FrancophonIA/ELRC3.0 huggingface dataset:
English: In view of (a) the evidence suggesting that linear GdCAs release Gd from their chelating ligand molecules due to the low kinetic and thermodynamic stability; (b) the known toxicity of unchelated gadolinium; (c) the data supporting the ability of linear GdCAs to distribute and accumulate in the brain; (d) the fact that linear agents are retained and persist for up to one year or longer in the brain; and (e) the deposition in other tissues with related harm; PRAC considered that there are reasonable and serious concerns raised as to the potential of neurological harm associated with the accumulation of gadolinium in the brain.
Croatian: Uzimajući u obzir (a) dokaz koji govori da linearni GdCA-ovi otpuštaju gadolinij iz kelacijskih molekula liganda zbog niske kinetičke i termodinamičke stabilnosti; (b) poznatu toksičnost nekelacijskog gadolinija; (c) podatke koji pokazuju sposobnost linearnih GdCA-ova da se distribuiraju i talože u mozgu; (d) činjenicu da se linearna sredstva zadržavaju u mozgu jednu godinu ili duže; i (e) taloženje u drugim tkivima uz povezanu štetu; PRAC smatra da postoje razumne i ozbiljne zabrinutosti u pogledu neurološkog oštećenja uzrokovanog taloženjem gadolinija u mozgu.
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.
Croatian: Ispitivanje na štakorima potvrdilo je i da je razina gadolinija u mozgu ovisno o dozi linearnih sredstava vjerojatno povezana s ukupnom dozom, a ne jednom velikom ili više malih doza.
English: Therefore, PRAC considered that restriction of the use of linear GdCAs to certain indications or to certain groups of patients would not be justified and would still leave patients exposed to the risk of gadolinium brain accumulation and that risk minimisation measures such as warnings in the SmPC or other contraindications would not limit the exposure to linear GdCAs as no safe level of gadolinium brain accumulation has been established.
Croatian: Stoga PRAC smatra da ograničenje uporabe linearnih GdCA-ova na određene indikacije ili na određene skupine bolesnika ne bi bilo opravdano i da bi bolesnici i dalje bili izloženi riziku od taloženja gadolinija u mozgu te da mjere za smanjenje rizika kao što su upozorenja u sažetku opisa svojstava lijeka ili druge kontraindikacije ne bi ograničile izloženost linearnim GdCA-ovima jer nije utvrđena sigurna razina za taloženje gadolinija u mozgu.
English: Macrocyclic agents show only a transient increase in Gd in the brain and undergo early washout.
Croatian: Makrociklička sredstva pokazuju samo prijelazno povećanje gadolinija u mozgu i rano se ispiru.
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.
Croatian: U ispitivanjima na štakorima, ostaci gadolinija u mozgu štakora nakon ponovljene primjene linearnih GdCA-ova pronađeni su u najmanje 3 različita oblika - topive male molekule, vjerojatno netaknuti GdCA, topive makromolekule i u najvećoj mjeri oblik koji nije topiv.
English: For the linear agent gadoxetic acid that has shown clinical utility in liver imaging, in view of its substantial liver uptake, its administration at a low dose (0.025 mmol/kg of body weight) and the short time to the delayed phase scanning (20 mins), the PRAC considered that it provides an additional benefit to patient management with an exposure to gadolinium that is minimised by the low dose administered and the short time to the delayed phase.
Croatian: U pogledu linearnog sredstva gadoksetične kiseline koja je pokazala kliničku korist pri snimanju jetre, uzimajući u obzir značajan unos u jetru, primjenu u niskoj dozi (0,025 mmol/kg tjelesne mase) i kratko vrijeme do odgođene faze snimanja (20 minuta), PRAC smatra da pruža dodatnu korist za upravljanje bolesnikom koji se izlaže gadoliniju jer se to izlaganje smanjuje primjenom niske doze i kratkim vremenom do odgođene faze.
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.
Croatian: GdCA sredstava su bubrezi, a produljeno vrijeme izlučivanja zbog teškog oštećenja bubrežne funkcije moglo bi teoretski povećati mogućnost taloženja u moždanom tkivu.
English: Non-clinical evidence also shows potential for release of gadolinium from the chelating ligand in the brain with linear GdCAs, but not with macrocyclic GdCAs (Frenzel et al. 2017).
Croatian: Neklinički dokazi također pokazuju potencijal otpuštanja gadolinija iz kelirajućeg liganda u mozgu nakon primjene linearnih GdCA-ova, ali ne nakon primjene makrocikličkih GdCA-ova (Frenzel i dr. 2017.).
English: In addition, with regards to the SmPCs of macrocyclic GdCAs (Dotarem, Prohance, and Gadovist) recommending higher dose in CNS imaging to improve visualisation and angiography but not in whole body imaging, PRAC considered that clinically relevant differences in diagnostic performance between Multihance and macrocyclic agents need to be supported by robust evidence from comparative clinical studies rather than a comparison of the approved SmPCs, which may have limitations.
Croatian: Nadalje, u pogledu sažetaka opisa svojstava lijeka za makrocikličke GdCA-ove (Dotarem, Prohance i Gadovist) u kojima se preporučuje veća doza za CNS snimanje kako bi se poboljšala vidljivost i angiografija, ali ne i za snimanje cijelog tijela, PRAC smatra da klinički relevantne razlike u dijagnostičkoj izvedbi Multihancea i makrocikličkih sredstava trebaju biti potkrijepljene snažnim dokazima iz komparativnih kliničkih ispitivanja, a ne usporedbom odobrenih sažetaka opisa svojstava lijeka koji imaju ograničenja.
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.
Croatian: Dokazano je da dva linearna GdCA-a, gadoksetičnu kiselinu i gadobensku kiselinu, unose hepatociti te su jedina sredstva specifična za jetru koja omogućuju snimanje jetre i u dinamičnoj i odgođenoj fazi.
English: PRAC recommended restriction of use, in the lowest dose that provides sufficient enhancement for diagnostic purposes and through appropriate warning in the product information in order to minimise the potential for accumulation of gadolinium in the brain and other organs and tissues.
Croatian: PRAC je preporučio ograničenje uporabe, primjenom najmanje doze koja pruža dovoljno poboljšanje u dijagnostičke svrhe i odgovarajućih upozorenja u informacijama o lijeku kako bi se smanjila mogućnost taloženja gadolinija u mozgu, drugim organima i tkivima.
English: However, in view of the extent of the hepatic uptake, the high dose (0.05 mmol/kg body weight) required and the long time to the onset of delayed phase imaging (40 mins), the PRAC considered that the benefit of gadobenic acid containing products in all the authorised indication including the liver imaging does not outweigh the potential and identified risks associated to the use of this product.
Croatian: Međutim, uzimajući u obzir razmjer unosa u jetru, potrebnu visoku dozu (0,05 mmol/kg tjelesne mase) i vrijeme potrebno za nastupanje odgođene faze snimanja (40 minuta), PRAC smatra da korist lijekova koji sadržavaju gadobensku kiselinu za sve odobrene indikacije, uključujući snimanje jetre, ne nadmašuje moguće i utvrđene rizike povezane s uporabom tog lijeka.
English: The T1 signal enhancement was documented in several non-clinical as well as clinical studies, demonstrating that the data is consistent across mouse, rat and human, which confirms the robustness of the findings of signal intensity increases.
Croatian: Poboljšanje T1 signala dokumentirano je u nekoliko nekliničkih, kao i kliničkih ispitivanja, što dokazuje da su podaci dosljedni kod miševa, štakora i ljudi.
English: PRAC maintained its view that conducting clinical studies to fully address the potential risk associated with Gd accumulation in the brain would not be feasible within a reasonable period of time.
Croatian: PRAC je ostao pri svojem mišljenju da provedba kliničkih ispitivanja radi potpunog rješavanja rizika povezanih s taloženjem gadolinija u mozgu nije provediva u razumnom vremenskom roku.
English: Intravenous linear Gadolinium-containing contrast agents (GdCAs)
Croatian: Intravenska linearna kontrastna sredstva koja sadržavaju gadolinij
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.
Croatian: Nadalje, dva GdCA proizvoda, gadopentetična kiselina i gadoterična kiselina ovlaštena su kao formulacije za intraartikularnu primjenu za MR artrografiju te mogu poboljšati vidljivost određenih lezija.
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.
Croatian: PRAC je ostao i pri svojim zaključcima o tome da koristi intraartikularne primjene lijeka Magnevist s linearnim GdCA sredstvima nadmašuju s njim povezane rizike (podliježe izmjenama informacija o lijeku) jer se lijek primjenjuje u vrlo niskim dozama i predstavlja nizak rizik od taloženja u tkivu.
English: While accumulation in terms of T1w signal intensity increases and gadolinium measured in the brain (likely in the form of intact GdCA molecule) has been seen in the short term with these agents, long-term persistence in the brain was not be observed.
Croatian: Iako je primijećeno kratkoročno taloženje u pogledu povećanja intenziteta T1w signala i izmjerenog gandolinija u mozgu (vjerojatno u obliku netaknute GdCA molekule) nakon primjene tih sredstava, nije primijećeno dugotrajno zadržavanje u mozgu.
English: A higher in vivo than in vitro stability would require the occurrence of stabilising agents in vivo, but no conclusive evidence confirming increases of the stability of the Gd complex in the body has been provided by the MAH.
Croatian: Da bi stabilnost bila veća in vivo nego in vitro potrebna je pojava sredstava za stabilizaciju in vivo, ali nositelj odobrenja nije podnio uvjerljive dokaze koji potvrđuju povećanje stabilnosti gadolinijskog kompleksa u tijelu.
English: Therefore, it is considered that gadoxetic acid brings an additional benefit to patient management with an exposure to gadolinium that is minimised by the low dose administered, the very significant hepatic uptake and the short time to the delayed phase scanning.
Croatian: Stoga se smatra da gadoksetična kiselina donosi dodatnu korist za upravljanje bolesnikom jer se izlaganje gadoliniju smanjuje primjenom male doze, značajnim unosom u jetru i kratkim vremenom snimanja u odgođenoj fazi.
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.
Croatian: Ova veza dodatno podupire tumačenja ispitivanja magnetske rezonancije (MRI) koja smatraju da je taloženje gadolinija u mozgu uzročno povezano s izlaganjem GdCA-ovima.
English: Impact of renal impairment
Croatian: Utjecaj oštećenja bubrega
English: No such enhancement was observed with gadoterate meglumine (Dotarem).
Croatian: Takvo poboljšanje nije primijećeno pri primjeni gadoterata meglumina (Dotarem).
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.
Croatian: • Smatra se da provedivost kliničkih ispitivanja, i promatračkih i intervencijskih radi rješavanja ozbiljnih zabrinutosti u vezi s mogućim neurološkim učincima nije moguća u razumnom vremenskom roku.
English: With regards to the MAH's claim that linear GdCAs do not cause more marked Gd retention and do not have a slower release from brain tissues compared to macrocyclic GdCAs, PRAC considered that the study of McDonald et al. (2017), confirming T1 hyperintensity in the rat lateral dentate nucleus 1 week after administration of macrocyclic agents (Gadovist and Prohance), has several shortcomings:
Croatian: U pogledu tvrdnji nositelja odobrenja za stavljanje u promet da linearni GdCA-ovi ne uzrokuju istaknutije zadržavanje gadolinija i ne otpuštaju se sporije iz moždanog tkiva u usporedbi s makrocikličkim GdCa-ovima, PRAC smatra da ispitivanje McDonalda i dr. (2017.) koje potvrđuje preosjetljivost T1 signala u bočnom dentatnom nukleusu štakora 1 tjedan nakon primjene makrocikličkih sredstava (Gadovist i Prohance) ima nekoliko nedostataka:
English: Data from non-clinical electron microscopy (EM) studies of brain tissue have also provided evidence of filamentous electron-dense Gd deposits in the regions where T1 hyper intensity has been observed following dosing with gadodiamide.
Croatian: Podaci iz nekliničkih ispitivanja elektronske mikroskopije (EM) moždanog tkiva dokazali su vlaknaste guste naslage gadolinija u područjima na kojima je primijećen T1 hiperintezitet nakon primjene doze gadodiamida.
English: physiology and functionality of many different areas of the body and internal organs as part of a diagnostic workup investigating a wide range of diseases including cancer, inflammatory diseases and degenerative conditions.
Croatian: To poboljšanje kontrasta pokazalo važnim za vizualizaciju anatomije, fiziologije i funkcionalnosti različitih dijelova tijela i unutarnjih organa u okviru dijagnostike u kojoj se istražuje cijeli niz bolesti, uključujući rak, upalne bolesti i degenerativna stanja.
English: The highest amount of gadolinium recovered from the rat brain tissue was found to be with gadodiamide, followed by gadobenate and gadopentetate.
Croatian: Najveća količina gadolinija pronađena u moždanom tkivu štakora bila je nakon primjene gadodiamida, zatim gadobenata te na kraju gadopentetata.
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;
Croatian: • ažuriranje sažetaka opisa svojstava lijeka kako bi liječnici bili upoznati s taloženjem u mozgu, smanjenje izlaganja i obavješćivanje o takvim promjenama;
English: Therefore, the PRAC considered that the benefits of these products outweigh their risks.
Croatian: Stoga PRAC smatra da koristi tih lijekova nadmašuju s njima povezane rizike.
English: The PRAC also noted that high GdCAs doses were tested (20x2.5 mmol) by McDonald et al., and the study duration is comparably short (e.g. the total doses tested in Frenzel et al 2017 was half that of McDonald et al (10x2.5mmol), while the time period to the last tissue sampling in Frenzel et al 2017 was 24 days instead of 7 days in McDonald 2017.)
Croatian: PRAC je napomenuo i da su McDonald i dr. ispitali velike doze GdCA-ova (20 x 2,5 mmol) te da je trajanje ispitivanja usporedivo kratko (npr. ukupan broj ispitanih doza u ispitivanju Frenzela i dr. iz 2017. bio je upola manji od onoga u ispitivanju McDonalda i dr. (10 x 2,5 mmol).
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).
Croatian: Ioni lantanida kao što je gadolinij mogu se vezati na enzime koji se vežu na Ca2+ i miješaju s kanalima kalcija zbog nadmetanja s Ca2+ u staničnim i biokemijskim procesima.
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.
Croatian: Omjer koristi i rizika lijekova koji sadržavaju intravensku gadobensku kiselinu (za sve indikacije osim snimanja jetre), gadodiamid, gadopentetičnu kiselinu (IV. prezentacija) i gadoversetamid više nije povoljan i ta se odobrenja za stavljanje u promet trebaju obustaviti.
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.
Croatian: U pogledu izjave o ranom ispiranju makrocikličkih sredstava „makrociklička sredstva pokazuju samo prijelazno povećanje gadolinija u mozgu te se rano ispiru”, CHMP smatra da je ta izjava dovoljna kako bi se objasnilo da su mjerenja gadolinija u mozgu tijekom duljeg vremenskog razdoblja pokazala drugačije rezultate u pogledu taloženja tijekom vremena kod linearnih i makrocikličkih sredstava.
English: For lifting the suspension, the PRAC recommended that MAHs should provide evidence:
Croatian: Kako bi se obustava ukinula, PRAC je nositeljima odobrenja za stavljanje u promet preporučio da dostave sljedeće dokaze:
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.
Croatian: • Da se uporaba linearnih GdCA sredstava i ograniči, bolesnici u preostalim skupinama i dalje će biti izloženi riziku jer se ne zna koja je sigurna razina za zadržavanje dekeliranog gadolinija u mozgu i drugim tjelesnim tkivima.
English: In view of the claimed differences of hypersensitivity reactions with Omniscan versus other GdCAs based on meta-analyses of available epidemiological data, PRAC considered these differences are too subtle to influence the benefit-risk balance, and that extremely large clinical trials would be necessary to confirm a statistical difference in frequency of hypersensitivity reactions.
Croatian: Uzimajući u obzir tvrdnje o razlikama u reakcijama preosjetljivosti nakon primjene Omniscana u usporedbi s drugim GdCA sredstvima koje se temelje na analizi dostupnih epidemioloških podataka, PRAC smatra da su te razlike toliko neznatne da ne mogu utjecati na omjer koristi i rizika te da je potrebno provesti iznimno velika klinička ispitivanja radi potvrđivanja statističke razlike u učestalosti reakcija preosjetljivosti.
English: With regards to the claimed higher relaxivity of Multihance resulting in a better image enhancement and diagnostic performance than other GdCAs, it was noted that higher relaxivity which results in a stronger signal and a brighter image does not automatically translate into differences in diagnostic performance.
Croatian: U pogledu tvrdnji o većoj relaksiviteta lijeka Multihance koja omogućuje poboljšavanje slike i dijagnostičke izvedbe u usporedbi s drugim GdCA sredstvima, utvrđeno je da veći relaksivitet koji rezultira jačim signalom i svjetlijom slikom ne dovodi nužno do razlika u dijagnostičkoj izvedbi.
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.
Croatian: Na temelju dostupnih podataka, nije moguće utvrditi određenu skupinu bolesnika koja neće doživjeti taloženje gadolinija u mozgu, budući da se taloženje gadolinija u mozgu očekuje i u djece i odraslih.
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.
Croatian: U okviru stručne skupine izraženo je i mišljenje da linearna sredstva ne bi trebalo obustaviti, ali bi se makrociklička sredstva trebala koristiti kao prvi odabir kontrastnog sredstva (osim za jetru), osim u slučaju da nositelji odobrenja za stavljanje u promet provedu relevantna ispitivanja koja jasno dokazuju da linearna sredstva omogućuju znatno bolje ishode pri upravljanju bolesnikom u usporedbi s makrocikličkim sredstvima.
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.
Croatian: CHMP nadalje smatra da omjer koristi i rizika za intravenske lijekove koji sadržavaju gadodiamid, gadopentetičnu kiselinu i gadoversetamid više nije povoljan.
English: In order to minimise the risk of Gd accumulation in the brain and the potential associated harm in relation to linear GdCAs, PRAC considered options for risk minimisation measures such as warnings in the SmPC, contraindications and other additional risk minimisation measures.
Croatian: Kako bi se smanjio rizik od taloženja gadolinija u mozgu i moguće štete povezane s linearnim GdCAovima, PRAC je razmotrio opcije mjera za smanjenje rizika, kao što su upozorenja u sažetku opisa svojstava lijeka, kontraindikacije te druge dodatne mjere za smanjenje rizika.
English: Elimination of GdCAs is therefore reduced in patient with renal dysfunction.
Croatian: Izlučivanje GdCA-ova stoga je smanjeno u bolesnika s bubrežnom disfunkcijom.
English: Non-chelated gadolinium has been shown to be toxic in non-clinical studies, with effects including cellular necrosis, fibrosis, and lesions related to mineral deposition.
Croatian: Neklinička ispitivanja pokazala su da je nekelirani gadolinij toksičan te ima učinke kao što su stanična nekroza, fibroza i lezije povezane s taloženjem minerala.
English: Particularly zinc, copper and iron (Frenzel et al., 2008) are described as competing metals which can liberate Gd; glycosaminoglycans like heparin may bind Gd and thereby remove it from its pharmacological chelator.
Croatian: Kao metali koji mogu osloboditi gadolinij posebno se navode cink, bakar i željezo (Frenzel i dr., 2008.); glikosaminoglikani poput heparina mogu vezati gadolinij i tako ga ukloniti iz farmakološkog kelatora.
English: Regarding the validity of an ex-vivo distribution study by Frenzel et al (2017), PRAC acknowledged the study does not contribute to the understanding in which form exactly Gd-based contrast agents are stored in the body, however PRAC considered that the study confirms, in line with other studies, that linear chelators lead to a higher amount of stored Gd and that there is a difference between linear and macrocyclic chelators in respect to binding to insoluble macromolecules.
Croatian: U pogledu valjanosti ex-vivo distribucijskog ispitivanja koje su proveli Frenzel i dr. (2017.), PRAC je utvrdio da ispitivanje ne objašnjava u kojem se točno obliku kontrastna sredstva koja se temelje na gadoliniju pohranjuju u tijelu, međutim PRAC smatra da ispitivanje potvrđuje, u skladu s drugim ispitivanjima, da linearni kelatori dovode do veće količine pohranjenog gadolinija te da postoji razlika između linearnih i makrocikličkih kelatora u pogledu vezanja na netopive makromolekule.
English: Non-clinical evidence also shows potential for release of gadolinium from the chelating ligand in the brain with linear GdCAs; the potential of release from the chelating ligand is not seen with macrocyclic GdCAs.
Croatian: Neklinički dokazi također pokazuju potencijal otpuštanja gadolinija iz kelirajućeg liganda u mozgu nakon primjene linearnih GdCA-ova; potencijal otpuštanja iz kelirajućeg liganda nije primijećen kod makrocikličkih GdCA-ova.