FrancophonIA/ELRC3.0 huggingface dataset:
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.
Slovenian: Zato je menil, da omejitev uporabe linearnih sredstev GdCA za nekatere indikacije ali nekatere skupine bolnikov ne bi bila utemeljena in bi bili bolniki še naprej izpostavljeni tveganju kopičenja gadolinija v možganih ter da ukrepi za zmanjšanje tveganja, kot so opozorila v povzetku glavnih značilnosti zdravila ali druge kontraindikacije, ne bi omejile izpostavljenosti sredstvom GdCA, saj varna raven kopičenja gadolinija v možganih ni bila ugotovljena.
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.
Slovenian: Podatki iz nekliničnih študij možganskega tkiva, pridobljeni z elektronsko mikroskopijo, so zagotovili tudi dokaze o filamentoznih depozitih gadolinija s povečano gostoto elektronov v predelih, kjer je bila po uporabi odmerkov gadodiamida ugotovljena hiperintenzivnost T1.
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.
Slovenian: Zato se meni, da gadoksetna kislina zagotavlja dodatno korist pri obravnavanju bolnika, pri čemer je izpostavljenost gadoliniju zaradi uporabljenega majhnega odmerka zmanjšana, prehod v hepatocite zelo velik in čas do zapoznele faze slikanja kratek.
English: Gadobenic acid also has shown to have clinical utility in the liver and undergoes hepatic uptake but to a lesser extent, requires a high dose (0.05 mmol/kg body weight), and a long time to the onset of delayed phase imaging (40 mins).
Slovenian: Tudi za gadobensko kislino se je izkazalo, da je klinično koristna v jetrih in prav tako prehaja v hepatocite, vendar v manjši meri, pri njej se zahteva večji odmerek (0,05 mmol/kg telesne mase), čas do začetka zapoznele faze slikanja pa je dolg (40 minut).
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.
Slovenian: Priporočil je omejitev uporabe na najmanjši odmerek, ki zagotavlja zadostno izboljšanje kontrasta za diagnostične namene, in z ustreznim opozorilom v informacijah o izdelku za zmanjšanje možnosti kopičenja gadolinija v možganih ter drugih organih in tkivih.
English: The macrocyclic agent gadobutrol did not show hyperintensity after this time period.
Slovenian: Pri gadobutrolu, ki je makrociklično sredstvo, se po enakem času hiperintezivnost ni pokazala.
English: The PRAC confirmed it had considered the totality of the data submitted by the MAHs in the context of the initial referral procedure.
Slovenian: Odbor PRAC je potrdil, da je v okviru postopka prve napotitve v celoti proučil vse podatke, ki sta jih predložila imetnika dovoljenja za promet z zdravilom.
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).
Slovenian: Neklinični dokazi tudi kažejo možnost sproščanja gadolinija iz kelatnega liganda v možganih pri linearnih sredstvih GdCA, pri makrocikličnih sredstvih GdCA pa ne (Frenzel idr., 2017).
English: • Based on non-clinical data, both linear and macrocyclic agents have the ability to distribute to the brain.
Slovenian: • na podlagi nekliničnih podatkov je bilo ugotovljeno, da imajo zmožnost razširitve v možgane linearna in makrociklična sredstva.
English: Furthermore, the standard deviation of Gd content in the brain was extraordinary high for Gadovist.
Slovenian: Poleg tega je bil pri Gadovistu odmik od običajne vsebnosti gadolinija v možganih izjemno velik.
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.
Slovenian: Odbor PRAC je v zvezi s trditvijo, da obstajajo razlike med preobčutljivostnimi reakcijami pri sredstvu Omniscan in drugih sredstvih Gdca, ki temelji na metaanalizah razpoložljivih epidemioloških podatkov, menil, da so te razlike premalo zaznavne, da bi vplivale na razmerje med koristmi in tveganji, ter da bi bilo treba za potrditev statistične razlike v pogostnosti preobčutljivostnih reakcij izvesti izjemno obsežno klinično preskušanje.
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.
Slovenian: Odbor PRAC je glede na (a) dokaze, ki nakazujejo, da linearna sredstva GdCA zaradi nizke kinetične in termodinamične stabilnosti sproščajo gadolinij iz svojih molekul kelatnega liganda; (b) znano toksičnost nekelatiranega gadolinija; (c) podatke, ki dokazujejo zmožnost linearnih sredstev GdCA za razširjanje in kopičenje v možganih; (d) dejstvo, da se linearna sredstva zadržijo v možganih do enega leta ali dlje; ter (e) odlaganje v drugih tkivih s povezanimi škodljivimi učinki, menil, da obstajajo upravičeni in resni pomisleki zaradi morebitnih škodljivih nevroloških učinkov, povezanih s kopičenja gadolinija v možganih.
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.
Slovenian: Izkazalo se je, da je to izboljšanje kontrasta pomembno za vizualizacijo anatomije, fiziologije in funkcionalnosti številnih različnih predelov telesa in notranjih organov v okviru diagnostičnih preiskav pri ugotavljanju najrazličnejših bolezni, vključno z rakom ter vnetnimi in degenerativnimi boleznimi.
English: Intravenous linear Gadolinium-containing contrast agents (GdCAs)
Slovenian: Linearna kontrastna sredstva, ki vsebujejo gadolinij (GdCA) za intravensko uporabo
English: For the suspension of intravenous medicinal products containing gadodiamide, gadopentetic acid, and gadoversetamide to be lifted, the marketing authorisation holder(s) shall submit evidence:
Slovenian: Za preklic začasnega umika dovoljenja za promet z zdravili za intravensko uporabo, ki vsebujejo gadodiamid, gadopentetsko kislino in gadoversetamid, imetnik(i) dovoljenja za promet z zdravilom predloži(jo) dokaze:
English: Skin prick testing could facilitate the identification of an alternative GdCA.
Slovenian: Določitev nadomestnega sredstva GdCA lahko olajša preskus z vbodom v kožo.
English: For these products, the PRAC considered that the risk can be managed though 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.
Slovenian: Odbor PRAC je za ta sredstva menil, da je tveganje mogoče obvladovati z omejitvijo uporabe na najmanjši odmerek, ki zagotavlja zadostno izboljšanje kontrasta za diagnostične namene, ter z ustreznim opozorilom v informacijah o izdelku za zmanjšanje možnosti kopičenja gadolinija v možganih ter drugih organih in tkivih.
English: In view of the claim regarding the cardiac indication of Omniscan, the PRAC highlighted that the primary goal of cardiac perfusion imaging is the detection of myocardial ischemia in patients with suspected coronary artery disease or cardiomyopathy.
Slovenian: Odbor PRAC je v zvezi z navedbo, da se Omniscan uporablja pri boleznih srca, poudaril, da je glavni cilj perfuzijskega slikanja srca ugotoviti miokardne ishemije pri bolnikih s sumom na koronarno srčno bolezen ali kardiomiopatijo.
English: • variation to the terms of the marketing authorisation for the macrocyclic agents (gadoteridol (Prohance), gadobutrol (Gadovist), gadoteric acid (Dotarem and Artirem)) with changes to SmPC sections 4.1 and 4.2.
Slovenian: • spremembo pogojev dovoljenja za promet z makrocikličnimi sredstvi gadoteridol (Prohance), gadobutrol (Gadovist), gadotersko kislino (Dotarem in Artirem)) s spremembami oddelkov 4.1 in 4.2 v povzetkih glavnih značilnosti zdravila.
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.
Slovenian: V zvezi s trditvijo, da ima sredstvo Multihance večjo relaksivnost in je zato kontrast slike boljši, diagnostična zmogljivost pa večja kot pri drugih sredstvih GdCA, je bilo opozorjeno, da večja relaksivnost, zaradi katere je signal močnejši, slika pa svetlejša, samodejno ne pomeni drugačne diagnostične zmogljivosti.
English: The absolute rate of hypersensitivity reactions with GdCAs is low and reported as approximately 0.01% to 0.001% across the studies investigating rates of hypersensitivity reactions.
Slovenian: V študijah, ki proučujejo stopnje preobčutljivostnih reakcij, je navedeno, da znaša približno 0,01 % do 0,001 %.
English: The highest amount of gadolinium recovered from the rat brain tissue was found to be with gadodiamide, followed by gadobenate and gadopentetate.
Slovenian: Ugotovljeno je bilo, da je bilo največ gadolinija pridobljenega iz možganskega tkiva podgan, ki so prejele gadodiamid, sledita mu gadobenat in gadopentetat.
English: Furthermore the CHMP took the opportunity to clarify that toxicities of non-chelated gadolinium discussed in the non-clinical section of the scientific grounds above have been observed with GdCAs in skin and other tissues (leading to NSF and skin plaques), which are considered to be related to Gadolinium released from the chelate.
Slovenian: odbor CHMP je to priložnost izkoristil tudi za pojasnilo, da so bili pri sredstvih GdCA ugotovljeni toksični učinki nekelatiranega gadolinija, obravnavani zgoraj v nekliničnem razdelku znanstvenih razlogov, na koži in v drugih tkivih (kjer povzročijo NSF in kožne plake); zanje se domneva, da so povezani z gadolinijem, ki se sprosti iz kelata.
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.
Slovenian: Odbor PRAC je glede na obseg prehajanja v hepatocite in potrebni velik odmerek (0,05 mmol/kg telesne mase) ter glede na dejstvo, da do začetka zapoznele faze slikanja poteče veliko časa (40 minut), menil, da korist izdelkov, ki vsebujejo gadobensko kislino, pri vseh odobrenih indikacijah, vključno s slikanjem jeter, ne prevlada nad morebitnimi in opredeljenimi tveganji, povezanimi z uporabo tega izdelka.
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.
Slovenian: Za gadoksetno kislino (linearno sredstvo), ki se je izkazala za klinično koristno pri slikanju jeter, je odbor PRAC glede na to, da se v znatni meri absorbira v jetra, da se uporablja v majhnem odmerku (0,025 mmol/kg telesne mase) in da do zapoznele faze slikanja poteče malo časa (20 minut), menil, da zagotavlja dodatno korist pri obravnavanju bolnikov, pri čemer se izpostavljenost gadoliniju zaradi uporabljenega majhnega odmerka in kratkega časa do zapoznele faze zmanjša.
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.
Slovenian: Višja stabilnost in vivo kot in vitro bi zahtevala pojav stabilizatorjev in vivo, imetnik dovoljenja za promet z zdravilom pa ni predložil trdnega dokaza za povečanje stabilnosti gadolinijevega kompleksa.
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.
Slovenian: Kot konkurenčne kovine, ki lahko povzročijo sproščanje gadolinija, so opisani zlasti cink, baker in železo (Frenzel idr., 2008); glikozaminoglikani, kot je heparin, lahko vežejo gadolinij in ga tako odstranijo iz njegovega farmakološkega kelatorja.
English: Based on the knowledge of the function of the affected brain areas (including DN and GP), these effects would include effects on fine motor skills or cognitive impairment, particularly in those with ongoing neurological disease which may mask these events.
Slovenian: Na podlagi poznavanja delovanja poškodovanih predelov možganov (vključno z DN in GP) bi ti učinki vključevali učinke na finomotorične sposobnosti ali kognitivno poslabšanje, zlasti pri bolnikih z nevrološko boleznijo, ki lahko te dogodke prikrije.
English: An in vitro study in rat neurons reported gadolinium-induced cytotoxicity via oxidative injury.
Slovenian: Študija in vitro na nevronih podgane je pokazala citotoksičnost, ki jo je povzročil gadolinij prek oksidativne poškodbe.
English: Only a transient increase in T1signal intensity and gadolinium concentration (measured by ICP-MS1, thus not distinguishing the molecular form of Gd) was observed with macrocyclic agents.
Slovenian: Pri makrocikličnih sredstvih je bilo ugotovljeno samo začasno povečanje intenzivnosti signala T1 in koncentracije gadolinija (merjeno z ICP-MS1, zato se molekularna oblika gadolinija ni zaznala).
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.
Slovenian: V nekliničnih študijah se je dokazalo, da je nekelatiran gadolinij toksičen ter med drugim povzroča celično nekrozo, fibrozo in lezije, povezane z odlaganjem mineralov.
English: In addition, toxicities have been observed with GdCAs in other organs, such as kidney (leading to NSF) and skin (leading to skin plaques), which are considered to be related to Gadolinium released from the chelate.
Slovenian: Poleg tega so bili pri sredstvih GdCA ugotovljeni toksični učinki tudi v drugih organih, npr. v ledvicah (kjer povzročijo NSF) in na koži (kjer povzročijo kožni plak), za katere se domneva, da so povezani z gadolinijem, ki se sprošča iz kelata.
English: Therefore, taking into account the serious concerns about the potential neurological harm, deposition in other tissues and its potential risks, and the already identified risks associated with the use of linear GdCAs (including the significant risk of NSF and the gadolinium-associated plaques), the PRAC considered that the benefit in enhancement of MR images does not outweigh the known and potential risks of these products.
Slovenian: Odbor PRAC je ob upoštevanju resnih pomislekov glede morebitnih škodljivih nevroloških učinkov, odlaganja v drugih tkivih in njegovih morebitnih tveganj ter že opredeljenih tveganj, povezanih z uporabo linearnih sredstev GdCA (vključno z znatnim tveganjem NSF in z gadolinijem povezanih plakov) menil, da korist pri izboljšanju kontrasta na magnetnoresonančnih slikah ne prevlada nad znanimi in morebitnimi tveganji teh izdelkov.
English: Accumulation in the brain
Slovenian: Kopičenje v možganih
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.
Slovenian: Čeprav je bilo pri teh sredstvih ugotovljeno kratkotrajno kopičenje glede na povečanje intenzivnosti signala T1w in gadolinija, merjenega v možganih (verjetno v obliki nespremenjene molekule sredstva GdCA), pa dolgotrajno zadrževanje v možganih ni bilo ugotovljeno.
English: Data appears to suggest that macrocyclic agents are also deposited in the brain but show only a transient increase in Gd and undergo early washout.
Slovenian: Podatki kažejo, da naj bi se tudi makrociklična sredstva odlagala v možganih, vendar pa se gadolinij poveča samo začasno in se kmalu izperejo.
English: There are several publications in rat models that have demonstrated a T1-weighted signal enhancement in the deep cerebellar nuclei (DCN) - the equivalent to the dentate nucleus (DN) in humans- after administration of the linear agents.
Slovenian: Na podlagi modelov s podgano je bilo objavljenih več primerov, ki so dokazali, da se po uporabi linearnih sredstev poveča T1-obtežen signal v globokih možganskih jedrih (DCN) - ki ustrezajo dentatnemu jedru (Nucleus dentatus - DN) pri ljudeh.
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.
Slovenian: Odbor PRAC je v zvezi s povzetki glavnih značilnosti zdravila za makrociklična sredstva GdCa (Dotarem, Prohance in Gadovist), v katerih se za boljšo vizualizacijo priporoča višji odmerek pri slikanju centralnega živčnega sistema in angiografiji, ne pa tudi pri slikanju celega telesa, menil, da bi bilo treba klinično pomembne razlike glede diagnostične zmogljivosti sredstva Multihance in makrocikličnih sredstev podpreti s trdnimi dokazi iz primerjalnih kliničnih študij in ne s primerjavo odobrenih povzetkov glavnih značilnosti zdravila, ki imajo lahko omejitve.
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.
Slovenian: Neklinični dokazi tudi kažejo možnost sproščanja gadolinija iz kelatnega liganda v možganih pri linearnih sredstvih GdCA; pri makrocikličnih sredstvih GdCA možnost sproščanja iz kelatnega liganda ni bila ugotovljena.
English: There is currently a cumulative amount of evidence in the literature that gadolinium is deposited in the brain.
Slovenian: V literaturi se je do zdaj nabralo kar nekaj dokazov o odlaganju gadolinija v možganih.
English: Adverse effects might be delayed and might be subtle, including effect on fine motor skills or cognitive impairment, particularly in those with ongoing neurological disease.
Slovenian: Neželeni učinki so lahko zapozneli in komaj zaznavni, vključno z učinkom na finomotorične sposobnosti ali kognitivno poslabšanje, zlasti pri bolnikih z nevrološko boleznijo.
English: Another study showed that administration of the linear GdCAs gadodiamide and gadobenic acid directly into the cerebrospinal fluid (CSF) resulted in increased signal intensity in the DCN in rats up to 5 weeks after administration.
Slovenian: Druga študija je dokazala, da so imele podgane, ki so prejele linearni sredstvi GdCA, in sicer gadodiamid in gadobensko kislino neposredno v cerebrospinalno tekočino, do pet tednov po uporabi povečano intenzivnost signala v globokih možganskih jedrih.
English: Spontaneous release of Gd from its chelator, competition of Gd with other metals (e.g. in metal rich areas of the brain), and competition of the chelator with other chelators (e.g. macromolecules) can occur in the body.
Slovenian: V telesu se lahko pojavi spontano sproščanje gadolinija iz njegovega kelatorja, tekmovanje gadolinija z drugimi kovinami (npr. v predelih možganov, bogatih s kovinami) in tekmovanje kelatorja z drugimi kelatorji (npr. makromolekulami).
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.
Slovenian: Odbor PRAC je za zmanjšanje tveganja kopičenja gadolinija v možganih in morebitno povezanih škodljivih učinkov v zvezi z linearnimi sredstvi GdCA proučil mogoče ukrepe za zmanjšanje tveganja, kot so opozorila v povzetku glavnih značilnosti zdravila, kontraindikacije in drugi dodatni ukrepi za zmanjšanje tveganja.
English: Therefore, in view of the evidence regarding accumulation of Gd in brain and the plausible harmful effects, and accumulation of Gd in other tissues and the identified related risk, and considering that less restrictive risk minimisation measures are not feasible or not sufficient to bring the risk of accumulation of gadolinium in the brain and other tissues to an acceptable level, PRAC considered the suspension of the marketing authorisation of intravenous linear GdCAs is the most appropriate measure to mitigate the risks related to these products.
Slovenian: Odbor PRAC je glede na dokaze o kopičenju gadolinija v možganih in verjetne škodljive učinke ter kopičenje gadolinija v drugih tkivih in opredeljena povezana tveganja ter ob upoštevanju dejstva, da manj omejevalni ukrepi za zmanjšanje tveganja niso izvedljivi ali ne zadostujejo za zagotovitev sprejemljive ravni tveganja kopičenja gadolinija v možganih in drugih tkivih, menil, da je začasni umik dovoljenja za promet z linearnimi sredstvi GdCA za intravensko uporabo najprimernejši ukrep za zmanjšanje tveganj, povezanih s temi izdelki.
English: Although no adverse neurological effects have yet been demonstrated to be caused by gadolinium accumulation in the brain, long-term safety data are limited.
Slovenian: Čeprav še niso bili dokazani neželeni nevrološki učinki, ki naj bi jih povzročilo kopičenje gadolinija v možganih, so podatki o dolgoročni varnosti omejeni.
English: Gadolinium-associated plaques
Slovenian: Plaki, povezani z gadolinijem
English: • In relation to the Magnevist (gadopentetic acid) for intra-articular injection, in view of the low dose, the limited potential for repeated exposure for patients and the absence of evidence of brain accumulation, CHMP considered that the benefits of this product outweigh its risks.
Slovenian: • odbor CHMP je v zvezi s sredstvom Magnevist (gadopentetska kislina) za intraartikularno injiciranje glede na majhen odmerek, omejeno možnost večkratne izpostavljenosti bolnikov in neobstoj dokazov o kopičenju v možganih, menil, da koristi tega izdelka prevladajo nad njegovimi tveganji.