FrancophonIA/ELRC3.0 huggingface dataset:
English: The results of the SIGNIFY study were published4 while this review was ongoing and are discussed below.
Croatian: Rezultati ispitivanja SIGNIFY objavljeni su4 dok je ovaj pregled bio u tijeku, a izloženi su niže u tekstu.
English: 2 - Detailed explanation of the scientific differences from PRAC recommendation
Croatian: 2. - etaljno pojašnjenje znanstvenih razlika u odnosu na preporuku PRAC-a
English: On 30 April 2014, the EMA received from the MAH a communication on the preliminary results of the SIGNIFY3 study.
Croatian: Dana 30. travnja 2014., EMA je zaprimila od nositelja odobrenja komunikaciju o preliminarnim rezultatima ispitivanja SIGNIFY3.
English: • The PRAC reviewed all data presented by the MAH on the safety and efficacy of ivabradine, including the results of the SIGNIFY study, as well as the views expressed by the cardiovascular scientific advisory group.
Croatian: • je PRAC pregledao sve podatke dostavljene od strane nositelja odobrenja o sigurnosti i djelotvornosti ivabradina, uključujući rezultate ispitivanja SIGNIFY, kao i mišljenja iznijeta od strane kardiovaskulana znanstvene savjetodavne skupine.
English: This is further supported by some of the data indicating that a heart rate <50 bpm is associated with a trend toward a higher CV risk.
Croatian: Ovo je nadalje podržano određenim podacima koji ukazuju da je frekvencija srca od <50 bpm povezana s trendom prema većem riziku od CV-a.
English: In angina, the usual recommended starting dose of ivabradine is 5 mg twice daily (b.i.d.).
Croatian: U slučaju angine, uobičajena preporučena doza ivabradina je 5 mg dva puta na dan (b.i.d.).
English: The beneficial effect of symptomatic improvement of angina is considered of clinical relevance.
Croatian: Korist za simptomatičko poboljšanje angine smatra se od kliničkog značaja.
English: The PRAC is of the opinion that the higher than approved dose used in the SIGNIFY study does not fully explain these findings.
Croatian: PRAC je mišljenja da veće doze od odobrenih korištene u ispitivanju SIGNIFY ne pojašnjavaju u potpunosti ove rezultate.
English: In February 2012, ivabradine was approved for the treatment of heart failure in the European Union based on the results of the SHIFT2 study.
Croatian: U veljači 2012., ivabradin je odobren za liječenje zatajenja srca u Europskoj uniji na temelju rezultata ispitivanja SHIFT2.
English: Having reviewed the PRAC recommendation, the CHMP agreed with the overall scientific conclusions and grounds for recommendation.
Croatian: Nakon pregleda preporuke PRAC-a, CHMP je suglasan sa cjelokupnim znanstvenim zaključcima i razlozima za preporuku.
English: Although not reaching statistical significance, similar trends were observed for the individual components of CV death and non-fatal myocardial infarction (MI).
Croatian: Iako nije postignut statistički značaj, slični su trendovi uočeni za individualne komponente CV smrti i nesmrtonosnog infarkta miokarda (MI).
English: • In symptomatic treatment of chronic stable angina pectoris, treatment should only be initiated in patients with HR ≥ 70 bpm.
Croatian: • u slučaju simptomatičnog liječenja kronične stabilne angine pektoris, liječenje treba započeti samo u bolesnika sa HR ≥ 70 bpm.
English: Therefore it is considered that overall, the results of the SIGNIFY study do not impact on the heart failure indication.
Croatian: Stoga, smatra se da cjelokupni rezultati ispitivanja SIGNIFY ne utječu na indikaciju zatajenja srca.
English: In addition, the higher dose of 10 mg could clarify the higher incidence of bradycardia during the SIGNIFY study in comparison to other large studies with ivabradine, BEAUTIFUL and SHIFT.
Croatian: Nadalje, veća doza od 10 mg može pojasniti višu incidenciju bradikardije tijekom ispitivanja SIGNIFY u usporedbi s drugim velikim ispitivanjima provedenima s ivabradinom, BEAUTIFUL i SHIFT.
English: • Warnings added on measurement of heart rate, lack of benefit on clinical outcomes, and atrial fibrillation.
Croatian: • upozorenja su dodana o mjerenju frekvencije srca, nedostatku koristi o kliničkim ishodima i atrijskoj fibrilaciji.
English: As a precaution, up-titration should only occur if the initial dose is well tolerated and the resting heart rate remains above 60 bpm.
Croatian: Kao mjera opreza, titranje prema većoj dozi treba nastupiti samo ako se početna doza dobro podnosi, a frekvencija srca u mirovanju ostaje iznad 60 bpm.
English: The potential impact of the SIGNIFY results in the heart failure indication was considered, but the two populations are substantially different in terms of underlying cardiac function and presence or absence of clinical heart failure.
Croatian: Razmotren je potencijalan učinak rezultata ispitivanja SIGNIFY u slučaju indikacije zatajenja srca, no dvije grupe populacije se značajno razlikuju u smislu srčane funkcije u podlozi i prisutnosti ili odsutnosti kliničkog zatajenja srca.
English: Therefore it is justified that ivabradine is discontinued or down titrated if the heart rate falls under 50 bpm.
Croatian: Stoga je opravdano da se terapija ivabradinom prekine ili titrira prema nižim dozama, ako frekvencija srca padne ispod 50 bpm.
English: There was no significant difference in the incidence of the primary endpoint between the ivabradine group and the placebo group (6.8% and 6.4%, respectively; HR=1.08, 95% CI [0.96 -1.20]; p=0.2).
Croatian: Nije uočena značajna razlika u incidenciji primarne završne točke između grupe koja je primala ivabradin i grupe koja je primala placebo (6,8% odnosno 6,4%; HR=1,08, 95% CI [0,96 -1,20]; p=0,2).
English: Overall conclusion
Croatian: Cjelokupan zaključak
English: This study used doses of ivabradine higher than the currently recommended in the product information (starting dose in SIGNIFY: 7.5 mg twice daily [5 mg twice daily if age>75 years], that could be increased up to 10 mg twice daily).
Croatian: Ovo je ispitivanje koristilo doze ivabradina veće od trenutno preporučenih u informacijama o lijeku (početna doza u ispitivanju SIGNIFY: 7,5 mg dva puta na dan [5 mg dva puta na dan u slučaju starosti bolesnika >75 godina], koja se može povećati do 10 mg dva puta na dan).
English: In the whole population (n=19102), ivabradine did not significantly affect the primary composite endpoint (PCE) or its individual components (CV death and non-fatal myocardial infarction).
Croatian: U cjelokupnoj populaciji (n=19102), ivabradin primarnu kompozitnu završnu točku (PCE) ili na njezine individualne komponente (CV smrt i nesmrtonosni infarkt miokarda).
English: The MAH is requested to submit within the agreed timelines, the final study protocol of the drug utilisation study.
Croatian: Od nositelja odobrenja zatraženo je da dostavi unutar dogovorenog vremenskog ograničenja, završni protokol ispitivanja za ispitivanje iskoristivosti lijeka.
English: There were also no significant differences between the two groups in the incidences of the components of the primary composite endpoint (death from CV causes and nonfatal MI).
Croatian: Također nije bilo značajnih razlika između dvije grupe u incidencijama komponenti primarne složene završne točke (smrti uzrokovana CV-om i nesmrtonosan MI).
English: In addition to CAD, ivabradine is currently also indicated for treatment of chronic heart failure on the basis of results from the previous SHIFT study.
Croatian: Uz CAD, ivabradin je trenutno također indiciran za liječenje kroničnog zatajenja srca na temelju rezultata prethodnog ispitivanja SHIFT.
English: Applying such a cut-off based on data from the BEAUTIFUL study is a reasonable measure to exclude patients who are likely to be at higher risk.
Croatian: Primjena takve granice na temelju podataka ispitivanja BEAUTIFUL jest odgovorna mjera za isključivanje bolesnika za koje je izgledno da su izloženi povišenom riziku.
English: • Concomitant use of grapefruit juice is now not recommended due to the potential for a pharmacokinetic interaction resulting in increased exposure to ivabradine.
Croatian: • sada se ne preporučuje istovremena primjena sa sokom grejpa uslijed moguće farmakokinetičke interakcije koja rezultira u povećanom izlaganju ivabradinu.
English: However, AF was not related to the higher outcome risk as patients with AF in relation to the proportion of patients with a subsequent endpoint was similar for ivabradine as for the placebo patients.
Croatian: No, AF nije povezana s povišenim rizikom ishoda budući da je udio bolesnika s AF u odnosu na udio bolesnika sa narednom završnom točkom bio sličan za ivabradin kao i za bolesnike koji su primali placebo.
English: Atrial fibrillation (AF) occurred in 5.3% of patients on ivabradine vs. 3.8% of patients on placebo.
Croatian: Arterijska fibrilacija (AF) nastupila je u 5,3% bolesnika koji su primali ivabradin u odnosu na 3,8% bolesnika koji su primali placebo.
English: • The PRAC concluded that there are clinically relevant benefits to the symptomatic treatment of angina pectoris with ivabradine.
Croatian: • PRAC je zaključio da postoje klinički relevantne koristi za simptomatičko liječenje angine pektoris ivabradinom.
English: Several pre-specified subgroup analyses were performed and the only significant interaction identified was in the incidence of the primary composite endpoint in the angina Canadian Cardiovascular Society (CCS) class ≥ II patients.
Croatian: Provedeno je nekoliko analiza unaprijed definiranih podgrupa, te je jedina značajna interakcija identificirana u incidenciji primarne složene završne točke angine u klasi ≥ II bolesnika sukladno Kanadskom kardiovaskularnom udruženju (Canadian Cardiovascular Society (CCS)).
English: • The PRAC also noted a small but significant increase of the combined risk of cardiovascular death and non-fatal myocardial infarction in a subgroup of symptomatic angina patients in the SIGNIFY study.
Croatian: • je PRAC također uočio maleno ali značajno povećanje u kombiniranom riziku kardiovaskularne smrti i nesmrtonosnog infarkta miokarda u podgrupi bolesnika sa simptomatičnom anginom u ispitivanju SIGNIFY.
English: This will be a multinational retrospective cohort study that will collect data from medical record abstraction (chart review) for patients with chronic stable angina pectoris initiating treatment with ivabradine in routine clinical practice in selected European countries.
Croatian: Ovo će biti multinacionalno retrospektivno ispitivanje kohorte kojim će se prikupiti podaci iz apstrakcije medicinske evidencije (pregled kartona) za bolesnika s kroničnom stabilnom anginom pektoris pokrećući liječenje ivabradinom u rutinskoj kliničkoj praksi u odabranim Europskim državama.
English: However, in the pre-specified subgroup of symptomatic angina patients (n=12049), a statistically significant increase in PCE was observed (HR=1.18; 95%CI [1.03-1.35]).
Croatian: No, u prethodno navedenoj podgrupi bolesnika sa simptomatičnom anginom (n=12049), uočeno je statistički značajno povećanje u PCE (HR=1,18; 95%CI [1,03-1,35]).
English: The CHMP considered it necessary to introduce a statement in section 4.8 of the Summary of Product Characteristics reflecting the incidence of atrial fibrillation in the SIGNIFY study.
Croatian: Mišljenje je CHMP-a kako je neophodno u dio 4.8 sažetka opisa svojstava lijeka uvrstiti izjavu koja opisuje incidenciju atrijske fibrilacije u ispitivanju SIGNIFY.
English: An additional risk minimisation activity was required by the PRAC.
Croatian: PRAC je zatražio dodanu mjeru za smanjivanje rizika.
English: Given the importance of ensuring that patient are not exposed to higher than recommended dose of ivabradine, the currently existing warning on concomitant intake of grapefruit juice should be strengthened to avoid a potential pharmacokinetic interaction.
Croatian: Uzimajući u obzir važnost osiguravanja da se bolesnik ne izlaže većim dozama ivabradina od preporučenih, trenutno postojeće upozorenje o istovremenom unosu soka grejpa treba dodatno naglasiti kako bi se izbjegla moguća farmakokinetička interakcija.
English: None of the factors identified in the SIGNIFY study had an impact on the beneficial effect of ivabradine observed in the SHIFT study.
Croatian: Nijedan od čimbenika identificiranih u ispitivanju SIGNIFY nije imao utjecaja na djelovanje ivabradina uočeno u ispitivanju SHIFT.
English: The SIGNIFY is a multicenter, randomized, double-blind, parallel-group, placebo-controlled, event-driven study which was designed to test the hypothesis that heart rate lowering with ivabradine reduces cardiovascular (CV) event rates in patients with stable coronary artery disease (CAD).
Croatian: SIGNIFY je multicentrično, randomizirano, dvostruko slijepo ispitivanje s paralelnim grupama, kontrolirano placebom i potaknuto događajima, koje je dizajnirano za testiranje hipoteze da snižavanje frekvencije srca s ivabradinom smanjuje učestalost kardiovaskularnih (CV) događaja u bolesnika sa stabilnom bolesti koronarnih arterija (CAD).
English: Also a lower dose and different titration method was used in the SHIFT study when compared to the SIGNIFY study.
Croatian: Nadalje manja doza i različite metode titranja primijenjene su u ispitivanju SHIFT prilikom usporedbe s ispitivanjem SIGNIFY.
English: In another clinical study evaluating the impact of grapefruit juice on ivabradine pharmacokinetics, an intake of 600 ml given as 200 ml three times a day for 3 days a moderate interaction level was observed with a 2.3-fold increase in ivabradine exposure.
Croatian: U drugom kliničkom ispitivanju koje je ocjenjivalo utjecaj soka grejpa na farmakokinetiku ivabradina, umjerena razina interakcije uočena je pri unosu doze od 600 ml koja je primjenjivana kao 200 ml tri puta na dan tijekom 3 dana uz 2,3 puta povećanjem u izlaganju ivabradinu.
English: Procoralan and Corlentor (both containing ivabradine) were granted a marketing authorisation in October 2005 for the indication “symptomatic treatment of chronic stable angina pectoris in patients with normal sinus rhythm, who have a contraindication or intolerance for beta-blockers”.
Croatian: Za lijekove Procoralan i Corlentor (oboje sadrže ivabradin) izdano je odobrenje za stavljanje lijekova u promet u listopadu 2005. za indikaciju „simptomatsko liječenje kronične stabilne angine pektoris u bolesnika s normalnim sinusnim ritmom, imaju kontraindikaciju ili netoleranciju na beta blokatore”.
English: These findings appear contradictory with findings from previous ivabradine studies in patients with CAD.
Croatian: Ovi se nalazi čine kontradiktornima s nalazima prethodnih ispitivanja ivabradina u bolesnika s CAD-om.
English: Due to the fact that the higher than approved dose used in the SIGNIFY study did not fully explain the findings of the study, it was considered key to benefit-risk balance to assess the effectiveness of the new risk minimisation measures and therefore this drug utilisation study is imposed as a condition to the marketing authorisation.
Croatian: Budući da činjenica da je u ispitivanju SIGNIFY korištena veća doza od odobrene nije u potpunosti pojasnila rezultate ispitivanja, ocjena djelotvornosti novih mjera smanjivanja rizika smatrana je ključnom te se stoga ovo ispitivanje iskoristivosti lijeka nameće kao uvjet za izdavanje odobrenja za stavljanje lijeka u promet.
English: The MAH shall distribute a Direct Healthcare Professional Communication (DHPC) to inform prescribers of the amendments to the product information.
Croatian: Nositelj odobrenja treba distribuirati Izravno pismo zdravstvenim djelatnicima (DHPC) kako bi obavijestio propisivače o dopunama informacija o lijeku.
English: Although baseline heart rate ≥ 70 bpm was an inclusion criteria in the SIGNIFY study, data from BEAUTIFUL study indicate a significant p-value for interaction for the primary composite endpoint when patient are divided around the 70 bpm cut-off level, although a significant beneficial effect was only observed for the MI endpoint in the heart rate ≥70 subgroup.
Croatian: Iako je osnovna vrijednost za frekvenciju srca od ≥ 70 bpm bio kriterij za uključivanje u ispitivanje SIGNIFY, podaci prikupljeni ispitivanjem BEAUTIFUL ukazuju na značajnu p-vrijednost za interakciju s primarnom složenom završnom točkom ako su bolesnici podijeljeni na graničnu razinu od oko 70 bpm, iako je značajno korisno djelovanje uočeno samo za završnu točku MI-a u podgrupi s frekvencijom srca od ≥70.
English: Ivabradine is a heart rate lowering agent with specific effect on the sinus node with no effects on intra-atrial, atrioventricular or intraventricular conduction times, myocardial contractility or ventricular repolarisation.
Croatian: Ivabradin je lijek za snižavanje frekvencije srca sa specifičnim djelovanjem na sinusne čvorove i bez djelovanja na intraatrijalno, atrioventrikularno ili vremena intraventrikularnog provođenja, mijokardijalnu kontraktivnost ili ventrikularnu repolarizaciju.
English: • The PRAC considered that the increased risks observed can be minimised by reinforcing the recommendation not to exceed the authorised posology, excluding patients with a resting heart rate < 70 bpm who are likely to be at greater risk, recommending discontinuation of treatment in the absence of improvement in angina symptoms within 3 months and contraindicating concomitant use of verapamil and diltiazem.
Croatian: • je PRAC zaključio da se uočeni povišeni rizik može smanjiti dodatnim naglašavanjem preporuke da se ne premašuje doziranje, isključujući bolesnike s frekvencijom srca u mirovanju < 70 bpm, za koje je izglednije da su izloženi većem riziku, preporučujući prekid liječenja u odsutnosti poboljšanja simptoma angine u roku od 3 mjeseca i kontraindiciranjem istovremene primjene verapamila i diltiazema.
English: • The PRAC further considered data on the incidence of atrial fibrillation, which is higher than previously recognised, and concluded that ivabradine treated patients should be monitored for the occurrence of atrial fibrillation to minimise the risk of atrial fibrillation.
Croatian: • je PRAC detaljno razmotrio podatke o incidenciji atrijske fibrilacije, koji su više od prepoznatih, i zaključio da se bolesnici liječeni ivabradinom trebaju kontrolirati kako bi se uočilo nastupanje atrijske fibrilacije sa ciljem smanjivanja rizika od atrijske fibrilacije.
English: The safety profile was dominated by adverse reactions already described for the product, notably all forms of bradycardia (17.9% ivabradine vs 2.1% placebo) and phosphenes (5.3% ivabradine vs 0.5% placebo).
Croatian: Sigurnosnim profilom dominirale su nuspojave već opisane za ovaj lijek, odnosno svi oblici bradikardije (17,9% bolesnika koji su primali ivabradin u odnosu na 2,1% bolesnika koji su primali placebo) i fosfene (5,3% bolesnika koji su primali ivabradin u odnosu na 0,5% bolesnika koji su primali placebo).
English: Given that the subgroup of symptomatic angina patients may correspond to the population of patients for whom one of the therapeutic indications for ivabradine is currently approved, the European Commission initiated on 8 May 2014 a procedure under Article 20 of Regulation (EC) No 726/2004 and requested the Agency to assess the above concerns and their impact on the benefit
Croatian: Uzimajući u obzir da podgrupa bolesnika sa simptomatičnom anginom može odgovarati populaciji bolesnika za koju je jedna od terapijskih indikacija ivabradina trenutno odobrena, Europska komisija pokrenula je 8. svibnja 2014. godine postupak sukladno članku 20.
English: Patients exposed to the 10 mg dose seemed to be at increased risk of a CV endpoint in comparison to patients not exposed to the 10 mg dose based on a time model evaluation.
Croatian: Čini se da su bolesnici izloženi maksimalnoj dozi od 10 mg bili izloženi povećanom riziku od završne točke CV-a u usporedbi s bolesnicima koji nisu bili izloženi dozi od 10 mg na temelju ocjene vremenskog modela.
English: The PRAC has therefore recommended the variation to the terms of the marketing authorisation for Corlentor and Procoralan.
Croatian: PRAC je stoga preporučio izmjenu uvjeta odobrenja za stavljanje u promet lijeka za lijekove Corlentor i Procoralan.
English: The SIGNIFY study in patients with CAD without clinical heart failure using doses higher than currently approved also showed no benefit in terms of CV outcome, but demonstrated a small significant increased risk on CV outcome for patients with symptomatic angina in a pre-specified analysis.
Croatian: Ispitivanjem SIGNIFY provedenim u bolesnika oboljelih od CAD-a bez kliničkog zatajenja srca primjenom doza većih od trenutno odobrenih također nisu utvrđene koristi u smislu ishoda CV-a, no demonstrirano je malo značajno povećanje rizika u ishodu CV-a za bolesnike sa simptomatičnom anginom u unaprijed specificiranoj analizi.
English: However the results of SIGNIFY highlight the need to make it explicit in the product information that ivabradine use in CAD patients has no benefits on CV outcomes and it will only have an effect on symptoms of angina pectoris.
Croatian: No, rezultati ispitivanja SIGNIFY naglašavaju potrebu izričitog navođenja u informacijama o proizvodu da primjena ivabradina u bolesnika s CAD-om nema koristi na ishod CV-a te da će imati učinak samo na simptome angine pektoris.
English: Based on the totality of the data assessed during the procedure and on the advice from the Scientific Advisory Group, the PRAC concluded that the benefit-risk balance of Procoralan/Corlentor remains favourable taking into account the product information amendments and subject to the risk minimisation measures and additional pharmacovigilance activity agreed.
Croatian: Na temelju ukupnosti svih podataka ocjenjenih tijekom postupka i na osnovu savjeta znanstvene savjetodavne skupine, PRAC je zaključio da omjer koristi i rizika za lijek Procoralan/Corlentor ostaje povoljan uzimajući u obzir dopune informacija o proizvodu, te je predmetom mjera za smanjivanje rizika i dodatnim usuglašenim mjerama na području farmakovigilancije.
English: The increased incidence of bradycardia in relation to the increased observed CV risk while on treatment with the higher initial dose and maximum dose (as in the SIGNIFY study), or concomitant diltiazem/verapamil or strong CYP3A4 inhibitors, indicates that the heart rate should not be extensively reduced.
Croatian: Povišena incidencija bradikardije u odnosu na povišeni uočeni rizik od CV-a tijekom terapije s povišenom početnom dozom i maksimalnom dozom (kao u ispitivanju SIGNIFY), ili istovremene primjene diltiazema/verapamila ili snažnih inhibitora CYP3A4, ukazuje da se frekvencija srca ne smije prekomjerno snižavati.
English: If atrial fibrillation develops during treatment, the benefits and risks of continued treatment with ivabradine should be carefully reconsidered.
Croatian: Ako se atrijska fibrilacija razvije tijekom liječenja, koristi i rizici od nastavljenog liječenja ivabradinom trebaju se pažljivo odvagnuti.
English: • The PRAC noted that the data from the SIGNIFY study showed that ivabradine does not have a beneficial effect on cardiovascular outcomes in coronary artery patients without clinical heart failure, and therefore its use is only beneficial for symptomatic treatment.
Croatian: • je PRAC napomenuo kako podaci iz ispitivanja SIGNIFY potvrđuju da ivabradin nema povoljan utjecaj na koronarne arterije bolesnika bez kliničkog zatajenja srca, i stoga uporaba je od koristi samo za simptomatičnu terapiju.
English: The CHMP, having considered the PRAC recommendation, agrees with the overall scientific conclusions by the PRAC and is of the opinion that the marketing authorisations for Corlentor and Procoralan should be varied.
Croatian: Nakon što je razmotrio preporuku PRAC-a, CHMP je suglasan sa cjelokupnim znanstvenim zaključcima od strane PRAC-a i mišljenja je da se odobrenje za stavljanje lijeka u promet za lijekove Corlentor i Procoralan treba izmijeniti.
English: • Concomitant treatment with moderate CYP3A4 inhibitors with heart rate reducing properties such as diltiazem or verapamil is now contraindicated.
Croatian: • sada je kontraindicirana istovremena terapija s umjerenim inhibitorima CYP3A4 sa svojstvima smanjivanja srčane frekvencije poput diltiazema ili verapamila.