FrancophonIA/ELRC3.0 huggingface dataset:
English: The consistency of the results in the oral and intranasal trials suggests that the reported events are causally associated with calcitonin.
Danish: Resultaternes konsistens i de orale og intranasale undersøgelser antyder, at de rapporterede hændelser er kausalt relateret til calcitonin.
English: Paget's disease hypercalcaemia of malignancy
Danish: Pagets sygdom hypercalcæmi ved malignitet.
English: The CHMP reviewed the currently available short and long-term evidence of efficacy of calcitonin in the authorised indications (as per Commission Decision of 12 June 2003), and the information about the risk of cancer with calcitonin from pre-clinical studies, clinical trials, post-marketing spontaneous reports, pharmacoepidemiological studies and published literature.
Danish: CHMP gennemgik den aktuelt tilgængelige evidens for calcitonins kort- og langtidsvirkning i de godkendte indikationer (som de forelå ved Kommissionens afgørelse af 12. juni 2003) og oplysningerne om risikoen for cancer fra calcitonin ud fra prækliniske undersøgelser, kliniske undersøgelser, spontane indberetninger efter markedsføring, farmakoepidemiologiske undersøgelser og offentliggjort litteratur.
English: in patients with impending pathologic fracture, the CHMP agreed that the treatment duration may be extended up to a recommended maximum of 6 months.
Danish: Under helt ekstraordinære omstændigheder, f.eks. hos patienter med truende patologisk fraktur, vedtog CHMP, at behandlingsperioden kan forlænges op til et anbefalet maksimum på 6 måneder.
English: The Odds Ratio (OR) for the incidence of cancer in these trials in patients treated with calcitonin was 1.61 (1.11-2.34).
Danish: Odds ratio (OR) for forekomsten af cancer i disse undersøgelser hos patienter, der blev behandlet med calcitonin, var 1,61 (1,11-2,34).
English: Therefore, the Committee recommended the variation of the marketing authorisations for calcitonin containing medicinal products (injectable formulations) in accordance with changes to the product information as set out in Annex III of the CHMP Opinion.
Danish: Udvalget anbefalede derfor ændringen af markedsføringstilladelserne for lægemidler, der indeholder calcitonin (injektionsformuleringer), i overensstemmelse med ændringerne til produktoplysningerne som er anført i bilag III til CHMP's udtalelse.
English: Although these studies in isolation were considered so far insufficient to establish a causal association due to some important limitations and the lack of any robust evidence of risk in humans, they assume a new significance in light of the more recent data from the calcitonin clinical trials.
Danish: Selvom disse undersøgelser alene blev betragtet som utilstrækkelige til at etablere en årsagsforbindelse på grund af nogle vigtige begrænsninger og manglen på en solid evidens for risiko hos mennesker, får de en ny betydning i lyset af de nyere data fra de kliniske undersøgelser med calcitonin.
English: However, the short-term nature of the intended use of calcitonin in these patients is expected to minimise the potential risk of cancer, and therefore the benefit/risk balance is considered to be positive, but the treatment duration should be limited.
Danish: Korttidsnaturen for den tilsigtede anvendelse af calcitonin hos disse patienter forventes imidlertid at minimere den potentielle cancerrisiko, og derfor vurderes benefit/risk-forholdet at være positivt, men behandlingsperioden bør være begrænset.
English: Further evidence of a positive association between calcitonin and cancer was provided from the analysis of recently conducted trials with the new oral calcitonin formulation.
Danish: Yderligere evidens for en positiv forbindelse mellem calcitonin og cancer blev tilvejebragt fra analysen af nyligt gennemførte undersøgelser med den nye orale calcitonin-formulering.
English: The CHMP noted that any meta-analysis driven by a safety signal will always be, per definition, conducted post-hoc, the objective of such an analysis being to quantitatively rule out a potential harm to patients.
Danish: CHMP bemærkede, at enhver metaanalyse, som drives af et sikkerhedssignal, pr. definition er post-hoc, da dens formål er kvantitativ udelukkelse af potentiel skade på patienterne.
English: The CHMP is of the view that it is not possible to reach a conclusion about the association between calcitonin and cancer progression from the results of the published non-clinical in vitro studies.
Danish: CHMP finder, at der ikke kan drages nogen konklusion om sammenhængen mellem calcitonin og progression af cancer ud fra resultaterne af de ikke-kliniske publicerede in vitro-undersøgelser.
English: A possible explanation, for the relatively short time of onset is that calcitonin promotes tumour progression rather than oncogenesis, as has also been suggested in the published literature addressing the role of calcitonin in prostate cancer.
Danish: En mulig forklaring på den relativt korte tid for angrebet er, at calcitonin fremmer tumorprogression snarere end onkogenese, som det også er foreslået i den offentliggjorte litteratur, der omhandler calcitonins rolle ved prostatacancer.
English: The CHMP considers that while this argument might be valid for the metaanalysis conducted on the studies with the oral formulations, it cannot be supported in the analysis with all intranasal trials where no clear heterogeneity is observed.
Danish: CHMP finder, at dette argument nok kan være gyldigt for metaanalysen af undersøgelserne med de orale formuleringer, men ikke er holdbart ved analysen med alle intranasale undersøgelser, hvor der ikke iagttages klar heterogenicitet.
English: Possible explanations for these discrepant results include the lower dose in the osteoporosis trial, and the premature discontinuation of male patients and an intensive prostate cancer screening programme in the second osteoarthritis trial, which identified additional cases and may have masked possible imbalances of cancer cases across the different treatment arms in these trials.
Danish: Mulige forklaringer på disse diskrepante resultater omfatter den lavere dosis i osteoporose-undersøgelsen, den præmature afbrydelse af mandlige patienter og et intensivt screeningsprogram for prostatacancer i den anden osteoarthritis-undersøgelse, som identificerede yderligere tilfælde og kan have maskeret mulig ubalance i cancertilfælde over de forskellige behandlingsarme i disse undersøgelser.
English: Its hypocalcaemic properties are mediated primarily through the inhibition of osteoclast-mediated bone resorption.
Danish: Dens hypocalcæmiske egenskaber fremmes primært ved hjælp af inhibering af osteoklast-fremmet knogleresorption.
English: However despite the likelihood that calcitonin is involved in cancer promotion the exact mechanism that could explain the increased occurrence of malignancies in calcitonin treated patients has not been fully elucidated.
Danish: Trods sandsynligheden for, at calcitonin er involveret i cancerfremme, er den nøjagtige mekanisme, der kan forklare den forøgede forekomst af malignitet hos calcitonin-behandlede patienter, imidlertid ikke fuldt ud belyst.
English: The increased risk of cancer with calcitonin in the other two trials with the new oral formulation, was not statistically significant incidence rate ratio of 1.61 (0.81-3.16) and 1.10 (0.821.48) for studies C2302 and A2303 respectively.
Danish: Den forøgede cancerrisiko med calcitonin i de to andre undersøgelser med den nye orale formulering var ikke statistisk signifikant med et forekomstrate-forhold på 1,61 (0,81-3,16) og 1,10 (0,82-1,48) hhv. for C2302- og A2303-undersøgelserne.
English: the prevention of acute bone loss due to sudden immobilisation such as in patients with recent osteoporotic fractures
Danish: forebyggelse af akut knogletab på grund af pludselig immobilisering, såsom hos patienter med nylige osteoporotiske frakturer
English: However, the new evidence related to the risk of cancer impacts the safety profile of calcitonin-containing medicines.
Danish: Den nye evidens vedrørende cancerrisikoen påvirker imidlertid sikkerhedsprofilen af lægemidler indeholdende calcitonin.
English: Considering the nature of the indication in the setting of advanced cancer, the benefit/risk balance in this indication is considered still to be positive.
Danish: I betragtning af indikationens natur ved konstatering af avanceret cancer vurderes benefit/risk-forholdet i denne indikation stadig at være positivt.
English: The CHMP noted that the low reporting is not unexpected in this particular situation where the event under scrutiny (i.e malignancies), is not uncommon in the target population that otherwise receive a number of concomitant medications, where the risk increases with time making it very unlikely for physicians to establish a possible relation.
Danish: CHMP bemærkede at den lave indberetningsfrekvens ikke er uventet i denne særlige situation, hvor den betragtede hændelse (ondartede lidelser) ikke er ualmindelig i målpopulationen, som i øvrigt sideløbende får en række andre lægemidler, hvor risikoen stiger med tiden, hvilket gør det meget usandsynligt, at læger fastslår en eventuel sammenhæng.
English: In order to maintain a positive benefit/risk balance for the indications of injectable formulation of calcitonin-containing products, the CHMP recommended changes to the Product Information, mainly in relation to the risk of cancer.
Danish: For at opretholde et positivt benefit/risk-forhold for indikationerne for injektionsformulering af lægemidler, der indeholder calcitonin, anbefalede CHMP ændringer til produktoplysningerne, først og fremmest i forbindelse med cancerrisikoen.
English: A number of published studies using prostate cancer cell lines and animal models have also suggested a role for calcitonin in prostate cancer progression.
Danish: En række offentliggjorte undersøgelser, hvori der anvendtes prostatacancercellelinjer og dyremodeller, har også antydet, at calcitonin spiller en rolle i progressionen af prostatacancer.
English: • The Committee considered that in order to maintain a positive benefit-risk for the above indications additional changes to the product information (section 4.2 Posology and method of administration, section 4.4 Special warnings and precautions for use and section 4.8 Undesirable effects) in relation to the risk of cancer should be included.
Danish: • Udvalget fandt, at for at opretholde et positivt benefit/risk-forhold for ovennævnte indikationer skal supplerende ændringer til produktoplysningerne i forbindelse med cancerrisikoen omfattes (afsnit 4.2 Dosering og administration, afsnit 4.4 Særlige advarsler og forsigtighedsregler vedrørende brugen og afsnit 4.8 Bivirkninger).
English: The most commonly reported malignancy in this study was prostate cancer.
Danish: Den mest almindelige rapporterede malignitet i denne undersøgelse var prostatacancer.
English: As mentioned before, it is agreed that the PROOF study shows a modest efficacy of calcitonin in the reduction of the risk of vertebral fractures.
Danish: Som nævnt anerkendes det, at PROOF-undersøgelsen viser en beskeden virkning af calcitonin til reduktion af risikoen for vertebralfrakturer.
English: Based on these data, the CHMP confirmed the benefits of injectable calcitonin in the short term treatment of the Paget's disease.
Danish: På baggrund af disse data fastslog CHMP injektions-calcitonins fordele i behandlingen af Pagets sygdom på kort sigt.
English: The indication of fracture prevention in osteoporosis, is supported by results from a reasonably sized, placebo controlled double blind study known as the PROOF (Prevent Recurrence of Osteoporotic Fractures) study.
Danish: Indikationen for forebyggelse af fraktur ved osteoporose understøttes af resultater fra en placebokontrolleret, dobbeltblind undersøgelse af rimelig størrelse, kendt som PROOF-undersøgelsen (“Prevent Recurrence Of Osteoporosis Fractures”).
English: Data suggest that there is some relation for prostate cancer but it is not possible to generalise these results.
Danish: Dataene tyder på nogen sammenhæng med prostatacancer, men resultaterne kan ikke generaliseres.
English: • Overall benefit-risk assessment
Danish: • Samlet vurdering af benefit/risk-forholdet
English: Calcitonin is a hypocalcaemic compound secreted from the thyroid.
Danish: Calcitonin er et hypocalcæmisk stof, der udskilles fra thyreoidea.
English: In addition to the published literature in relation to the use of injectable calcitonin for hypercalcaemia in malignancy, this indication is further supported by its established use in clinical practice.
Danish: Ud over den offentliggjorte litteratur i forbindelse med anvendelsen af injektions-calcitonin til hypercalcæmi ved malignitet er denne indikation yderligere understøttet af dens etablerede anvendelse i klinisk praksis.
English: The most commonly reported malignancies in these trials were basal cell carcinoma and breast cancer.
Danish: De almindeligst rapporterede maligniteter i disse undersøgelser var basalcellecarcinom og brystcancer.
English: Annex II Scientific conclusions and grounds for variation to the terms of the marketing authorisations of the injectable formulations of calcitonin and suspension of the marketing authorisations of the intranasal formulations of calcitonin
Danish: Bilag II Videnskabelige konklusioner og årsager til ændring af betingelserne i markedsføringstilladelserne for injektionsformuleringer af calcitonin og suspendering af markedsføringstilladelserne for de intranasale formuleringer af calcitonin
English: The increase in absolute risk of cancer for patients treated with calcitonin compared with placebo in the intra-nasal trials was 2.36%.
Danish: Stigningen i absolut cancerrisiko for patienter, der blev behandlet med calcitonin, sammenlignet med placebo i de intranasale undersøgelser, var 2,36 %.
English: Even though there is some uncertainty surrounding the true magnitude of this risk which appears to be different across the different trials the relative risk is consistently higher in patients treated with calcitonin compared with placebo.
Danish: Selvom der er nogen usikkerhed omkring den korrekte størrelse af denne risiko, der synes at være forskellig hen over de forskellige undersøgelser, er den relative risiko konsistent højere hos patienter, der er behandlet med calcitonin, sammenlignet med placebo.
English: • The Committee also took in to account that in patients with osteoporosis, intranasal calcitonin treatment is to be administered on a long-term basis.
Danish: • Udvalget tog endvidere i betragtning, at intranasal calcitonin-behandling hos patienter med osteoporose skal indgives gennem lang tid.
English: However none of the arguments presented refute the conclusion derived from the results of the intranasal (and oral) studies, which suggests that that there is an increased risk of cancer associated with the use of calcitonin.
Danish: Ingen af de fremførte argumenter kan imidlertid tilbagevise konklusionen af de intranasale (og orale) undersøgelser, der viser øget cancerrisiko i forbindelse med brug af calcitonin.
English: In addition, the metaanalysis of the trials with the new formulation showed a statistical significant increase in the incidence rate ratio for patients treated with calcitonin, 1.33 (1.035-1.72), similar to the increase observed during the intranasal trials.
Danish: Yderligere viste metaanalysen af undersøgelserne med den nye formulering en statistisk signifikant forøgelse i forekomstrate-forholdet for patienter, der blev behandlet med calcitonin, 1,33 (1,035-1,72), i lighed med den observerede forøgelse under de intranasale undersøgelser.
English: The results of the biggest of the trials conducted with intra-nasal calcitonin , study CT320 (also known as the PROOF study), provides some evidence of an increased risk of cancer in the calcitonin arm compared with placebo even though the reported results fail to reach statistical significance (relative risk, 95%CI: 1.47 (0.91-2.36)).
Danish: Resultaterne fra den største af undersøgelserne, der blev udført med intranasal calcitonin, CT320undersøgelsen (også kendt som PROOF-undersøgelsen), tilvejebringer nogen evidens for en forøget cancerrisiko i calcitonin-armen sammenlignet med placebo, selvom de rapporterede resultater ikke opnår statistisk signifikans (relativ risiko, 95 % CI: 1.47 (0,91-2,36)).
English: However the PSA analysis alone is of limited value as it is known that factors other than prostate cancer can influence PSA values and cannot explain the higher incidence of prostate cancer in patients treated with calcitonin.
Danish: PSA-analysen er dog af begrænset værdi, da det er kendt, at andre faktorer end prostatacancer kan påvirke PSA-niveauer og ikke kan forklare den højere forekomst af prostatacancer hos patienter, der blev behandlet med calcitonin.
English: During this procedure the CHMP reviewed the available evidence on the risk of cancer with the use of calcitonin.
Danish: Under denne procedure gennemgik CHMP den tilgængelige evidens for cancerrisikoen ved anvendelse af calcitonin.
English: With regards to the use of injectable calcitonin in acute bone loss prevention, the evidence of efficacy is based on published literature.
Danish: Med hensyn til anvendelsen af injektions-calcitonin til forebyggelse af akut knogletab er evidensen for virkning baseret på offentliggjort litteratur.
English: • The Committee considered all the available data on the efficacy and safety of calcitonin-containing medicines in particular new data in relation to the risk of cancer.
Danish: • Udvalget vurderede alle tilgængelige data om virkning og sikkerhed for lægemidler, der indeholder calcitonin, især nye data i forbindelse med cancerrisikoen.
English: The limited efficacy data in this indication need to be balanced against an increased risk of cancer as demonstrated in the analysis of calcitonin trials.
Danish: De begrænsede virkningsdata i denne indikation skal balanceres mod en forøget cancerrisiko som påvist i analysen af calcitonin-undersøgelserne.
English: While it is recognised by the CHMP that the inclusion or exclusion of single trials will adjust the overall odds ratio (OR) in different directions, it is acknowledged that it is reasonable to conduct a list of sensitivity analyses to assess the robustness of the results.
Danish: CHMP tilslutter sig, at udeladelse eller medtagelse af enkelte undersøgelser vil påvirke det overordnede odds ratio (OR) i forskellig retning, men det regnes for rimeligt at foretage en række følsomhedsanalyser til vurdering af resultaternes pålidelighed.
English: • The Committee in light of the previous review and in the absence of new efficacy data, considered that the intranasal calcitonin-containing medicines can be effective in the treatment of established postmenopausal osteoporosis in order to reduce the risk of vertebral fractures.
Danish: • Udvalget udtalte i lyset af den foregående gennemgang og i mangel af nye virkningsdata, at de intranasale lægemidler, der indeholder calcitonin, kan være effektive i behandlingen af etableret postmenopausal osteoporose ved at reducere risikoen for vertebralfrakturer.
English: Overall there appears to be sufficient and consistent evidence from the intranasal and oral calcitonin trials, that calcitonin is associated with an increased risk of cancer.
Danish: Samlet synes der at være tilstrækkelig og konsistent evidens fra de intranasale og orale calcitoninundersøgelser for, at calcitonin er forbundet med en forøget cancerrisiko.
English: Even so, the CHMP concluded that there is evidence of an increased risk of cancer among the exposed, with some degree of consistency - especially among the larger studies.
Danish: Desuagtet konkluderede CHMP, at der i nogen grad gennemgående er evidens for øget cancerrisiko blandt de eksponerede patienter - navnlig i de større undersøgelser.
English: Further evidence of a possible association between calcitonin and the risk of cancer is provided by a meta-analysis of 17 randomised, controlled, double blind studies with intranasal calcitonin performed by one of the MAHs.
Danish: Yderligere evidens for en mulig forbindelse mellem calcitonin og cancerrisikoen er tilvejebragt af en meta-analyse af 17 randomiserede, kontrollerede, dobbeltblinde undersøgelser med intranasal calcitonin, udført af en af indehaverne af markedsføringstilladelserne.
English: While this argument might be valid for observational studies, the CHMP is of the view that potential bias in randomised clinical trials that could favour one of the treatment arms is unlikely, as the randomisation procedure provides sufficiently well balanced groups.
Danish: Dette argument kan måske være gyldigt for observationsundersøgelser, men i en randomiseret klinisk undersøgelse finder CHMP det usandsynligt, at der vil være skævhed til fordel for en af behandlingsgrupperne, da randomiseringsproceduren giver tilstrækkeligt velafbalancerede grupper.
English: Considering the availability of alternative treatments in this indication, the CHMP agreed that the use of calcitonin in Paget's disease should be limited to 3 months, and only in patients who do not respond to alternative treatments or for whom such treatments are not suitable, for example those with severe renal impairment.
Danish: I betragtning af tilgængeligheden af alternative behandlinger til denne indikation vedtog CHMP, at anvendelsen af calcitonin til Pagets sygdom skal begrænses til 3 måneder, og kun til patienter, der ikke reagerer på alternative behandlinger, eller for hvem sådanne behandlinger ikke er egnede, for eksempel dem med svær nyreinsufficiens.
English: The MAH also raised some points on the methodological flaws of the meta-analysis of the 17 intranasal calcitonin studies and provided a re-analysis of data.
Danish: Indehaveren af markedsføringstilladelsen rejste desuden visse spørgsmål vedrørende de metodemæssige mangler i metaanalysen af de 17 intranasale calcitoninundersøgelser og fremlagde en reanalyse af data.
English: In the first of these trials (study C2301), a statistical significant increased risk of cancer was reported in patients treated with calcitonin compared with placebo (incidence rate ratio 4.13 (1.67-10.19)).
Danish: I den første af disse undersøgelser (undersøgelse C2301) blev en statistisk signifikant, forøget cancerrisiko rapporteret hos patienter, der blev behandlet med calcitonin, sammenlignet med placebo (forekomstrate-forhold 4,13 (1,67-10,19)).
English: The CHMP agrees that the PROOF study provides support for the efficacy with regard to vertebral fracture rates in the 200 IU dose group corresponding to a p-value of 0.032 and with no statistically significant changes in the lower (100 IU) and higher (400 IU) dose groups.
Danish: CHMP tilsluttede sig, at PROOF-undersøgelsen med en p-værdi på 0,032 understøtter virkningen på forekomsten af vertebralfrakturer hos den gruppe, der fik 200 IE, og - uden statistisk signifikante ændringer - hos gruppen på den lavere dosis (100 IE) og gruppen på den højere dosis (400 IE).
English: The MAH also questions the validity of the evidence of the available clinical trials that substantiated the efficacy of the product, arguing that the evidence is not valid for safety because of confounding factors.
Danish: Indehaveren af markedsføringstilladelsen betvivler desuden validiteten af evidensen fra de foreliggende kliniske undersøgelser til dokumentation af produktets virkning og hævder, at dokumentationen ikke er sikkerhedsmæssigt valid på grund af konfunderende faktorer.
English: As discussed previously the efficacy of calcitonin in the treatment of Paget's disease is limited and is partially validated by its well known use and its pharmacological plausibility.
Danish: • Behandling af Pagets sygdom (injektionsformulering) Som tidligere diskuteret er calcitonins virkning i behandlingen af Pagets sygdom begrænset og er delvist valideret gennem dens velkendte anvendelse og dens farmakologiske plausibilitet.
English: The consistency of the evidence across clinical trial data, provide strong evidence of a causal association.
Danish: Konsistensen af evidens i kliniske undersøgelsesdata tilvejebringer stærk evidens for en årsagssammenhæng.