FrancophonIA/ELRC3.0 huggingface dataset:
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).
Slovenian: V tej študiji so uporabili odmerke ivabradina, ki so večji od trenutno priporočenih odmerkov v informacijah o zdravilu (začetni odmerek v študiji SIGNIFY: 7,5 mg dvakrat na dan (5 mg dvakrat na dan, če je bila starost > 75 let), ki ga je bilo mogoče povečati do 10 mg dvakrat na dan).
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.
Slovenian: To bo multinacionalna retrospektivna kohortna študija, ki bo zbrala podatke iz izvlečkov zdravniških kartotek (pregled kartotek) pri bolnikih s kronično stabilno angino pektoris, ki začnejo zdravljenje z ivabradinom v redni klinični praksi v izbranih evropskih državah.
English: Grounds for the recommendation
Slovenian: Podlaga za priporočilo
English: Patients exposed to 10 mg dose versus not exposed to 10 mg showed a higher risk for bradycardia (E=2.54 [1.54-4.82]), observation supported by data from two small parallel studies also using the 10 mg dose.
Slovenian: Pri bolnikih, izpostavljenih odmerku 10 mg, so v primerjavi z bolniki, ki temu odmerku niso bili izpostavljeni, pokazali povečano tveganje bradikardije (E = 2,54 (1,54-4,82)), kar so podprli podatki iz dveh manjših vzporednih študij, ki sta prav tako vključevali odmerek 10 mg.
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.
Slovenian: • odbor PRAC je nadalje obravnaval podatke o incidenci atrijske fibrilacije, ki je večja, kot so menili prej, in sklenil, da je treba bolnike, zdravljene z ivabradinom, spremljati za pojav atrijske fibrilacije, da se zmanjša tveganje atrijske fibrilacije.
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).
Slovenian: V incidenci primarnega opazovanega dogodka med skupino z ivabradinom in skupino s placebom ni bilo nobene pomembne razlike (6,8 % oziroma 6,4 %, razmerje tveganja = 1,08, 95-% IZ (0,961,20), p = 0,2).
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.
Slovenian: Kot previdnostni ukrep se sme odmerek povečati samo, če bolnik začetni odmerek dobro prenaša in srčni utrip v mirovanju ostane nad 60 udarcev/min.
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]).
Slovenian: Vendar so pri vnaprej opredeljeni podskupini bolnikov s simptomatsko angino pektoris (n = 12049) opazili statistično pomembno povečanje PCE (razmerje tveganja = 1,18; 95-% IZ (1,03-1,35).
English: The MAH shall distribute a Direct Healthcare Professional Communication (DHPC) to inform prescribers of the amendments to the product information.
Slovenian: Imetnik dovoljenja za promet z zdravilom bo razdelil dopis za neposredno komunikacijo z zdravstvenimi delavci, s katerim bodo zdravniki, ki bodo zdravila predpisovali, obveščeni o spremembah informacij o zdravilu.
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.
Slovenian: • odbor PRAC je menil, da je mogoče opažena povečana tveganja zmanjšati z okrepitvijo priporočil, naj se ne preseže odobreno odmerjanje, se izključijo bolniki s srčnim utripom v mirovanju < 70 udarcev/min, ki bodo verjetno izpostavljeni večjemu tveganju, se prekine zdravljenje, če ne pride do izboljšanja simptomov angine pektoris v treh mesecih, in se vključi kontraindikacija za sočasno zdravljenje z verapamilom ter diltiazemom;
English: The beneficial effect of symptomatic improvement of angina is considered of clinical relevance.
Slovenian: Koristen učinek simptomatskega izboljšanja angine pektoris je klinično pomemben.
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.
Slovenian: Ivabradin je učinkovina za upočasnitev srčnega utripa s posebnim učinkom na sinuatrialni nodus in brez učinkov na čas intraatrijskega, atrioventrikularnega ali intraventrikularnega prevajanja, kontraktilnost miokardija ali ventrikularno repolarizacijo.
English: • In symptomatic treatment of chronic stable angina pectoris, treatment should only be initiated in patients with HR ≥ 70 bpm.
Slovenian: • pri simptomatskem zdravljenju kronične stabilne angine pektoris se sme zdravljenje začeti samo pri bolnikih s srčnim utripom  70 udarcev/min.
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.
Slovenian: Opravili so mnoge analize vnaprej opredeljenih podskupin; edina pomembna interakcija je bila incidenca primarnega sestavljenega opazovanega dogodka pri bolnikih z angino pektoris razreda ≥ II po razvrstitvi kanadskega kardiovaskularnega združenja (CCS).
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.
Slovenian: Pretehtali so morebitni vpliv rezultatov študije SIGNIFY pri indikaciji srčnega popuščanja, vendar sta se populaciji pomembno razlikovali glede na osnovno delovanje srca in prisotnost ali odsotnost kliničnega srčnega popuščanja.
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”.
Slovenian: Zdravili Procoralan in Corlentor (ki vsebujeta ivabradin) sta oktobra 2005 pridobili dovoljenje za promet za indikacijo „simptomatsko zdravljenje kronične stabilne angine pektoris pri bolnikih z normalnim sinusnim ritmom, pri katerih so betaadrenergični antagonisti kontraindicirani ali jih ne prenašajo.“
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.
Slovenian: • odbor PRAC je v študiji SIGNIFY ugotovil tudi majhno, vendar pomembno povečanje kombiniranega tveganja kardiovaskularne smrti in nesmrtnega miokardnega infarkta pri podskupini bolnikov s simptomatsko angino pektoris.
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.
Slovenian: • odbor PRAC je ugotovil, da podatki iz študije SIGNIFY kažejo, da ivabradin nima koristnega učinka na kardiovaskularne izide pri bolnikih s koronarno arterijsko boleznijo brez kliničnega srčnega popuščanja, zato je njegova uporaba koristna samo za simptomatsko zdravljenje;
English: The PRAC has therefore recommended the variation to the terms of the marketing authorisation for Corlentor and Procoralan.
Slovenian: Posledično je odbor PRAC priporočil spremembo pogojev dovoljenja za promet z zdraviloma Procoralan in Corlentor.
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.
Slovenian: Na podlagi celotnih podatkov, ocenjenih med postopkom, in nasveta Znanstvene svetovalne skupine je odbor PRAC sklenil, da razmerje med tveganji in koristmi zdravil Procoralan/Corlentor ostaja pozitivno, če se upoštevajo spremembe informacij o zdravilu in ukrepi za zmanjševanje tveganja ter izvajajo dodatne dogovorjene farmakovigilančne dejavnosti.
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.
Slovenian: Vendar atrijska fibrilacija ni bila povezana z večjim tveganjem izida, saj je bil delež bolnikov z atrijsko fibrilacijo glede na delež bolnikov s poznejšim opazovanim dogodkom podoben v skupini z ivabradinom kot pri placebu.
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.
Slovenian: Povečana incidenca bradikardije, povezana s povečanim opaženim kardiovaskularnim tveganjem med zdravljenjem z večjim začetnim odmerkom in največjim odmerkom (kot v študiji SIGNIFY) ali sočasnim zdravljenjem z diltiazemom/verapamilom ali močnimi zaviralci CYP3A4, kaže, da se srčni utrip ne sme preveč upočasniti.
English: Furthermore a drug utilisation study shall be performed to describe the characteristics of users of ivabradine, patterns of use and assess adherence to the risk minimisation measures.
Slovenian: Poleg tega bo opravljena študija o uporabi zdravila, s katero bodo opisali značilnosti uporabnikov ivabradina in vzorce uporabe ter ocenili upoštevanje ukrepov za zmanjševanje tveganja.
English: On the basis of efficacy and safety data from studies that became available after the initial marketing authorisation including the BEAUTIFUL1 study, the indication was extended in October 2009 to include combination with beta-blockers in patients whose angina is inadequately controlled with an optimal beta-blocker dose and whose heart rate is >60 bpm.
Slovenian: Na podlagi podatkov o učinkovitosti in varnosti iz študij, ki so bile izdane po prvotni izdaji dovoljenja za promet z zdravilom, vključno s študijo BEAUTIFUL1, so indikacijo oktobra 2009 razširili na kombinacijo z betaadrenergičnimi antagonisti pri bolnikih s srčnim utripom > 60 udarcev/min, pri katerih angina pektoris ni zadostno nadzorovana z optimalnim odmerkom betaadrenergičnih antagonistov.
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.
Slovenian: V študiji SIGNIFY pri bolnikih s koronarno arterijsko boleznijo brez kliničnega srčnega popuščanja, v kateri so se uporabili odmerki, večji od trenutno odobrenih, prav tako niso dokazali koristi glede kardiovaskularnega izida, vendar so v vnaprej opredeljeni analizi ugotovili pomembno, rahlo povečano tveganje za kardiovaskularne izide pri bolnikih s simptomatsko angino pektoris.
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.
Slovenian: Čeprav je bilo vključitveno merilo v študiji SIGNIFY izhodiščni srčni utrip  70 udarcev/min, podatki iz študije BEAUTIFUL kažejo pomembno vrednost p pri interakciji primarnega sestavljenega opazovanega dogodka, kadar so bolniki razdeljeni glede na omejitev 70 udarcev/min, čeprav so pri podskupini s srčnim utripom ≥ 70 pomemben koristen učinek opazili samo za opazovani dogodek miokardnega infarkta.
English: • Concomitant treatment with moderate CYP3A4 inhibitors with heart rate reducing properties such as diltiazem or verapamil is now contraindicated.
Slovenian: • sočasno zdravljenje z zmernimi zaviralci CYP3A4 z lastnostmi upočasnitve srčnega utripa, kot sta diltiazem in verapamil, je zdaj kontraindicirano;
English: Background information
Slovenian: Osnovne informacije
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.
Slovenian: Vendar so rezultati študije SIGNIFY izpostavili potrebo po poudarku v informacijah o zdravilu, da uporaba ivabradina pri bolnikih s KAD nima nobenih koristi na kardiovaskularne izide in bo imela učinek samo na simptome angine pektoris.
English: The PRAC is therefore of the opinion that the benefit-risk balance of ivabradine remains favourable taking into account the product information amendments and subject to the risk minimisation measures and additional pharmacovigilance activities agreed.
Slovenian: odbor PRAC zato meni, da razmerje med tveganji in koristmi ivabradina ostaja pozitivno, če se upoštevajo spremembe informacij o zdravilu in ukrepi za zmanjševanje tveganja ter izvajajo dodatne dogovorjene farmakovigilančne dejavnosti.
English: This indication concerns use in chronic heart failure New York Heart Association (NYHA) class II to IV with systolic dysfunction, in patients in sinus rhythm with heart rate ≥75 bpm, in combination with standard therapy including beta-blocker therapy or when beta-blocker therapy is contraindicated or not tolerated.
Slovenian: Ta indikacija je povezana z uporabo pri kroničnem srčnem popuščanju razreda II do IV po razvrstitvi Newyorškega kardiološkega združenja (NYHA) s sistolično disfunkcijo pri bolnikih s sinusnim ritmom in srčnim utripom ≥ 75 udarcev/min v kombinaciji s standardnim zdravljenjem, ki vključuje betaadrenergične antagoniste, ali kadar je zdravljenje z betaadrenergičnimi antagonisti kontraindicirano ali ga bolnik ne prenaša.
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.
Slovenian: Na podlagi rezultatov študije SHIFT2 so februarja 2012 ivabradin v Evropski uniji odobrili za zdravljenje srčnega popuščanja.
English: These findings appear contradictory with findings from previous ivabradine studies in patients with CAD.
Slovenian: Te ugotovitve nasprotujejo ugotovitvam iz prejšnjih študij ivabradina pri bolnikih s koronarno arterijsko boleznijo.
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.
Slovenian: Po preučitvi priporočila odbora PRAC se je odbor CHMP strinjal z njegovimi splošnimi znanstvenimi zaključki in menil, da je treba dovoljenji za promet z zdraviloma Procoralan in Corlentor spremeniti.
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.
Slovenian: Poleg KAD je ivabradin na podlagi rezultatov iz predhodne študije SHIFT trenutno indiciran tudi za zdravljenje kroničnega srčnega popuščanja.
English: • The PRAC concluded that there are clinically relevant benefits to the symptomatic treatment of angina pectoris with ivabradine.
Slovenian: • odbor PRAC je sklenil, da so koristi simptomatskega zdravljenja angine pektoris z ivabradinom klinično pomembne;
English: The MAH will conduct a drug utilisation study to describe the characteristics of users of ivabradine, as well as describing the patterns of use of ivabradine and adherence to the risk minimisation measures.
Slovenian: Imetnik dovoljenja za promet z zdravilom bo izvedel študijo o uporabi zdravila, s katero bo opisal značilnosti uporabnikov ivabradina in vzorce uporabe ivabradina ter upoštevanja ukrepov za zmanjševanje tveganja.
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.
Slovenian: Na podlagi ocene časovnega modela je videti, da so imeli bolniki, izpostavljeni odmerku 10 mg, povečano tveganje za kardiovaskularni opazovani dogodek v primerjavi z bolniki, ki niso bili izpostavljeni odmerku 10 mg.
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).
Slovenian: Prav tako ni bilo pomembnih razlik v incidenci komponent primarnega sestavljenega opazovanega dogodka med obema skupinama (smrt zaradi kardiovaskularnih vzrokov in nesmrtni miokardni infarkt).
English: Although it does not fully explain the findings, a contributor to the increased risk of CV events appears to be the high starting dose and maximum dose used in the SIGNIFY study, exceeding the currently approved maximum dose.
Slovenian: Videti je, da je bil dejavnik, ki je prispeval k povečanemu tveganju za kardiovaskularne dogodke, velik začetni odmerek in največji odmerek v študiji SIGNIFY, ki je presegel trenutno odobreni največji odmerek, vendar s tem ni mogoče popolnoma razložiti ugotovitev.
English: Concomitant use of diltiazem/verapamil (which also have an additional heart rate lowering effect) and strong CYP3A4 inhibitors have also shown to increase the incidence of bradycardia events and the risk of MI. Concomitant treatment is currently not recommended but this should be strengthened to a contraindication to minimize the risk of clinically relevant interactions.
Slovenian: Pokazali so tudi, da sočasna uporaba diltiazema/verapamila (ki ima prav tako dodaten učinek na upočasnitev srčnega utripa) in močnih zaviralcev CYP3A4 poveča incidenco dogodkov bradikardije in tveganje miokardnega infarkta.
English: MorBidity-mortality EvAlUaTion of the If inhibitor ivabradine in patients with coronary disease and left ventricULar dysfunction.
Slovenian: 1 Ocena obolevnosti in umrljivosti za zaviralec If, ivabradin, pri bolnikih s koronarno boleznijo in disfunkcijo levega prekata.
English: Additional clarifications were also introduced in the DHPC.
Slovenian: Dodatna pojasnila so vključena tudi v dopis za neposredno komunikacijo z zdravstvenimi delavci.
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).
Slovenian: SIGNIFY je multicentrična, randomizirana, dvojno slepa, s placebom nadzorovana študija z vzporednimi skupinami, ki je temeljila na neželenih dogodkih.
English: Although not reaching statistical significance, similar trends were observed for the individual components of CV death and non-fatal myocardial infarction (MI).
Slovenian: Podobno gibanje so opazili pri posameznih komponentah kardiovaskularne smrti in nesmrtnega miokardnega infarkta (MI), vendar niso dosegli statistične pomembnosti.
English: Study assessInG the morbi-mortality beNefits of the If inhibitor ivabradine in patients with coronary arterY disease.
Slovenian: 3 Študija za ocenjevanje koristi zaviralca If, ivabradina, za obolevnost in umrljivost pri bolnikih s koronarno arterijsko boleznijo.
English: Scientific conclusions 1 - PRAC recommendation
Slovenian: - Priporočilo odbora PRAC
English: Systolic Heart failure treatment with the If inhibitor ivabradine Trial.
Slovenian: 2 Preskušanje zdravljenja sistoličnega srčnega popuščanja z zaviralcem If, invabradinom.
English: Ivabradine, a specific heart rate lowering agent, has demonstrated symptomatic improvement of angina symptoms in patients with stable CAD. A large study in patients with CAD and left ventricular dysfunction (BEAUTIFUL study) could not demonstrate a benefit in terms of CV outcome.
Slovenian: Pri ivabradinu, posebni učinkovini za upočasnitev srčnega utripa, so dokazali simptomatsko izboljšanje simptomov angine pektoris pri bolnikih s stabilno koronarno arterijsko boleznijo.
English: dose in the SIGNIFY study (higher than the current approved 7.5 mg b.i.d.
Slovenian: Pri bolnikih v študiji SIGNIFY, pri katerih so odmerek povečali na največ 10 mg dvakrat na dan (več kot trenutno odobreni odmerek 7,5 mg dvakrat na dan), se je večina opazovanih dogodkov pojavila, ko so bolniki jemali največji odmerek.
English: BACKGROUND INFORMATION
Slovenian: OSNOVNE INFORMACIJE
English: A Decision was issued by the European Commission on 4 July 2006.
Slovenian: Odločbo je Evropska Komisija izdala dne 4. julija 2006.
English: The referral procedure started on 19 September 2005.
Slovenian: Postopek se je začel dne 19. septembra 2005.
English: The divergences identified at the start of the referral were resolved.
Slovenian: Razlike, ugotovljene na začetku napotitvenega postopka, so bile odpravljene.
English: • Travelling to any country that requires an International Certificate of Vaccination for entry (which may or may not depend on the previous itinerary).
Slovenian: • ki potujejo v katerokoli državo, ki za vstop zahteva Mednarodno potrdilo o cepljenju (kar je lahko odvisno ali neodvisno od predhodnega potovalnega načrta)
English: • Travelling to, passing through or living in an endemic area.
Slovenian: • ki potujejo, se prehodno zadržujejo ali živijo na endemičnem področju,
English: Active immunisation against yellow fever in persons from 9 months of age:
Slovenian: aktivna imunizacija proti rumeni mrzlici pri osebah, starih več kot 9 mesecev:
English: • Handling potentially infectious materials (e.g. laboratory personnel).
Slovenian: • ki rokujejo s potencialno kužnimi snovmi (npr. laboratorijsko osebje).
English: The CHMP gave a positive opinion on 27 April 2006 recommending the harmonisation of the SPC for STAMARIL and associated names.
Slovenian: CHMP je 27. aprila 2004 izdal pozitivno mnenje, s katerim priporoča uskladitev SPC za STAMARIL in z njim povezana imena.
English: STAMARIL is a viral vaccine and the antigen of the vaccine act prophylactic by stimulating an immune response against the above-yellow fever.
Slovenian: STAMARIL je virusno cepivo in antigen cepiva deluje profilaktično tako, da stimulira imunski odgovor proti zgoraj omenjeni rumeni mrzlici.
English: The CHMP having considered the Rapporteur and the Co-Rapporteur assessment reports, the scientific discussion within the Committee and the comments from the Marketing Authorisation Holders (MAH), was of the opinion that the benefit/risk ratio of STAMARIL and associated names is considered to be positive in the following indications:
Slovenian: Ob upoštevanju poročil o oceni zdravila poročevalca in so-poročevalca, znanstvenih razprav znotraj odbora in pripomb imetnikov dovoljenj za promet z zdravilom (MAH) je CHMP menil, da je razmerje med koristmi in tveganji zdravila STAMARIL in z njim povezanih imen pozitivno v naslednjih indikacijah:
English: The list of product names concerned is given in Annex I. The scientific conclusions are provided in Annex II together with the amended SPC in Annex III.
Slovenian: Seznam zadevnih imen proizvodov je naveden v Dodatku I. Znanstveni zaključki so podani v Dodatku II skupaj z dopolnjenim Povzetkom glavnih značilnosti zdravila (SPC) v Dodatku III.