FrancophonIA/ELRC3.0 huggingface dataset:
English: The benefits and the risks of oral ketoconazole in dermatophytosis (Tinea Capitis, Tinea Barbae, Tinea Corporis, Tinea Cruris, Tinea Pedis, and Tinea Manuum) Pityriasis Versicolor, Malassezia folliculitis, Infections Due to Candida Species, Cutaneous candidiasis, Chronic Mucocutaneous Candidosis, Oropharyngeal Candidosis, Oesophageal Candidosis, Chronic Recurrent Vulvovaginal Candidosis, Systemic Mycoses (Paracoccidioidomycosis, Histoplasmosis, Coccidioidomycosis, Blastomycosis) were reviewed by the MAH which concluded that ketoconazole had an acceptable safety profile when used at low dose for short periods in benign diseases, but that its use at high doses for extended periods could only be supported where there was good efficacy and the risks of hepatotoxicity were outweighed by the mortality and serious morbidity of the disease.
Danish: Indehaveren af markedsføringstilladelsen gennemgik fordele og risici ved oralt ketoconazol ved dermatofytoser (tinea capitis, tinea barbae, tinea corporis, tinea cruris, tinea pedis og tinea manuum) pityriasis versicolor, Malassezia-follikulitis, infektioner forårsaget af Candida, kutan candidiasis, kronisk mukokutan candidiasis, orofaryngeal candidiasis, esofageal candidiasis, kronisk recidiverende vulvovaginal candidiasis, systemiske mykoser (paracoccidioidomykose, histoplasmose, coccidioidomykose, blastomykose) og konkluderede, at ketoconazol har en acceptabel sikkerhedsprofil ved anvendelse af lave doser i korte perioder i godartede tilfælde, men at anvendelse i høje doser gennem længere tid kun kunne støttes, når der var god virkning, og risiciene for hepatotoksicitet opvejedes af sygdommens dødelighed og alvorlige morbiditet.
English: Although the efforts of the company to substantiate the use of ketoconazole in rescue therapy of other azoles in superficial fungal infections was acknowledged, the cases series were limited and could not adequately ascertain the benefit of the drug in rescue therapy as claimed by the company.
Danish: Gruppen noterede sig virksomhedens bestræbelser på at underbygge anvendelsen af ketoconazol ved superficielle mykoser som redningsbehandling til andre azoler, men det begrænsede antal tilfælde kunne ikke tilstrækkeligt godtgøre lægemidlets fordele til redningsbehandling som påberåbt af virksomheden.
English: The analysis also showed that the use of oral ketoconazole was associated with the highest crude incidence rate per 10 000 patients for acute liver injury among other oral antifungals as well as with the development of chronic hepatitis and cirrhosis.
Danish: Analysen viste også, at oralt ketoconazol var forbundet med den højeste bruttoforekomst af akut leverskade pr. 10.000 patienter blandt orale antimykotika og med udvikling af kronisk hepatitis og cirrhose.
English: Uncertainties still remain about the liver toxicity mechanism of ketoconazole.
Danish: Der er fortsat usikkerhed om mekanismen bag ketoconazols hepatotoksicitet.
English: • The Committee reviewed all the available data on the efficacy and safety of ketoconazolecontaining medicines for oral use, in particular data in relation to the risk of hepatotoxicity provided by the MAHs in writing and in the oral explanations;
Danish: • udvalget gennemgik alle foreliggende data om virkning og sikkerhed af lægemidler indeholdende ketoconazol til oral anvendelse, navnlig data om risikoen for hepatotoksicitet, som indehaverne af markedsføringstilladelse havde fremlagt skriftligt og ved de mundtlige fremlæggelser,
English: • The Committee considered that available data from pre-clinical studies, clinical trials, postmarketing spontaneous case reports, pharmaco-epidemiological studies and published literature have shown that the use of oral ketoconazole-containing products is associated with a high risk of serious hepatotoxicity, best demonstrated by the causality assessments of fatal/life-threatening hepatotoxicity cases;
Danish: • udvalget fandt, at de foreliggende data fra prækliniske undersøgelser, kliniske undersøgelser, spontane indberetninger af case-rapporter efter markedsføring, farmakoepidemiologiske undersøgelser og den publicerede litteratur har vist, at anvendelse af orale lægemidler indeholdende ketoconazol er forbundet med høj risiko for alvorlig hepatotoksicitet, som klarest fremgår af kausalitetsvurderingerne ved fatale/livstruende tilfælde af hepatotoksicitet,
English: Therefore, pursuant to Article 116 of Directive 2001/83/EC, the CHMP recommends the suspension of the Marketing Authorisations for all medicinal product(s) referred to in Annex I. The conditions for the lifting of the suspension of the Marketing Authorisation(s) are set out in Annex III.
Danish: Udvalget konkluderede derfor, at benefit/risk-forholdet for lægemidler indeholdende ketoconazol til oral anvendelse ikke er gunstigt til behandling af mykoser, I medfør af artikel 116 i direktiv 2001/83/EF anbefaler CHMP derfor suspendering af markedsføringstilladelserne for alle lægemidler omhandlet i bilag I. Betingelserne for ophævelse af suspenderingen af markedsføringstilladelserne fremgår af bilag III.
English: Ketoconazole 20mg/ml oral suspension and ketoconazole 100mg tablet formulations are no longer authorised in any EEA Member State.
Danish: Ketoconazol er ikke længere godkendt i nogen EØS-medlemsstat som oral suspension, 20 mg/ml, eller tabletter, 100 mg.
English: • Blastomycosis
Danish: • Blastomykose
English: In addition, the experts would not easily foresee the utility of ketoconazole when resistance to agent(s) of the class is detected as cross resistance is frequent and there is a lack of evidence around the potential susceptibility to ketoconazole when resistance to other azoles occurs.
Danish: Desuden fandt eksperterne det vanskeligt at forvente nytte af ketoconazol, når der konstateres resistens over for et eller flere midler i klassen, da krydsresistens forekommer hyppigt, og da der mangler evidens om eventuel følsomhed for ketoconazol ved resistens over for andre azoler.
English: There was also insufficient evidence to claim or refute a benefit for any antifungal agent in treating candidiasis and the studies presented by the MAHs on the efficacy of ketoconazole on other Candida spp.
Danish: Der var heller ikke tilstrækkelig evidens til at hævde eller afvise gavnlig virkning af noget antimykotisk middel til behandling af candidiasis, og de af markedsføringstilladelsesindehaverne forelagte undersøgelser om virkningen af ketoconazol ved infektioner med andre Candida-arter var begrænsede.
English: • Orapharyngeal and esophageal candidosis
Danish: • Orofaryngeal og esofageal candidiasis
English: • Dermatophytosis
Danish: • Dermatofytose
English: • Chronic, recurrent vaginal candidosis
Danish: • Kronisk recidiverende vaginal candidiasis
English: The MAH provided a detailed report examining efficacy of oral ketoconazole by approved indication.
Danish: Indehaveren af markedsføringstilladelsen forelagde en udførlig gennemgang af virkningen af oralt ketoconazol for hver af de godkendte indikationer.
English: In order to minimise the risks, the MAH has proposed to eliminate all indications that require prolonged treatment at higher dosages, e.g., systemic mycoses requiring treatment for 6 months or longer, taking into account that hepatotoxicity has usually been reported after extensive cumulative exposure to ketoconazole, and to limit indications to Malassezia folliculitis, Tinea capitis and chronic mucocutaneous candidiasis in patients who had either developed intolerance or failed to respond to alternative oral and/or IV antifungal therapy.
Danish: For at minimere risiciene har indehaveren af markedsføringstilladelsen foreslået at slette alle indikationer, der kræver længerevarende brug af høje doser, f.eks. systemiske mykoser, der kræver behandling i seks måneder eller længere, på baggrund af, at hepatotoksicitet sædvanligvis er blevet indberettet efter omfattende kumulativ eksponering for ketoconazol, og at begrænse indikationerne til at omfatte Malassezia-follikulitis, tinea capitis og kronisk mukokutan candidiasis i tilfælde med manglende tolerance eller respons over for andre orale og/eller intravenøse antimykotika.
English: It was concluded that the results of the current analysis of all cases of potential hepatotoxicity with oral ketoconazole-containing medicinal product confirm the risk of serious hepatotoxicity associated with the use of oral ketoconazole, best demonstrated by the causality assessments of fatal/lifethreatening hepatotoxicity cases.
Danish: Det blev konkluderet, at resultaterne af den aktuelle analyse af alle tilfælde af potentiel hepatotoksicitet med orale lægemidler indeholdende ketoconazol bekræfter, at der er risiko for alvorlig hepatotoksicitet ved oral anvendelse af ketoconazol, hvilket bedst fremgår af kausalitetsvurderingen ved fatale/livstruende tilfælde af hepatotoksicitet.
English: • Cutaneous candidosis
Danish: • Kutan candidiasis
English: The results of the current analysis of all cases of potential hepatotoxicity with oral ketoconazolecontaining medicinal product confirmed the risk of serious hepatotoxicity associated with the use of oral ketoconazole, best demonstrated by the causality assessments of fatal/life-threatening hepatotoxicity cases.
Danish: Den aktuelle analyse af alle tilfælde af potentiel hepatotoksicitet med orale lægemidler indeholdende ketoconazol bekræfter risikoen for alvorlig hepatotoksicitet i forbindelse med brug af oralt ketoconazol, hvilket klarest fremgår af kausalitetsvurderingerne af fatale/livstruende tilfælde af hepatotoksicitet.
English: The MAH proposed to withdraw all indications that require prolonged treatment at higher dosages, e.g., systemic mycoses requiring treatment for 6 months or longer taking into account the fact that hepatotoxicity has usually been reported after extensive cumulative exposure to ketoconazole and to limit indications to Malassezia folliculitis, Tinea capitis and chronic mucocutaneous candidiasis in patients who had either developed intolerance or failed to respond to alternative oral and/or IV antifungal therapy.
Danish: Indehaveren af markedsføringstilladelsen foreslog at trække alle de indikationer tilbage, der kræver længerevarende brug af høje doser, f.eks. systemiske mykoser, der kræver en behandlingstid på seks måneder eller længere, da hepatotoksicitet sædvanligvis er blevet indberettet efter omfattende kumulativ eksponering for ketoconazol, samt at begrænse indikationerne til Malassezia-follikulitis, tinea capitis og kronisk mukokutan candidiasis ved intolerance eller manglende respons på behandling med andre orale og/eller intravenøse antimykotika.
English: - hepatotoxicity with ketoconazole has been reported at a daily dose of 200 mg (median) which is the recommended daily dose; - the incidence and seriousness of hepatotoxicity associated with the use of oral ketoconazole is higher than with the use of other antifungals in the treatment of superficial, sub-cutaneous and systemic fungal infections, with the highest crude incidence rate per 10 000 patients for acute liver injury among other oral antifungals and with its use associated with the development of chronic hepatitis and cirrhosis (Chien et al, 1997; Garcia et al, 1999); - the onset of hepatotoxicity with ketoconazole usually occurs between 1 and 6 months after initiation of treatment (55% of the cases when the time to onset was documented) but has also be reported earlier than 1 month (including few days) after initiation of treatment (35% of the cases when the time to onset was documented);
Danish: Markedsføringstilladelsesindehaverens gennemgang af litteraturdata og data efter markedsføring viste, at - der er beskrevet hepatotoksicitet med ketoconazol ved dosis på 200 mg dagligt (median), som er den anbefalede daglige dosis, - hyppigheden og alvorligheden af hepatotoksicitet ved oral anvendelse af ketoconazol er højere end med andre antimykotika til behandling af superficielle, subkutane og systemiske mykoser, idet bruttoraten af akutte leverskader pr. 10 000 patienter er den højeste blandt de orale antimykotika, og dets anvendelse er forbundet med udvikling af kronisk hepatitis og cirrhose (Chien et al, 1997; Garcia et al,
English: • Paracoccidioidomycosis
Danish: • Paracoccidioidomykose
English: • Coccidioidomycosis
Danish: • Coccidioidomykose
English: Systemic fungal infections.
Danish: Systemiske mykoser
English: • Chronic mucocutaneous candidosis
Danish: • Kronisk mukokutan candidiasis
English: Amongst other risk minimisation activities proposed by the MAH were the restriction of prescribing by physicians experienced in treating rare fungal skin disease and rare sub-sets of common fungal disease, Limitation of the use: short treatment periods and treatment of susceptible infecting pathogens only (Candida) and enhanced communication on the risks.
Danish: Blandt andre risikominimeringsaktiviteter, der blev foreslået af markedsføringstilladelsesindehaveren, var, at ordinationsretten begrænses til læger med erfaring i behandling af sjældne mykotiske hudsygdomme og sjældne undergrupper af almindelige mykoser.
English: Additional expert advice was sought from an ad-hoc expert group.
Danish: Der blev indhentet yderligere ekspertrådgivning fra en ad hoc-ekspertgruppe.
English: New results from CRYSTAL have also become available.
Danish: Der er desuden kommet nye resultater fra CRYSTAL.
English: However additional measures must be implemented to minimise potential risks in these patients.
Danish: Der skal imidlertid gennemføres supplerende foranstaltninger til at minimere de potentielle risici for sådanne patienter.
English: Benefit risk balance
Danish: Benefit/risk-forhold
English: In accordance with the EU legislation, this type of action required that an EU review procedure be carried out.
Danish: I henhold til EU-lovgivningen kræver sådanne handlinger, at der foretages en EUgennemgangsprocedure.
English: While the re-examination was ongoing some Member States decided to suspend or limit the marketing or use of these medicines in their territories.
Danish: Mens den fornyede gennemgang foregik, besluttede medlemsstaterne at suspendere eller begrænse markedsføringen eller anvendelsen af disse lægemidler på deres områder.
English: HES solutions have been the object of two reviews.
Danish: Opløsninger af HES har været omfattet af to gennemgange.
English: Protocols and results of these studies will be submitted to national competent authorities according to agreed timelines.
Danish: Protokollerne for og resultaterne af disse undersøgelser skal forelægges de nationale kompetente myndigheder i henhold til aftalte tidsfrister.
English: This is subject to restrictions, warnings and other changes to the product information.
Danish: Dette er betinget af begrænsninger, advarsler og andre ændringer i produktinformationen,
English: Details of this recommendation are presented hereafter.
Danish: Detaljer vedrørende denne anbefaling fremgår af nedenstående.
English: Although 90-day mortality was lower among patients receiving colloids, this requires further investigations.
Danish: Skønt 90-dages dødeligheden var lavere hos de patienter, der fik kolloider, kræver dette yderligere undersøgelser.
English: Monitoring of renal function in patients is recommended for at least 90 days.
Danish: Der anbefales overvågning af nyrefunktionen i mindst 90 dage.
English: Consequently the CMDh decided that synopsis were not required in advance of the recommended scientific advice.
Danish: CMDh afgjorde følgelig, at der ikke behøvedes en synopsis inden den anbefalede videnskabelige rådgivning.
English: An European drug utilisation study will also be conducted to evaluate the effectiveness of the recommended risk minimisation measures.
Danish: Desuden skal udføres en undersøgelse af lægemiddelanvendelse i Europa til vurdering af effektiviteten af de anbefalede risikominimeringsforanstaltninger.
English: The product information will be updated to reflect these restrictions and warnings.
Danish: Produktoplysningerne skal ajourføres med disse begrænsninger og advarsler.
English: Companies had been encouraged to submit core elements of the risk management plan, but the CMDh considered that this should be a condition.
Danish: Virksomhederne var blevet opfordret til at forelægge hovedelementerne i risikostyringsplanen, men CMDh fandt, at dette burde være en betingelse.
English: The MAHs are also encouraged to submit risk management plans to national competent authorities.
Danish: Indehaverne af markedsføringstilladelserne opfordres desuden til at forelægge risikohåndteringsplaner for de nationale kompetente myndigheder.
English: The PRAC issued a recommendation on available data for this review in June 2013, concluding that HES solutions should be suspended in all patient populations.
Danish: PRAC fremsatte i juni 2013 en anbefaling om de foreliggende data med henblik på denne gennemgang og konkluderede, at opløsninger indeholdende HES bør suspenderes til alle patientpopulationer.
English: In view of the above and considering that the study protocols of the drug utilisation study and of the two randomised clinical trials are conditions to the marketing authorisation, the CMDh noted that these elements should be reflected in a risk management plan.
Danish: I betragtning af ovenstående og af, at protokollerne for undersøgelsen af lægemiddelanvendelse og for de to randomiserede kliniske undersøgelser er betingelser for markedsføringstilladelsen, bemærkede CMDh, at disse elementer skulle afspejles i en risikostyringsplan.
English: Overall summary of the scientific evaluation of solutions for infusion containing hydroxyethyl starch medicinal products by PRAC
Danish: Samlet resumé af PRAC's videnskabelige vurdering af lægemidler indeholdende opløsninger af hydroxyethylstivelse til infusion
English: Hydroxyethyl starch (HES) solutions for infusion include products with starch derived from potato or corn with different molecular weights and substitution ratios.
Danish: Opløsninger af hydroxyethylstivelse (HES) til infusion er produkter med stivelse udvundet af kartofler eller majs med forskellige molekylvægte og substitutionsforhold.
English: HES containing solutions for infusion were indicated mainly for the treatment and prophylaxis of hypovolaemia and hypovolemic shock.
Danish: Opløsninger indeholdende HES til infusion var hovedsagelig indiceret til behandling og forebyggelse af hypovolæmi og hypovolæmisk shock.
English: • The PRAC also concluded that there was need for further risk minimisation measures such as information to patients and healthcare professionals.
Danish: • PRAC konkluderede endvidere, at der behøves yderligere risikominimeringsforanstaltninger såsom information til patienter og sundhedspersoner.
English: In hypovolaemic patients with normal pulmonary function, the use of colloids to maintain colloid-osmotic pressure may limit the development of peripheral as well as pulmonary oedema (Vincent JL 2000).
Danish: Hos hypovolæmiske patienter med normal lungefunktion kan anvendelse af kolloider til opretholdelse af det kolloidosmotiske tryk begrænse udviklingen af såvel perifert ødem som lungeødem (Vincent, JL, 2000).
English: Having reviewed the PRAC recommendation, the CMDh agreed with the overall scientific conclusions and grounds for recommendation.
Danish: Efter at have gennemgået PRAC's anbefaling tilsluttede CMDh (koordinationsgruppen vedrørende gensidig anerkendelse og decentraliserede procedurer (human)) sig de overordnede videnskabelige konklusioner og begrundelsen for anbefalingen.
English: Following requests for re-examination by marketing authorisation holders (MAHs), the PRAC confirmed its previous position under the Article 31 in October 2013.
Danish: Efter anmodninger om fornyet gennemgang fra indehaverne af markedsføringstilladelse fastholdt PRAC i oktober 2013 sit tidligere standpunkt i henhold til artikel 31.
English: Some publications also suggest that colloids might help to prevent positive fluid balance and/or overinfusion of fluids (Wills 2005, Naing CM and Win DK 2010).
Danish: Nogle publikationer tyder desuden på, at kolloider kan medvirke til at undgå positiv væskebalance og/eller overinfusion af væsker (Wills, 2005, Naing, CM og Win, DK, 2010).
English: Hamaji et al 2013 also showed that significantly fewer red blood cell transfusions were required in the HES group.
Danish: Hamaji et al., 2013, viste ligeledes, at der krævedes væsentligt færre transfusioner af erytrocytter i HES-gruppen.
English: • The PRAC noted the conclusions of a review under article 31 of Directive 2001/83/EC.
Danish: • PRAC tog konklusionerne af en gennemgang i henhold til artikel 31 i direktiv 2001/83/EF til efterretning.
English: Some of authors argue that a positive net fluid balance is associated with a decrease in organ perfusion and an increased mortality (e.g. Sadaka F et al. 2013, Payen D et al. 2008).
Danish: Nogle af forfatterne hævder, at en positiv nettovæskebalance er forbundet med nedsat organperfusion og øget dødelighed (f.eks. Sadaka, F., et al., 2013, Payen, D., et al., 2008).
English: The first review was initially started under the framework of Article 31 of Directive 2001/83/EC.
Danish: Den første blev oprindeligt iværksat i rammerne af artikel 31 i direktiv 2001/83/EF.
English: Some benefit for elective surgical patients has also been shown in short-term surrogate hemodynamic outcomes along with a modest volume sparing effect (Hartog et al. 2011).
Danish: Der er også set nogen gavnlig virkning hos elektive operationspatienter i form af kortsigtede hæmodynamiske surrogatudfald sammen med en beskeden volumenbesparende virkning (Hartog et al. 2011).
English: The CMDh amended the due date for the submission of the protocol of the drug utilisation study which is now also due within 6 months of the European Commission Decision in order to harmonise submission dates of all conditions.
Danish: CMDh ændrede fristen for indsendelse af protokollen til undersøgelsen af lægemiddelanvendelse til også at være 6 måneder fra Europa-Kommissionens beslutning, således at indsendelsesdatoerne er ensrettet for alle betingelserne.
English: Core elements of a direct healthcare professional communication were agreed, together with the timelines for distribution, and that studies should be conducted.
Danish: Der blev vedtaget hovedelementer i en direkte henvendelse til sundhedspersoner, ligesom en tidsplan for udsendelsen samt udførelse af undersøgelser.
English: In addition, in the BaSES study, the hospitalisation time was significantly reduced in patients treated with 6% HES 130/0.4 compared to 0.9% NaCl.
Danish: Desuden var der i BaSES-undersøgelsen væsentligt kortere indlæggelsestid ved behandling med 6 % HES 130/0,4 end med 0,9 % natriumchlorid.
English: To this end the MAHs were strongly advised to seek scientific advice with the European Medicines Agency, in time for the submission of the study protocols to the national competent authorities (NCAs) within 6 months of the European Commission Decision.
Danish: Indehaverne af markedsføringstilladelse blev stærkt tilrådet at søge videnskabelig rådgivning herom hos Det Europæiske Lægemiddelagentur i tide før indsendelse af undersøgelsernes protokoller til de nationale kompetente myndigheder inden for seks måneder efter Europa-Kommissionens beslutning.
English: Particular caution should be exercised when treating patients with impaired hepatic function or in patients with blood coagulation disorders.
Danish: Særlig forsigtighed bør udvises ved behandling af patienter med nedsat leverfunktion eller koagulationsforstyrrelser.
English: Detailed explanation for the differences from the PRAC recommendation
Danish: Detaljeret begrundelse for afvigelserne fra PRAC's anbefaling
English: The experts suggested that benefit of HES may be seen in particular in perioperative bleeding.
Danish: Eksperterne pegede på, at fordelene ved hydroxyethylstivelse muligvis navnlig ses ved perioperativ blødning.