FrancophonIA/ELRC3.0 huggingface dataset:
English: • The suspension of the marketing authorisation for dihydroergotamine containing medicinal products referred to in Annex I in the event that no other indications are approved as part of their marketing authorisation.
Slovenian: • začasni umik dovoljenja za promet z zdravili iz Priloge I, ki vsebujejo dihidroergotamin, če se kot del njihovega dovoljenja za promet z zdravilom ne odobrijo druge indikacije.
English: One case was confounded by medical history and in 25 cases co-suspected drugs were reported: benfluorex (4 cases), dexflenfuramine (4 cases), pergolide (1 case), beta blockers (9 cases), fenofibrate (2 cases) and ergot derivative drug (8 cases).
Slovenian: Pri enem primeru so si pomagali z zdravstveno anamnezo, pri 25 primerih pa so poročali o sumu učinka sočasnih zdravil: benfluoreks (4 primeri), deksflenfuramin (4 primeri), pergolid (1 primer), zaviralci betaadrenergičnih receptorjev (9 primerov), fenofibrat (2 primera) in derivati ergot-alkaloidov (8 primerov).
English: The double-blind, randomised, placebo-controlled studies were old and generally not carried out with the current up-to-date methodology.
Slovenian: Dvojno slepe, randomizirane, s placebom nadzorovane študije so bile stare in navadno niso vključevale sodobne metodologije.
English: Systolic blood pressure of the placebo and the dihydroergotamine group differed already at baseline.
Slovenian: Sistolični krvni tlak v skupinah s placebom in dihidroergotaminom se je razlikoval že v izhodišču.
English: The seriousness of such adverse effects and their possible fatal outcome is underlined.
Slovenian: Odbor je izpostavil resnost teh neželenih učinkov in njihov morebitni smrtni izid.
English: The efficacy of dihydroergotamine in the acute treatment of migraine attack is not within the scope of this referral and will not be discussed.
Slovenian: Učinkovitost dihidroergotamina pri akutnem zdravljenju migrenskega napada je zunaj sklopa tega napotitvenega postopka in se ne bo obravnavala.
English: Overall, the CHMP was of the opinion that no situation could justify exposing a patient to risk of fibrosis and ergotism considering the very limited data on efficacy.
Slovenian: Na splošno je odbor CHMP menil, da nobene okoliščine ne upravičujejo izpostavitve bolnika tveganju za fibrozo in ergotizem, saj so podatki o učinkovitosti zelo omejeni.
English: In the acute treatment of migraine, it is administered parenterally or in the form of a nasal spray because of the low bioavailability of the unchanged drug by the oral route.
Slovenian: Pri akutnem zdravljenju migrene se daje parenteralno ali v obliki pršila za nos, saj je biološka uporabnost nespremenjenega zdravila, ki se daje peroralno, majhna.
English: In addition, it was the IV formulation of the product that was used and not the oral formulation that is in the scope of this referral procedure.
Slovenian: Poleg tega se je uporabila intravenska formulacija zdravila in ne peroralna, ki jo zajema ta napotitveni postopek.
English: Only one study, Thulesius (1986), demonstrated a significant decrease of immediate drop in blood pressure after standing up with 10mg per day dihydroergotamine compared to placebo, in patients with hypotension induced by treatment with psychotropic drugs and it became available after the initial marketing authorisation was granted.
Slovenian: Samo ena študija, Thulesius (1986), je pokazala pomembno zmanjšanje nenadnega padca krvnega tlaka po vstajanju ob uporabi 10 mg dihidroergotamina na dan v primerjavi s placebom, in sicer pri bolnikih s hipotenzijo, ki so jo povzročila psihotropna zdravila.
English: These co-suspected drugs are known to induce fibrosis.
Slovenian: Za ta zdravila je znano, da povzročajo fibrozo.
English: Agonism to 5-HT2B receptors induces a proliferative response and mitogenicity of the cells expressing this receptor leading to fibrogenesis.
Slovenian: Agonizem za receptorje 5-HT2B sproži proliferativni odziv in mitogenost celic, ki izražajo ta receptor, kar povzroči fibrogenezo.
English: After 4 months of treatment, the attack frequency decreased by 2.0 ± 1.6 (-60.0%) with dihydroergotamine versus 1.7 ± 1.5 (-48.8%) with placebo (p = 0.014 for the relative variations).
Slovenian: Po 4 mesecih zdravljenja se je pogostnost napadov zmanjšala za 2,0 ± 1,6 (-60,0 %) v skupini z dihidroergotaminom v primerjavi z 1,7 ± 1,5 (-48,8 %) v skupini s placebom (p = 0,014 za relativne variacije).
English: • Ancillary treatment of visual acuity decrease and visual field disturbances presumably of vascular origin
Slovenian: • dodatno zdravljenje zmanjšane ostrine vida in motenj vidnega polja, za katere se domneva, da so žilnega izvora;
English: The frequency of attacks of migraine (the primary efficacy criteria) was not statistically significant (dihydroergotamine group (-1.84 ± 1.55) vs. placebo group (-1.67 ± 1.49) (p=0.220)).
Slovenian: Razlika v pogostnosti napadov migrene (primarno merilo za učinkovitost) ni bila statistično pomembna (skupina z dihidroergotaminom (-1,84 ± 1,55) v primerjavi s skupino s placebom (-1,67 ± 1,49) (p = 0,220)).
English: A post-hoc analysis was performed in the sub-group of patients (n=288) with functional handicap and quality of life (QOL) decrease (defined by Migraine Specific Quality of Life, MSQ<80).
Slovenian: Pri podskupini bolnikov (n = 288) s funkcionalno oviranostjo in poslabšano kakovostjo življenja (opredeljeno z rezultatom MSQ < 80; Migraine Specific Quality of Life - z migreno povezana kakovost življenja).
English: To conclude, ergotism is an adverse reaction of ergot derivative drugs well-known to occur in a context of overdose or interaction.
Slovenian: Če povzamemo, je ergotizem neželeni učinek zdravil, ki vsebujejo derivate ergot-alkaloidov, za katerega je dobro znano, da se pojavi v sklopu prevelikega odmerjanja ali interakcije.
English: In the only recent, large study with appropriate design (double-blind, placebo-controlled, 5-month treatment study) (PROMISE study) that became available after the granting of the initial marketing authorisation, the evidence for efficacy of dihydroergotamine in the prevention of migraine has not been demonstrated as there was no statistically significant difference between dihydroergotamine and placebo.
Slovenian: V edini nedavni veliki študiji z ustreznim načrtom (dvojno slepi, s placebom nadzorovani, 5-mesečni študiji zdravljenja) (študiji PROMISE), ki je bila objavljena po odobritvi prvotnega dovoljenja za promet z zdravilom, niso ugotovili dokazov za učinkovitost dihidroergotamina pri preprečevanju migrene, saj ni bilo statistično pomembne razlike med dihidroergotaminom in placebom.
English: Therefore, even if it is highly pharmacologically plausible that ergot derivatives acting as 5HT2B receptor agonists may induce "serotonergic" valve disease similar to that induced by carcinoid tumours or fibrotic lesions of other tissues, it must be remembered that some ergot derivatives are not 5-HT2B receptor agonists.
Slovenian: Čeprav je farmakološko zelo verjetno, da lahko derivati ergot-alkaloidov, ki delujejo kot agonisti receptorjev 5-HT2B, povzročijo „serotoninergično“ bolezen zaklopke, podobno tisti, ki jo povzročajo karcinoidni tumorji ali fibrotične lezije v drugih tkivih, je treba izpostaviti, da nekateri derivati ergotalkaloidov niso agonisti receptorjev 5-HT2B.
English: The marketing authorisation holders (MAHs) submitted all available efficacy data from clinical trials and observational studies, including data that became available since the granting of the initial marketing authorisation.
Slovenian: Imetniki dovoljenj za promet z zdravilom so predložili vse razpoložljive podatke o učinkovitosti iz kliničnih preskušanj in opazovalnih študij, vključno s podatki, ki so bili pridobljeni po odobritvi prvotnega dovoljenja za promet z zdravilom.
English: Moreover, the number of cases reported with a contraindicated concomitant drug reveals that information in the SmPC is not sufficient to avoid an exposition of the patient to the serious risk of ergotism.
Slovenian: Poleg tega število poročanih primerov s kontraindiciranim sočasnim zdravilom kaže, da informacije v povzetku glavnih značilnosti zdravila niso zadostne, da bi se izognili izpostavljenosti bolnika resnemu tveganju ergotizma.
English: For all products the concomitant use of CYP3A inhibitors is contraindicated with dihydroergotamine (section 4.5) and for others the concomitant use of vasonconstrictive agent is also contraindicated.
Slovenian: Pri vseh zdravilih z dihidroergotaminom je sočasna uporaba z zaviralci CYP3A kontraindicirana (poglavje 4.5), pri nekaterih pa je prav tako kontraindicirana sočasna uporaba z vazokonstriktivnimi učinkovinami.
English: Based on the clinical experience the group considered that no special population exists that could benefit from the treatment with this active substance in the prophylaxis of migraine headache.
Slovenian: Na podlagi kliničnih izkušenj je skupina menila, da ne obstaja nobena posebna populacija, ki bi ji lahko zdravljenje s to učinkovino koristilo pri preprečevanju migrenskega glavobola.
English: On the efficacy side for the indication “prophylaxis of migraine headache” data derive from a few randomised, double-blind, placebo-controlled studies or double-blind non placebo-controlled and open label studies, the majority of which was conducted after the granting of the initial marketingauthorisation.
Slovenian: Za učinkovitost pri indikaciji „preprečevanje migrenskega glavobola“ so bili predloženi podatki iz nekaj randomiziranih, dvojno slepih, s placebom nadzorovanih študij ali dvojno slepih, s placebom nenadzorovanih, odprtih študij, od katerih je bila večina izvedenih po odobritvi prvotnega dovoljenja za promet z zdravilom.
English: With regard to the reported cases, the CHMP noted the problem of under-reporting for this product considering the period that it is on the market.
Slovenian: Pri poročanih primerih je odbor CHMP opazil težavo s preredkim poročanjem za to zdravilo glede na to, da je že dolgo v prometu.
English: Likewise, the efficacy of dihydroergotamine administered by subcutaneous, intramuscular or intravenous injection or intranasal spray is not within the scope of this referral and will be not discussed.
Slovenian: Učinkovitost dihidroergotamina, ki se daje s subkutanim, intramuskularnim ali intravenskim injiciranjem ali pršilom za nos, je prav tako zunaj sklopa tega napotitvenega postopka in se ne bo obravnavala.
English: Overall, the varying affinity for serotoninergic receptors with the different ergot derivatives and the therapeutic doses used may explain the differences observed for notification rates for the fibrotic reactions.
Slovenian: Na splošno lahko spreminjajoča afiniteta za serotoninergične receptorje pri različnih derivatih ergotalkaloidov in terapevtskih odmerkih razloži razlike, opažene pri poročanih deležih fibrotičnih reakcij.
English: Therefore, other mechanisms inducing fibrosis cannot be excluded, which suggests a causal link between fibrosis and agonism of 5-HT2A and 5-HT1B receptors and also plausible effect on serotonin transporter.
Slovenian: Zato ni mogoče izključiti drugih mehanizmov, ki povzročajo fibrozo, kar kaže na vzročno povezavo med fibrozo in agonizmom receptorjev 5-HT2A ter 5HT1B in tudi na verjetni učinek na transmitorje serotonina.
English: For the indication “orthostatic hypotension” the submitted studies were considered by the CHMP of poor methodological quality: they were mainly uncontrolled trials with only 1 double-blind study but with low number of patients.
Slovenian: Odbor CHMP je menil, da je kakovost metodologije pri študijah, predloženih za indikacijo „ortostatska hipotenzija“, slaba: večinoma so bila to nenadzorovana preskušanja s samo 1 dvojno slepo študijo, ki pa je vključevala majhno število bolnikov.
English: The relationship between fibrosis and serotoninergic receptor activation, particularly 5-HT2B receptors by ergot derivatives is extensively described in the literature.
Slovenian: Povezava med fibrozo in aktivacijo serotoninergičnih receptorjev, predvsem receptorjev 5-HT2B, ki jo povzročajo derivati ergot-alkaloidov, je obširno opisana v literaturi.
English: In addition, given that fibrosis is a serious life threatening reaction, observed after long duration of treatment with dihydroergotamine (a drug used in indications requiring long duration of treatment) this has an impact on the benefit-risk balance of the products.
Slovenian: Ker je fibroza resna, smrtno nevarna reakcija, ki se pojavi po dolgem času od zdravljenja z dihidroergotaminom (zdravilom, ki se uporablja z indikacijami, ki zahtevajo dolgotrajno zdravljenje), ima to vpliv na razmerje med tveganji in koristmi teh zdravil.
English: A total of 363 subjects were treated with dihydroergotamine or placebo during 4 months after 1 month of placebo “run-in”.
Slovenian: Skupno 363 preskušancev so po enomesečnem uvajalnem obdobju s placebom 4 mesece zdravili z dihidroergotaminom ali placebom.
English: However, given the number of cases reported with dihydroergotamine, with symptoms related to ergotism (despite probable lacking cases) even when dihydroergotamine is used as recommended (no overdosage, no contraindicated drug, and short time treatment), the high pharmacological plausibility and a suggestive chronology in most of the cases, it is considered that patients are exposed to a high risk of ergotism when treated with dihydroergotamine.
Slovenian: Vendar glede na število primerov, o katerih so poročali pri dihidroergotaminu, s simptomi, povezanimi z ergotizmom (kljub verjetno preredko poročanim primerom), tudi če se je dihidroergotamin uporabljal, kot je priporočeno (brez prevelikega odmerjanja, brez kontraindiciranega zdravila in s kratkotrajnim zdravljenjem), veliko farmakološko verjetnost in sugestivni časovni potek v večini primerov menijo, da so bolniki pri zdravljenju z dihidroergotaminom izpostavljeni velikemu tveganju ergotizma.
English: Ergot derivatives are recognised as being capable of inducing fibrosis, in particular heart valve fibrosis.
Slovenian: Znano je, da lahko derivati ergot-alkaloidov povzročijo fibrozo, predvsem fibrozo srčne zaklopke.
English: The CHMP noted the position of several MAHs that there is not enough evidence to support an indication of oral dihydroergotamine in the symptomatic treatment of veno-lymphatic insufficiency and was of the opinion that no scientific conclusion can be drawn regarding the efficacy of dihydroergotamine based on these study results.
Slovenian: Odbor CHMP je upošteval stališče več imetnikov dovoljenj za promet z zdravilom, da ni zadostnih dokazov, ki bi podprli indikacijo peroralnega dihidroergotamina pri simptomatskem zdravljenju veno-limfatične insuficience, in je menil, da na podlagi teh rezultatov študij ni mogoče sklepati o znanstvenih zaključkih glede učinkovitosti dihidroergotamina.
English: Almost all cases were serious (93% of the cases where seriousness was reported) and treatment with dihydroergotamine was discontinued in 91% of the cases (for which information is available) and in 57% of these cases, the outcome has been reported as improved or recovered.
Slovenian: Zdravljenje z dihidroergotaminom so prekinili pri 91 % primerov (za katere so na voljo podatki), od katerih so pri 57 % poročali o izboljšanju ali okrevanju.
English: However, a total of 134 cases of ergostim or symptoms potentially related to ergotism have been reported by the MAHs.
Slovenian: Imetniki dovoljenj za promet z zdravilom so poročali o skupno 134 primerih ergotizma ali simptomih, morebitno povezanih z ergotizmom.
English: The authorised oral doses seem to have weak or null efficacy due to the low bioavailability of the drug.
Slovenian: Odobreni peroralni odmerki imajo šibek učinek ali ga sploh nimajo, saj je biološka uporabnost zdravila majhna.
English: The CHMP also stated that the study population, consisting only of drug induced orthostatic hypotension patients, is not representative to conclude on the efficacy of dihydroergotamine in the total population of orthostatic hypotension patients.
Slovenian: Odbor CHMP je prav tako navedel, da populacija v študiji, ki vključuje samo bolnike z ortostatsko hipotenzijo, ki so jo povzročila zdravila, ni dovolj reprezentativna, da bi lahko sklepali na učinkovitost dihidroergotamina v celotni populaciji bolnikov z ortostatsko hipotenzijo.
English: • Acute retinopathies of vascular origin
Slovenian: • akutna retinopatija žilnega izvora;
English: In the preventive treatment of migraine, dihydroergotamine is administered orally for long term.
Slovenian: Pri preprečevalnem zdravljenju migrene se dihidroergotamin daje peroralno in dolgotrajno.
English: The efficacy of dihydroergotamine in the prevention of migraine in this study has not been demonstrated taking into account that there was no statistically significant difference between dihydroergotamine and placebo with respect to the reduction of the frequency of migraine attacks (the primary efficacy criterion) in the overall population.
Slovenian: Učinkovitost dihidroergotamina pri preprečevanju migrene se v tej študiji ni pokazala, saj v splošni populaciji ni bilo statistično pomembne razlike med dihidroergotaminom in placebom glede zmanjšanja pogostnosti migrenskih napadov (primarno merilo za učinkovitost).
English: With regard to the risk of ergotism, the review of cases provided by the MAHs was not exhaustive and the methodology used to retrieve cases of ergotism was unclear for most of the MAHs.
Slovenian: Pri tveganju za ergotizem pregled primerov, ki so jih priložili imetniki dovoljenj za promet, ni bil izčrpen, metodologija, uporabljena za ugotavljanje primerov ergotizma, pa je bila večini imetnikov dovoljenj za promet z zdravilom nejasna.
English: In addition, a scientific advisory group (SAG) was convened in December 2012 at the request of the CHMP during which the experts discussed, based on their clinical experience, whether this substance plays a role in the treatment of orthostatic hypotension.
Slovenian: Znanstveno svetovalna skupina je na pobudo odbora CHMP decembra 2012 sklicala sestanek, na katerem so strokovnjaki na podlagi svojih kliničnih izkušenj razpravljali o tem, ali ima ta učinkovina vlogo pri zdravljenju ortostatske hipotenzije.
English: In addition, a scientific advisory group (SAG) was convened in December 2012 at the request of the CHMP during which the experts discussed, based on their clinical experience, whether this substance plays a role in the prophylaxis of migraine headache.
Slovenian: Znanstveno svetovalna skupina je na pobudo odbora CHMP decembra 2012 sklicala sestanek, na katerem so strokovnjaki na podlagi svojih kliničnih izkušenj razpravljali o tem, ali ima ta učinkovina vlogo pri preprečevanju migrenskega glavobola.
English: In the only recent, large study with appropriate design (PROMISE study) there was no statistically significant difference between dihydroergotamine and placebo with respect to the reduction of the frequency of migraine attacks (the primary efficacy criterion) in the overall population.
Slovenian: V edini nedavni veliki študiji z ustreznim načrtom (študiji PROMISE) ni bilo statistično pomembne razlike med dihidroergotaminom in placebom pri zmanjševanju pogostnosti migrenskih napadov (primerno merilo za učinkovitost) v splošni populaciji.
English: The Committee concluded that the benefit-risk balance of dihydroergotamine containing products for oral use is not favourable pursuant to Article 116 of Directive 2001/83/EC for prophylaxis of migraine, for orthostatic hypotension and for symptomatic treatment of veno-lymphatic insufficiency.
Slovenian: Odbor je zaključil, da skladno s členom 116 Direktive 2001/83/ES razmerje med tveganji in koristmi pri zdravilih za peroralno uporabo, ki vsebujejo dihidroergotamin, ni ugodno za preprečevanje migrene, ortostatske hipotenzije in simptomatsko zdravljenje veno-limfatične insuficience.
English: • Orthostatic hypotension
Slovenian: • ortostatska hipotenzija;
English: Although significant reduction in venous capacity, capillary flow of erythrocytes and peak flow of reactive hyperemia were demonstrated, due to a very small study group, the uncontrolled design and other methodological limitations, the CHMP could not draw any conclusion on the efficacy of dihydroergotamine.
Slovenian: Čeprav so pokazali pomembno zmanjšanje venske kapacitete, kapilarnega pretoka eritrocitov in največjega pretoka pri reaktivni hiperemiji, odbor CHMP ni mogel podati zaključkov glede učinkovitosti dihidroergotamina zaradi zelo majhne skupine v študiji, nenadzorovanega načrta in drugih metodoloških omejitev.
English: In conclusion, the studies provided by the MAHs were not carried out with up-to-date methodology.
Slovenian: Študije, ki so jih predložili imetniki dovoljenj za promet z zdravilom, niso vključevale sodobne metodologije.
English: • Ancillary treatment of Raynaud's syndrome
Slovenian: • dodatno zdravljenje Raynaudovega sindroma.
English: − Symptomatic treatment of veno-lymphatic insufficiency.
Slovenian: • simptomatsko zdravljene veno-limfatične insuficience.
English: No significant improvement over placebo was observed in the subset of patients with unaffected QOL.
Slovenian: Pri podskupini bolnikov z normalno kakovostjo življenja niso opazili nobenega pomembnega izboljšanja v primerjavi s placebom.
English: • The variation to the terms of the marketing authorisation for dihydroergotamine containing medicinal products referred to in Annex I, to delete the below indications from the Product Information (specific wording of the indication may vary from product to product and from country to country) as well as any relevant reference to these indications in the Product Information, when there are other therapeutic indications approved as part of their marketing authorisation:
Slovenian: • spremembo pogojev dovoljenja za promet z zdravili iz Priloge I, ki vsebujejo dihidroergotamin, tako da se iz informacij o zdravilu izbrišejo spodaj navedene indikacije (natančno besedilo za indikacijo se lahko med zdravili in državami razlikuje) ter druge zadevne reference na te indikacije, kadar so kot del dovoljenja za promet z zdravilom odobrene druge terapevtske indikacije: preprečevanje migrenskega glavobola; ortostatska hipotenzija; simptomatsko zdravljenje veno-limfatične insuficience.
English: • Adverse drug reactions with a substance marketed for a long time are generally less reported
Slovenian: • se o neželenih učinkih pri učinkovini, ki je v prometu dolgo časa, navadno poroča redkeje;
English: However the CHMP noted that beta blockers are not widely recognised as a cause of fibrosis.
Slovenian: Vendar je odbor CHMP izpostavil, da ni splošno priznano, da zaviralci betaadrenergičnih receptorjev povzročajo fibrozo.
English: The CHMP also noted the position of several MAHs that there is not enough evidence to support an indication of oral dihydroergotamine in orthostatic hypotension.
Slovenian: Odbor CHMP je prav tako upošteval stališče mnogih imetnikov dovoljenj za promet z zdravilom, da ni dovolj dokazov, ki bi podprli indikacijo peroralnega dihidroergotamina pri ortostatski hipotenziji.
English: For the percentage of responders (61.1% in the dihydroergotamine group vs. 55.9% in the placebo group) the difference was not statistically significant.
Slovenian: Razlika v deležu bolnikov z odzivom ni bila statistično pomembna (61,1 % v skupini z dihidroergotaminom v primerjavi s 55,9 % v skupini s placebom).
English: Grounds for the suspension/variation to the terms of the marketing authorisations
Slovenian: Razlogi za spremembo pogojev dovoljenj za promet z zdravilom ali njihov začasni umik
English: To conclude, given the cases reported for a reaction difficult to diagnose early (delayed symptoms) and probably under reported, the use of the drug at an approved dosage, added to a plausible pharmacological profile, dihydroergotamine is considered to be strongly associated with a risk of fibrotic reactions.
Slovenian: Glede na to, da so poleg verjetnega farmakološkega profila poročani primeri povezani z reakcijo, ki je težavna za diagnosticiranje (zapozneli simptomi) in verjetno preredko poročana, lahko sklenemo, da je uporaba dihidroergotamina z odobrenim odmerkom povezana s tveganjem fibrotičnih reakcij.