed to these agents during diagnostic procedures:
Slovenian: Imetniki dovoljenja za promet z zdravilom so predlagali več ukrepov za zmanjšanje tveganja v zvezi s kopičenjem in zadrževanjem sredstev GdCA v možganih bolnikov, ki so tem sredstvom izpostavljeni med diagnostičnimi postopki:
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.
Slovenian: • zapoznele faze, ki je odvisna od selektivne absorbcije sredstva GdCA s strani funkcionalnih hepatocitov, s čimer se izboljšata kontrast in vizualizacija normalnega jetrnega parenhima, hkrati pa tudi prikaz in odkrivanje lezij, kot so ciste in hepatocelularni karcinomi.
English: • the dynamic phase, for which all the authorised GdCAs can provide enhancement of liver imaging,
Slovenian: • dinamične faze, v kateri lahko vsa odobrena sredstva GdCA izboljšajo kontrast pri slikanju jeter;
English: The brain soluble fractions from animals receiving linear agents contained a proportion of macromolecules; gadolinium-bound macromolecules were not detected in the brain of animals that received macrocyclic agents.
Slovenian: Topni deli možganov živali, ki so prejele linearna sredstva, so vsebovali delež makromolekul; v možganih živali, ki so prejele makrociklična sredstva, makromolekule, vezane na gadolinij, niso bile ugotovljene.
English: For all Gd contrast agents, the experts stated that the general “As Low As Reasonably Achievable” (ALARA) principles should be used and that the exposure to all GdCAs should be minimised, either by reducing the dose or using alternative diagnostic methods, if possible.
Slovenian: Strokovnjaki so povedali, da bi bilo treba za vsa gadolinska kontrastna sredstva uporabljati splošna načela „tako nizko, kakor je to mogoče doseči z uporabo razumnih ukrepov“ in da bi bilo treba izpostavljenost vsem sredstvom GdCA zmanjšati z zmanjšanjem odmerka ali uporabo nadomestnih diagnostičnih metod, če je mogoče.
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.
Slovenian: Perfuzijsko slikanje pri MRI se po navadi opravi v mirovanju in med farmakološko obremenitvijo (npr. z adenozinom ali dipiridamolom) s tehniko dinamičnega slikanja, pri kateri se intenzivnost signala v miokardiju oceni med izločanjem kontrastnega sredstva iz bolusa.
English: Gadolinium containing products have been stratified by risk category for NSF, and warnings and restrictions on the use of the higher NSF risk products in patients with impaired renal function are included in the product information, including contraindication of the high NSF risk products in patients with severe renal impairment or acute kidney injury (AKI) and a switch to the use of low risk products.
Slovenian: Izdelki, ki vsebujejo gadolinij, so bili razvrščeni po kategoriji tveganja NSF, opozorila in omejitve uporabe izdelkov z večjim tveganjem NSF pri bolnikih z motnjami v delovanju ledvic pa so vključena v informacije o izdelku, vključno s kontraindikacijo izdelkov z velikim tveganjem NSF pri bolnikih s hudo ledvično okvaro ali akutno odpovedjo ledvic (AKI) in preusmeritvijo na uporabo izdelkov z majhnim tveganjem.
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.
Slovenian: Odbor PRAC je proučil tudi možnost omejitve števila odmerkov za bolnike ter zaključil, da za omejitev števila odmerkov obstajajo praktične težave, saj ni mogoče ugotoviti, katero kontrastno sredstvo so bolniki prejeli prej in ne bi bilo mogoče zagotoviti učinkovite omejitve števila odmerkov, ki jih bolnik prejme v času življenja.
English: Many preparations especially of linear Gd-based contrast agents contain free chelator in surplus in order to rapidly catch liberated Gd.
Slovenian: Številni pripravki, zlasti linearna kontrastna sredstva, ki temeljijo na gadoliniju, vsebujejo presežek prostega kelatorja, da se nanj hitro ujame sproščeni gadolinij.
English: Despite worldwide use serious adverse reactions are rare; urticaria is the most common manifestation.
Slovenian: Kljub uporabi po vsem svetu so hude neželene reakcije redke, najpogosteje se manifestirajo kot koprivnica.
English: Release of gadolinium in patients with severe renal impairment can result in nephrogenic systemic fibrosis (NSF), a serious and life-threatening syndrome involving fibrosis of the skin, joints and internal organs.
Slovenian: Sproščanje gadolinija pri bolnikih s hudo ledvično okvaro lahko povzroči nefrogeno sistemsko fibrozo (NSF), resen in življenjsko nevaren sindrom, ki vključuje fibrozo kože, sklepov in notranjih organov.
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.
Slovenian: Odobrene indikacije za sredstva GdCA so splošne in se nanašajo na slikanje telesa, ki vključuje vse organe, razen pri sredstvih GdCA s ciljnimi indikacijami, ki se nanašajo na posebne fizikalno-kemijske lastnosti, ki omogočajo izboljšan prikaz posebnih značilnosti.
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.
Slovenian: Ena skupina strokovnjakov (v kateri je bil tudi predstavnik bolnikov) je podprla priporočilo odbora PRAC (tj. začasen umik dovoljenja za promet z linearnimi sredstvi, razen za Primovist in Magnevist) ter njegovo utemeljitev, razen začasnega umika dovoljenja za Multihance za slikanje jeter v eni državi članici, kjer za to indikacijo niso na voljo makrociklična sredstva in Primovist ni na voljo.
English: • To complement the information in the SmPC with evidence-based educational programs;
Slovenian: • dopolnitev informacij v povzetku glavnih značilnosti zdravila z izobraževalnimi programi na podlagi dokazov;
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:
Slovenian: Odbor PRAC je glede na razpoložljive podatke opazovanj, ki do zdaj niso potrdili tveganja, povezanega s kopičenjem gadolinija v možganih, menil, da:
English: Therefore, pursuant to Article 116 of Directive 2001/83/EC, the CHMP recommends the suspension of the marketing authorisations for intravenous medicinal products containing gadodiamide, gadopentetic acid, and gadoversetamide.
Slovenian: Zato v skladu s členom 116 Direktive 2001/83/ES priporoča začasen umik dovoljenj za promet z zdravili za intravensko uporabo, ki vsebujejo gadodiamid, gadopentetsko kislino in gadoversetamid.
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.
Slovenian: Odbor za zdravila za uporabo v humani medicini (CHMP) je v predhodni predložitvi v skladu s členom 31 Direktive 2010/83/ES zaključil, da je uporaba sredstev GdCA povezana s tveganjem nefrogene sistemske fibroze (NSF), resnega in življenjsko nevarnega sindroma, ki pri bolnikih z ledvično okvaro vključuje fibrozo kože, sklepov in notranjih organov.
English: • the significance of the study by Welk et al. (2016) is limited and the conclusion that these results do not indicate an association between exposure to GdCAs and the development of parkinsonism is premature.
Slovenian: • je pomen študije, ki so jo izvedli Welk idr., (2016) omejen, rezultati pa ne kažejo povezave med izpostavljenostjo sredstvom GdCA in razvojem parkinsonizma.
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.
Slovenian: Gadolinij, vezan na makromolekule, naj bi imel višjo relaksivnost in naj bi bil pri nizki koncentraciji zmožen ustvariti T1-obtežen signal.
English: These effects can be mimicked in vitro and will further diminish the stability of the GdCA complex in vivo.
Slovenian: Te učinke je mogoče posnemati in vitro, stabilnost kompleksa sredstva GdCA pa se bo in vivo še dodatno zmanjšala.
English: Gadobenic acid undergoes hepatic uptake.
Slovenian: Gadobenska kislina prehaja v hepatocite.
English: • The rather high and particularly highly variable Gd tissue level in saline control animals.
Slovenian: • precej visoka in zlasti zelo spremenljiva raven gadolinija v tkivu živali, pri katerih je bila uporabljena kontrolna raztopina natrijevega klorida.
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).
Slovenian: Odbor PRAC je v zvezi s trditvijo, da se iz gadodiamida v telo ne sprosti skoraj nič gadolinija, opozoril, da se in vitro pri 37 °C gadolinij hitro odcepi od svojega kelatorja v človeški serum (Frenzel idr., 2008).
English: For the linear agents evaluated in non-clinical studies the T1 signal intensity in the DCN has been shown to persist for at least 1 year without any reduction in intensity.
Slovenian: Za linearna sredstva, ovrednotena v nekliničnih študijah, se je dokazalo, da se je v globokih možganskih jedrih intenzivnost signala T1 ohranila vsaj eno leto, brez zmanjšanja njegove intenzivnosti.
English: PRAC conclusions on grounds for re-examination
Slovenian: Zaključki odbora PRAC v zvezi z razlogi za ponovno proučitev
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.
Slovenian: Vendar je menil, da je klinična koristnost, ki prevlada nad tveganji, povezanimi s kopičenjem gadolinija, omejena na zapoznelo fazo slikanja jeter, zato je priporočil, naj se indikacija gadobenske kisline omeji samo na to uporabo.
English: This relationship further strengthens the interpretation of the MRI studies as evidence that accumulation of gadolinium in the brain is causally related to exposure to GdCAs.
Slovenian: Ta povezava še dodatno podpira razlago iz študij MRI v dokaz, da je kopičenje gadolinija v možganih vzročno povezano z izpostavljenostjo sredstvom GdCA.
English: GdCAs can be differentiated by their structure: linear (gadodiamide, gadopentetic acid, gadobenic acid, gadoxetic acid, gadoversetamide) or macrocyclic (gadoteridol, gadobutrol, gadoteric acid), and by the overall charge on the complex formed (ionic or non-ionic).
Slovenian: Sredstva GdCA je mogoče razlikovati po njihovi strukturi: linearna (gadodiamid, gadopentetska kislina, gadobenska kislina, gadoksetna kislina, gadoversetamid) ali makrociklična (gadoteridol, gadobutrol, gadoterska kislina) in po skupnem naboju tvorjenega kompleksa (ionski ali neionski).
English: The precise molecular forms of the soluble macromolecular bound Gd are not known but it is plausible that the macromolecules are bound to a dechelated Gd3+ ion.
Slovenian: Natančna molekulska oblika gadolinija, vezanega na topne makromolekule, ni znana, verjetno pa so makromolekule vezane na dekelatiran ion Gd3+.
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.
Slovenian: Upravičena je domneva, da gadolinij lahko dekelatira iz linearnih sredstev GdCA in se veže na makromolekule v človeških možganih podobno, kot je bilo ugotovljeno pri možganih glodavcev.
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.
Slovenian: • Podatki o stabilnosti ter študije in vitro in neklinične študije dokazujejo, da linearna kontrastna sredstva, ki vsebujejo gadolinij, (GdCA) sproščajo gadolinij iz molekul ligandov v večji meri kot makrociklična sredstva;
English: • In addition to NSF, there is also evidence that other harmful outcomes are associated with exposure to linear GdCAs, in particular gadolinium-associated skin plaques.
Slovenian: • poleg dokazov za NSF obstajajo tudi dokazi, da so z izpostavitvijo linearnim sredstvom GdCA povezani tudi drugi škodljivi izidi, zlasti kožni plaki, povezani z gadolinijem;
English: The benefit of GdCAs has been demonstrated based on their ability to improve the quality of imaging for MRIs compared to unenhanced MRI scans by supporting the diagnostic performance of such scans in the detection of disease, prognosis and patient management in order to achieve a particular clinical outcome.
Slovenian: Koristnost sredstev GdCA je bila dokazana na podlagi njihove zmožnosti za izboljšanje kakovosti slik pri magnetnoresonančnem slikanju v primerjavi s slikami MRI, pri katerih kontrast ni bil izboljšan, saj povečajo diagnostično zmogljivost takih slik pri ugotavljanju bolezni, napovedi in obravnavanju bolnika za dosego določenega kliničnega izida.
English: The CHMP concluded that the risk of NSF is different for the different gadolinium-containing contrast agents, which lead to the categorisation of GdCAs into three risk groups for NSF (high risk, medium risk and low risk).
Slovenian: Zaključil je, da različna kontrastna sredstva, ki vsebujejo gadolinij, pomenijo različno tveganje NSF, zato so bila sredstva GdCA razvrščena v tri skupine tveganj NSF (veliko tveganje, srednje tveganje in majhno tveganje).
English: In view of the above, and the claim on the lack of clinical evidence of neurotoxicity due to deposited gadolinium, PRAC considered that while the clinical consequences of gadolinium retention in the brain are currently unknown or remain unclear, absent or limited information from case reports cannot be taken as evidence that such toxicity does not occur.
Slovenian: Odbor PRAC je glede na navedeno in ob upoštevanju trditve o pomanjkanju kliničnih dokazov za nevrotoksičnost zaradi odloženega gadolinija menil, da kljub temu da klinične posledice zadrževanja gadolinija v možganih trenutno niso znane ali so še vedno nejasne, neobstoječih ali omejenih informacij v poročilih o primerih ni mogoče šteti za dokaz, da taka toksičnost ne obstaja.
English: • CHMP considered options for risk minimisation measures.
Slovenian: • obor CHMP je proučil mogoče ukrepe za zmanjšanje tveganja.
English: Intra-articular products containing gadopentetic acid and gadoteric acid are administered at very low doses and present a low risk of tissue accumulation.
Slovenian: Izdelki za intraartikularno uporabo, ki vsebujejo gadopentetsko kislino in gadotersko kislino, se uporabljajo v zelo majhnih odmerkih in pomenijo majhno tveganje kopičenja v tkivu.
English: PRAC considered that it is highly unlikely that the release of Gd from gadodiamide is slower in vivo than in vitro.
Slovenian: Menil je, da je zelo malo verjetno, da bi bilo sproščanje gadolinija iz gadodiamida in vivo počasnejše kot in vitro.