FrancophonIA/ELRC3.0 huggingface dataset:
English: The major route of excretion for GdCAs is renal, and prolonged elimination time due to severely impaired renal function could theoretically increase the potential for accumulation in brain tissue.
Slovenian: Sredstva GdCA se v glavnem izločijo prek ledvic, zaradi podaljšanega časa izločanja pri hudih motnjah v delovanju ledvic pa bi se teoretično lahko povečala možnost kopičenja v možganskem tkivu.
English: They are administered at low concentrations, approximately 200-fold lower than the intravenous use GdCA products, and the potential for patients to receive large numbers of repeated exposures is less for the MR arthrography indication than for the indications for the intravenous product.
Slovenian: Uporabljata se v nizkih koncentracijah, približno 200-krat nižjih kot pri intravenski uporabi izdelkov GdCA, možnost, da bi bolniki prejeli veliko ponovljenih izpostavljenosti, pa je pri indikaciji magnetnoresonančne artrografije manjša kot pri indikacijah izdelka za intravensko uporabo.
English: Repeat toxicity studies for gadodiamide showed that the absolute low levels of gadolinium in the brain were observed at 1 week post-dosing.
Slovenian: Ponovljene študije toksičnosti gadodiamida so dokazale, da so bile en teden po uporabi odmerkov v možganih ugotovljene absolutno nizke ravni gadolinija.
English: Such studies are considered unlikely to be feasible in view of the heterogeneity of the patient population that undergoes MRI.
Slovenian: Take študije zaradi heterogenosti populacije bolnikov, ki opravijo MRI, verjetno ne bi bile izvedljive.
English: There was also an intermediate position within the expert group that expressed a view that the linear agents should not be suspended but that macrocyclic agents should be used as the first line contrast agent (excepting for the liver), unless the MAHs produced relevant trial data clearly indicating superior patient management outcomes with use of their linear agent compared to macrocyclics.
Slovenian: Obstajalo je tudi vmesno stališče, in sicer v skupini strokovnjakov, ki je izrazila stališče, da se za linearna sredstva ne bi smelo začasno umakniti dovoljenja za promet, makrociklična sredstva pa bi se morala uporabljati kot kontrastno sredstvo prve izbire (razen pri jetrih), razen če je imetnik dovoljenja za promet z zdravilom predložil ustrezne podatke o preskušanju, ki jasno kažejo boljše izide pri obravnavanju bolnikov z uporabo linearnega sredstva kot z makrocikličnimi sredstvi.
English: The regions of the brain with the greatest potential for brain accumulation are the dentate nucleus and globus pallidus.
Slovenian: Predela možganov, kjer je kopičenje najbolj verjetno, sta nucleus dentatus in globus pallidus.
English: PRAC considered potential clinical studies to be conducted in order to fully address the serious concerns of plausible neurological effects.
Slovenian: Odbor PRAC je proučil morebitne klinične študije, ki bi se lahko izvedle za celovito obravnavanje resnih pomislekov glede verjetnih nevroloških učinkov.
English: In view of the above, the PRAC considered that the benefits of macrocyclic agents outweigh their risks.
Slovenian: Odbor PRAC je glede na navedeno menil, da koristi makrocikličnih sredstev prevladajo nad njihovimi tveganji.
English: • or that the product (potentially modified or not) does not undergo significant dechelation and does not lead to retention of gadolinium in tissues, including the brain in humans.
Slovenian: • ali da izdelek (lahko spremenjen ali ne) bistveno ne dekelatira ali ne povzroči zadrževanja gadolinija v tkivih, vključno z možgani pri ljudeh.
English: With regards to the claim that gadodiamide (Omniscan) has a unique indication in myocardial perfusion imaging PRAC considered that the whole body MRI indication encompasses imaging of the heart, including myocardial perfusion imaging.
Slovenian: Odbor PRAC je v zvezi s trditvijo, da ima gadodiamid (Omniscan) edinstveno indikacijo pri perfuzijskem slikanju miokardija kot takem, menil, da indikacija MRI celotnega telesa vključuje slikanje srca, vključno s perfuzijskim slikanjem miokardija.
English: Furthermore, CHMP agreed that a communication to healthcare professionals through a joint DHPC should be sent by the MAHs, to which the MAHs agreed.
Slovenian: Odbor CHMP se nadalje strinja, da bi morali imetniki dovoljenj za promet z zdravili zdravstvene delavce obvestiti v skupnem pismu za zdravstvene delavce, s čimer so se imetniki dovoljenja za promet strinjali.
English: In addition, two GdCA products, gadopentetic acid and gadoteric acid, are authorised as formulations for intra-articular administration for magnetic resonance arthrography and they are able to enhance specific lesions.
Slovenian: Poleg tega sta dva izdelka GdCA, in sicer gadopentetska kislina in gadoterska kislina, odobrena kot pripravka za intraartikularno uporabo pri magnetnoresonančni artrografiji; z njima je mogoče povečati določene lezije.
English: Toxicity of GdCAs has primarily been attributed to the dissociation of Gd from the chelated complexes.
Slovenian: Toksičnost sredstev GdCA je bila najprej pripisana disociaciji gadolinija iz kelatiranih kompleksov.
English: The CHMP further considered the statement addressing the potential harm associated with the gadolinium accumulation in the brain: “although no adverse neurological effects, such as cognitive or movement disorders, have been demonstrated to be caused by gadolinium accumulation in the brain, long-term safety data are limited.
Slovenian: Odbor CHMP je nadalje proučil navedbo, ki obravnava morebitne škodljive učinke, povezane s kopičenjem gadolinija v možganih: „čeprav še niso bili dokazani škodljivi nevrološki učinki, kot so kognitivne motnje ali motnje gibanja, ki naj bi jih povzročilo kopičenje gadolinija v možganih, so podatki o dolgoročni varnosti omejeni.
English: In view of the very low potential for retention of gadolinium in tissues, their stability and low risk of dechelation, PRAC maintained its recommendation that the benefits of macrocyclic agents outweigh their risks.
Slovenian: Odbor PRAC je glede na zelo majhno možnost zadrževanja gadolinija v tkivih, njihovo stabilnost in majhno tveganje dekelacije ohranil stališče, da koristi makrocikličnih sredstev prevladajo nad njihovimi tveganji.
English: Therefore the benefit of gadoxetic acid outweighs its risk.
Slovenian: Zato korist gadoksetne kisline prevlada nad njenimi tveganji.
English: Nevertheless, further analysis did not reveal Gd in them so that a low tissue Gd level was assumed, and it was not questioned what otherwise these dense structures could be.
Slovenian: Vendar nadaljnja analiza v njih ni razkrila gadolinija, zato se je domnevalo, da je raven gadolinija v tkivu nizka, ni pa se raziskalo, kaj bi sicer te goste strukture lahko bile.
English: • The restriction of the use of linear GdCAs will still leave patients in the remaining population exposed to the risk of harm, without knowing safe threshold level for retention in the brain and other tissues of the body to dechelated gadolinium.
Slovenian: • Po omejitvi uporabe linearnih sredstev GdCA bi bili bolniki v preostali populaciji še vedno izpostavljeni tveganju škodljivih učinkov, pri čemer ne bi bila znana varna mejna vrednost za zadrževanje dekelatiranega gadolinija v možganih in drugih tkivih telesa.
English: A rat study also confirmed the finding that dose-dependent level of Gd in the brain for linear agents was likely to be related to cumulative dose rather than a single large or repeat small dose regimens.
Slovenian: Študija na podganah je tudi potrdila ugotovitev, da je pri linearnih sredstvih raven gadolinija v možganih, ki je odvisna od odmerka, verjetno povezana s skupnim odmerkom in ne z režimoma enega velikega odmerka ali več majhnih odmerkov.
English: Indeed, PRAC considered the results of two intra-individual, crossover comparisons of 0.1 mmol/kg body weight with Multihance vs 0.1 mmol/kg body weight of two active comparators (gadopentetate dimeglumine and gadodiamide), in patients with known or suspected brain or spine disease undergoing MRI of the central nervous system (CNS) (MH-109, MH-130) and concluded that the studies were using a blinded comparison of MRI images obtained with two GdCAs side by side and have produced results favouring Multihance on the basis of brighter appearance of the images, but not reflecting any difference in the diagnostic information available or the impact on diagnostic thinking, patient management or clinical outcome.
Slovenian: Odbor PRAC je dejansko proučil rezultate dveh povezanih intraindividualnih primerjav uporabe sredstva Multihance v odmerku 0,1 mmol/kg telesne mase in dveh primerjalnih sredstev (gadopentetat dimeglumin in gadodiamid) v odmerku 0,1 mmol/kg telesne mase pri bolnikih z znano boleznijo možganov ali hrbtenice ali sumom na tako bolezen, ki so opravili MRI centralnega živčnega sistema (CNS) (MH-109, MH-130), ter zaključil, da so v študijah uporabili slepo primerjavo slik MRI, pridobljenih z vzporedno uporabo obeh sredstev GdCA, pridobljeni rezultati pa so zaradi svetlejših slik dali prednost sredstvu Multihance, niso pa izrazili razlik glede razpoložljivih diagnostičnih informacij ali vpliva na diagnostično razmišljanje, obravnavanje bolnika ali klinični izid.
English: Smith et al. 2017 described that stored Gd still decreases after one week so that obviously a transiently stored pool exists which is different from the material that persists long-term.
Slovenian: so leta 2017 opisali, da se količina shranjenega gadolinija po enem tednu še vedno zmanjšuje, tako da očitno obstaja skupina, ki se shrani kratkotrajno in se razlikuje od snovi, ki se ohrani dolgotrajno;
English: With regards to the condition for lifting the suspension the MAH shall submit evidence “that the product (potentially modified or not) does not undergo significant dechelation and does not lead to retention of gadolinium in tissues, including the brain in humans”, CHMP agreed in general with the proposal, however considered it necessary clarifying the meaning of this condition to avoid misunderstandings.
Slovenian: odbor CHMP se je v zvezi s pogojem, da mora imetnik dovoljenja za preklic začasnega umika dovoljenja predložiti dokaz, „da izdelek (lahko spremenjen ali ne) bistveno ne dekelatira ali ne povzroči zadrževanja gadolinija v tkivih, vključno z možgani pri ljudeh“, na splošno strinjal s predlogom, vendar je menil, da je treba pojasniti pomen tega pogoja za preprečitev nesporazumov.
English: Macrocyclic GdCAs
Slovenian: Makrociklična sredstva GdCA
English: There have been more recent MRI studies that have documented signal intensity increases in the brain in association with macrocyclic GdCAs, suggesting that these agents may also deposit gadolinium in the brain.
Slovenian: Na voljo so novejše MRI študije, s katerimi je bilo dokumentirano povečanje intenzivnosti signala v možganih v povezavi z makrocikličnimi sredstvi GdCA, kar kaže, da morda tudi ta sredstva odlagajo gadolinij v možganih.
English: Data in post mortem tissue samples have shown that the highest concentration of gadolinium in the brain was observed in patients that had several exposures to gadodiamide, suggesting that number of doses received had an impact on the deposition of gadolinium.
Slovenian: Podatki o vzorcih tkiv, vzetih po smrti, so pokazali, da je bila najvišja koncentracija gadolinija v možganih ugotovljena pri bolnikih, ki so bili večkrat izpostavljeni gadoliniju, kar kaže, da je število prejetih odmerkov vplivalo na odlaganje gadolinija.
English: With regards to the consideration of the risk of NSF, whilst PRAC relied on the previous assessment and classification of the risk of NSF across the GdCAs products, PRAC considered that the NSF risk contributes to the safety profile of GdCAs and is taken into account to conclude on the whole safety profile of these products and the subsequent impact on their benefit-risk balance.
Slovenian: V zvezi s pomislekom glede tveganja NSF je odbor PRAC na podlagi predhodne ocene in razvrstitve tveganja NSF pri izdelkih GdCA menil, da tveganje NSF prispeva k varnostnemu profilu sredstev GdCA ter se upošteva pri zaključku o celotnem varnostnem profilu teh izdelkov in naknadnem vplivu na njihovo razmerje med koristmi in tveganji.
English: The CHMP, in addition, considers that the benefit-risk balance of intravenous medicinal products containing gadodiamide, gadopentetic acid, and gadoversetamide is no longer favourable.
Slovenian: Poleg tega meni, da razmerje med koristmi in tveganji zdravil za intravensko uporabo, ki vsebujejo gadodiamid, gadopentetsko kislino in gadoversetamid ni več ugodno.
English: Based on the data available, no specific patient group that would not experience Gd retention in the brain could be identified, as both children and adults are expected to show accumulation of Gd in the brain.
Slovenian: Na podlagi razpoložljivih podatkov ne bi bilo mogoče opredeliti specifične skupine bolnikov, pri kateri se gadolinij ne bi zadržal v možganih, saj se pričakuje, da se bo pokazalo, da se gadolinij odlaga v možganih otrok in odraslih.
English: In view of a potential difference in the frequency of hypersensitivity reactions, PRAC pointed out that these are known infrequent reactions for all GdCAs.
Slovenian: Odbor PRAC je v zvezi z morebitno različno pogostnostjo preobčutljivostnih reakcij poudaril, da je znano, da te pri vseh sredstvih GdCA niso pogoste.
English: PRAC also maintained its conclusions that benefits of the intra-articular presentation of the linear GdCA Magnevist outweigh their risks (subject to changes to the product information) as they are administered at very low doses and present a low risk of tissue accumulation.
Slovenian: Odbor PRAC je tudi vztrajal pri zaključkih, da intraartikularna uporaba linearnega sredstva GdCA Magnevist prevlada nad njegovimi tveganji (vendar je treba spremeniti informacije o izdelku), saj se uporablja v zelo majhnih odmerkih in pomeni majhno tveganje kopičenja v tkivu.
English: Macrocyclic GdCAs have a very low potential for retention of gadolinium in tissues, are very stable and have a low risk of dechelation.
Slovenian: Pri makrocikličnih sredstvih GdCA je možnost zadrževanja gadolinija v tkivih zelo majhna, zelo so stabilna in pomenijo majhno tveganje dekelacije.
English: The implemented risk minimisation measures appear to be effective based on annual reviews of spontaneous case reports.
Slovenian: Na podlagi letnih pregledov spontanih poročil o primerih se zdi, da so bili izvedeni ukrepi za zmanjšanje tveganja učinkoviti.
English: However, they described the TEM finding of electrondense lumps in the tissues of ProHance-treated animals which at first were assumed to be Gd deposits, obviously because they looked like them.
Slovenian: Opisali pa so zatrdline s povečano gostoto elektronov, ki so jih s transmisijsko elektronsko mikroskopijo (TEM) ugotovili v tkivih živalih, obravnavanih s sredstvom ProHance, za katere se je najprej domnevalo, da so depoziti gadolinija, očitno zato, ker so jim bili podobni.
English: Since the finalisation of the referral, several studies in animals and in humans have been published showing accumulation of gadolinium following administration of GdCAs in tissues such as liver, kidney, muscle, skin and bone.
Slovenian: Po zaključku napotitve je bilo objavljenih več študij na živalih in ljudeh, ki so po uporabi sredstev GdCA pokazale kopičenje gadolinija v tkivih, npr. v jetrih, ledvicah, mišicah, koži in kosteh.
English: Final benefit-risk balance
Slovenian: Končno razmerje med koristmi in tveganji
English: This is a clinically relevant benefit as they allow enhancement of dynamic phase liver imaging for highly vascularised hepatic lesions and also detection of lesions that are visible only in the delayed phase.
Slovenian: To je klinično pomembna korist, saj omogočata izboljšanje kontrasta v dinamični fazi slikanja jeter pri zelo vaskulariziranih jetrnih lezijah in tudi za odkrivanje lezij, ki jih je mogoče videti samo v zapozneli fazi.
English: • PRAC considered options for risk minimisation measures.
Slovenian: • odbor PRAC je proučil mogoče ukrepe za zmanjšanje tveganja.
English: Firstly, PRAC noted that accumulation in the brain is an intrinsic property of intravenous linear GdCAs and therefore, information on brain accumulation in the SmPC will not lead to a reduction of potential risks associated with this accumulation.
Slovenian: Prvič, odbor PRAC je poudaril, da je kopičenje v možganih intrinzična lastnost linearnih sredstev GdCA za intravensko uporabo, zato se zaradi informacij o kopičenju v možganih v povzetku glavnih značilnosti zdravila ne bodo zmanjšala morebitna tveganja, povezana s tem kopičenjem.
English: • variation to the terms of the marketing authorisation for the intraarticular linear agent gadopentetic acid (Magnevist), and the intravenous linear agents gadoxetic acid (Primovist) and gadobenic acid (Multihance) with changes to SmPC sections 4.1, 4.2, 4.4 and 5.2, including removal of indications,
Slovenian: • spremembo pogojev dovoljenja za promet z linearnim sredstvom gadopentetska kislina za intraartikularno uporabo (Magnevist) ter linearnimi sredstvi gadoksetno kislino (Primovist) in gadobensko kislino (Multihance) za intravensko uporabo s spremembami oddelkov 4.1, 4.2, 4.4 in 5.2 v povzetkih glavnih značilnosti zdravila, vključno z izbrisom indikacij,
English: With regards to the claim of a lower risk of cardiovascular adverse events for Multihance, PRAC considered that nonclinical data as well as available clinical data do not indicate a difference in cardiovascular risk (inducing QT prolongation) within the delayed phase liver imaging agents.
Slovenian: Odbor PRAC je v zvezi s trditvijo, da pomeni sredstvo Multihance manjše tveganje neželenih kardiovaskularnih dogodkov, menil, da neklinični podatki in razpoložljivi klinični podatki ne kažejo različnega kardiovaskularnega tveganja (vključno s podaljšanjem QT) pri sredstvih za slikanje jeter v zapozneli fazi.
English: For lifting the suspension, the PRAC recommended that MAHs should provide evidence:
Slovenian: Za preklic začasnega umika dovoljenja je odbor PRAC priporočil, naj imetniki dovoljenja za promet z zdravilom zagotovijo dokaze:
English: The benefit-risk balance of medicinal products containing intravenous gadobenic acid (in all other indications than liver imaging), gadodiamide, gadopentetic acid (IV presentation), and gadoversetamide is no longer favourable and these marketing authorisations should be suspended.
Slovenian: Razmerje med koristmi in tveganji pri zdravilih, ki vsebujejo gadobensko kislino za intravensko uporabo (pri vseh drugih indikacijah, razen slikanja jeter), gadodiamid, gadopentetsko kislino (predstavitev IV ) in gadoversetamid ni več ugodno ter bi bilo treba ta dovoljenja za promet začasno umakniti.
English: Another study showed that at one year, Gd levels in the brain following administration of gadoteric acid, a macrocyclic agent, are over 30 fold lower compared to gadodiamide (linear).
Slovenian: študija je dokazala, da so po enem letu ravni gadolinija v možganih po uporabi gadoterske kisline, ki je makrociklično sredstvo, več kot 30-krat nižje kot pri gadodiamidu (linearno sredstvo).
English: Therefore, it can be concluded that renal impairment is not a requirement for Gd deposition, but it may however increase the amount of Gd deposited in the brain.
Slovenian: Zato je mogoče zaključiti, da ledvična okvara ni zahteva za odlaganje gadolinija, vendar lahko ljub temu poveča količino odloženega gadolinija v možganih.
English: There are practical difficulties in clinical daily life for implementing an effective restriction of the number of doses administered during the lifetime of a patient.
Slovenian: V vsakdanjem kliničnem življenju obstajajo praktične težave za izvajanje učinkovite omejitve števila odmerkov, ki jih bolnik prejme v svojem življenju.
English: PRAC also considered the two linear GdCAs, gadoxetic acid (Primovist) and gadobenic acid (Multihance).
Slovenian: Odbor PRAC je tudi proučil dve linearni sredstvi GdCA, in sicer gadoksetno kislino (Primovist) in gadobensko kislino (Multihance).
English: In relation to the statement about the macrocyclic early washout “macrocyclic agents show only a transient increase in Gd in the brain and undergo early washout”, the CHMP considered it sufficient to reflect the observation that measurements of gadolinium in the brain over longer periods showed differences between linear and macrocyclic agents in terms of accumulation over time.
Slovenian: Odbor CHMP je v zvezi z navedbo, da se makrociklična sredstva kmalu izperejo, „makrociklična sredstva kažejo samo začasno povečanje gadolinija v možganih in se kmalu izperejo“, menil, da to zadostuje za upoštevanje ugotovitve, da so meritve gadolinija v možganih v daljši obdobjih pokazale razlike med linearnimi in makrocikličnimi sredstvi glede kopičenja skozi čas.
English: The ground concerning the skin plaques “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” is based on a limited number of cases, and therefore CHMP did not consider it relevant as ground for the suspension of some of the IV linear GdCAs.
Slovenian: razlog, povezan s kožnimi plaki, „obstajajo dokazi za NSF in dokazi, da so z izpostavitvijo linearnim sredstvom GdCA povezani tudi drugi škodljivi izidi, zlasti kožni plaki, povezani z gadolinijem“, temelji na omejenem številu primerov, zato je odbor CHMP menil, da to ni pomemben razlog za začasni umik dovoljenja za promet z nekaterimi linearnimi sredstvi GdCA (IV);
English: Repetitive administration of gadodiamide in rats with renal failure was associated with an increase in the T1 hypersignal in the deep cerebellar nuclei relative to controls with normal renal function.
Slovenian: Pri podganah z ledvično okvaro je bila večkratna uporaba gadodiamida povezana s povečanjem hipersignala T1 v globokih možganskih jedrih glede na preverjanja pri normalnem delovanju ledvic.
English: In rat studies, residual Gd found in the rat brain after repeated administration of linear GdCAs was present in at least 3 distinctive forms - soluble small molecules, presumably intact GdCA, soluble macromolecules and to the largest extent an insoluble form.
Slovenian: V študijah na podganah je bilo ugotovljeno, da je bil gadolinij, ki je ostal v možganih podgan po večkratni uporabi linearnih sredstev GdCA, prisoten v vsaj treh različnih oblikah - topne majhne molekule, domnevno nespremenjeno sredstvo GdCA v obliki topnih makromolekul, v največjem obsegu pa v netopni obliki.
English: However, these data should be considered in the context of the non-clinical studies showing higher levels of gadolinium in brain tissue after exposure to linear GdCAs, compared with exposure to macrocyclic GdCAs.
Slovenian: Te podatke pa bi bilo treba proučiti v okviru nekliničnih študij, ki so po izpostavljenosti linearnim sredstvom GdCA pokazale višje ravni gadolinija v možganskem tkivu kot pri izpostavljenosti makrocikličnim sredstvom GdCA.
English: Cardiac MR including perfusion and delayed enhancement imaging provides relevant information in terms of viable tissue in various cardiovascular disorders needed for work up and management of these diseases.
Slovenian: Z magnetno resonanco srca, ki vključuje perfuzijsko slikanje in slikanje v zapozneli fazi z izboljšanim kontrastom, se pri različnih kardiovaskularnih boleznih zagotovijo ustrezne informacije o živem tkivu, potrebne za preiskave in zdravljenje teh bolezni.
English: Two linear GdCAs, gadoxetic acid and gadobenic acid, have been shown to have an uptake by hepatocytes and are the only liver-specific agents that can provide both the dynamic and the delayed phase imaging.
Slovenian: Za dve linearni sredstvi GdCA, in sicer za gadoksetno kislino in gadobensko kislino, se je izkazalo, da jih hepatociti absorbirajo in da sta edini sredstvi za jetra, ki omogočata slikanje v dinamični in zapozneli fazi.