natgillin/translations-raw huggingface dataset:
CMDh er af den opfattelse, at de foreslåede supplerende foranstaltninger, der beskrives nedenfor, vil være gennemførlige og effektive til at minimere risiciene tilstrækkeligt ved at øge bevidstheden hos sundhedspersoner og sikre, at adgangen til HES-infusionsvæske, opløsning, forbeholdes sundhedspersoner, som har fået tilstrækkelig oplæring.
The CMDh is of the position that the proposed additional measures described below would be feasible and effective to sufficiently minimise the risks by increasing awareness of HCPs, as well as ensuring that access to HES solutions for infusion is reserved to HCPs that have received adequate training.
Det bemærkes også, at skønt der er påvist en fordel i form af en volumenbesparende effekt, og selvom der er nogen støtte for kortvarige hæmodynamiske virkninger, er det usikkert, i hvilket omfang dette er ensbetydende med mere patientrelevante resultater.
Is it also noted that although the benefit has been demonstrated in terms of a volume-sparing effect, and there is some support for short-term hemodynamic effects, it remains uncertain to what extent this translates into more patient-relevant outcomes.
PRAC undersøgte nøje alle de oplysninger, der var givet vedrørende et potentielt udækket medicinsk behov på nationalt plan, hvis markedsføringstilladelserne for HES-infusionsvæske, opløsning, skulle blive suspenderet.
The PRAC carefully considered all the information provided in relation to a potential unmet medical need at national level should the marketing authorisations for HES solutions for infusion be suspended.
CMDh vedtog desuden en plan for formidlingen af dette direkte brev til sundhedspersoner.
The CMDh also agreed on a communication plan for the dissemination of this DHPC.
Der kan således forventes en direkte korrelation mellem indikationen for behandling med HES-infusionsvæske, opløsning, den nødvendige dosis heraf, og risikoen for nyreskade og død.
Consequently, a direct correlation is to be expected between the indication for treatment with HES solutions for infusion, the dose of HES solutions for infusion required and with the risk for renal injury and death.
Under hensyn til meningsforskellene blandt eksperterne om visse vigtige spørgsmål, PRACmedlemmernes synspunkter på den nationale situation, hvad angår den kliniske anvendelse af disse lægemidler, og interessenternes svar, mener PRAC ikke, at lægemidlernes kliniske nytte opvejer risikoen for død og nyresvigt hos den andel af patienterne, der har kritisk sygdom eller sepsis, som fortsat vil blive eksponeret for HES-opløsninger til infusion.
Overall, taking into account the divergences amongst the experts on some important issues, the position from the PRAC members on the national situation regarding the clinical use of these products and the stakeholders submissions, PRAC did not consider the clinical utility of these products to outweigh the risk of mortality and renal failure to the proportion of patients with critical illness or sepsis that continue to be exposed to HES solutions for infusion.
PRAC har taget hensyn til alle elementer, der er udtrykt vedrørende den virkning, som en suspendering af markedsføringstilladelsen for HES-infusionsvæske, opløsning, vil have på et potentielt udækket medicinsk behov på nationalt plan, herunder de skriftlige og mundtlige bemærkninger fra indehaverne af markedsføringstilladelse, svarene fra medlemsstaterne samt andre interessenters synspunkter.
The PRAC has considered all elements expressed in relation to the impact of a suspension of the marketing authorisation for HES solutions for infusion on a potential unmet medical need at national level, including comments submitted by the MAHs in writing and at oral explanations, responses from Member States and other stakeholders' views.
HES-infusionsvæske, opløsning, fandtes desuden at blive anvendt til behandling af livstruende medicinske tilstande.
It was also considered that HES solutions for infusion are used for the treatment of life-threatening medical conditions.
• Udvalget for Risikovurdering inden for Lægemiddelovervågning (PRAC) har behandlet sagen vedrørende hydroxyethylstivelse (HES), infusionsvæske, opløsning (jf. bilag I) i henhold til proceduren i artikel 107i i direktiv 2001/83/EF.
• The Pharmacovigilance Risk Assessment Committee (PRAC) considered the procedure under Article 107i of Directive 2001/83/EC, for hydroxyethyl starch (HES) solution for infusion (see Annex I).
PRAC anbefalede desuden, at der blev foretaget et studie af lægemiddelanvendelse for at vurdere disse risikominimeringsforanstaltningers effektivitet.
PRAC also recommended a drug utilisation study to evaluate the effectiveness of these risk minimisation measures.
CMDh vedgik, at de ordinerende ikke ofte ville komme til at administrere opløsningen og derfor ikke ville se denne advarselsetiket.
See all contraindications in the SmPC.” The CMDh acknowledged that the prescribers would not often administer the solution and therefore could not see this warning label.
PRAC bemærkede, at de kliniske studier (TETHYS og PHOENICS), der blev pålagt efter de tidligere indbringelsesprocedurer med henblik på at beskrive HES-lægemidlers effekt og sikkerhed ved traumer og elektiv kirurgi, dvs. lægemidlernes målpopulation, stadig er i gang.
The PRAC noted that the clinical studies imposed following previous referrals procedures (TETHYS and PHOENICS) to characterise the efficacy and safety in trauma and elective surgery, which is currently the target population for which the product is indicated are ongoing.
PRAC har desuden yderligere overvejet risikominimeringsforanstaltningernes gennemførlighed og forventede effektivitet.
The PRAC have also further considered for the feasibility and likely effectiveness of risk minimisation measures.
Protokollen til studiet af lægemiddelanvendelse skal forelægges PRAC til vurdering senest 3 måneder efter Kommissionens afgørelse.
The DUS protocol should be submitted for assessment to the PRAC within 3 months of the Commission Decision.
I sin vurdering gennemgik PRAC den samlede evidens, herunder alle nytilkomne data siden de forrige indbringelsesprocedurer, herunder resultater fra studier af lægemiddelanvendelsen, kliniske studier, metaanalyser af kliniske studier, erfaring efter markedsføring, EudraVigilance-databasen, litteraturgennemgang, skriftlige og mundtlige svar fra indehaverne af markedsføringstilladelse samt interessentsvar og ekspertudtalelser fra et ad hoc-ekspertmøde, idet der også er taget hensyn til beskrivelsen af fordele og risici i de forrige indbringelsesprocedurer.
In its assessment, the PRAC considered the totality of evidence which includes all newly available data since the previous referral procedures, including results from DUSs, clinical studies, meta-analyses of clinical studies, post-marketing experience, Eudravigilance data, literature review, responses submitted by the marketing authorisation holders (MAHs) in writing and at oral explanations as well as stakeholders' submissions and views expressed by experts during an ad-hoc experts meeting, taking into account also the characterisation of benefits and risks concluded in the previous referral procedures.
Revideret begrundelse for PRAC's anbefaling
Revised grounds for PRAC recommendation
I protokollen bør indehaveren af markedsføringstilladelse tage hensyn til erfaringerne fra det tidligere udførte studie af lægemiddelanvendelse.
For this protocol, the MAH should take into account the experience gathered from the previously conducted DUS.
Ved elektiv kirurgi og traumepatienter er der godtgjort et positivt benefit/risk-forhold.
A positive benefit-risk balance has been established in elective surgery and trauma patients.
Udførelse af dette studie vil være en betingelse for markedsføringstilladelserne for HESinfusionsvæske, opløsning.
The conduct of this study will be a condition to the marketing authorisations for HES solutions for infusion.
PRAC konkluderede, at den påståede kliniske nytteværdi af disse produkter ikke opvejer risikoen for dødelighed og nyresvigt for den del af patienterne, der har kritisk sygdom eller sepsis og fortsat udsættes for HES-infusionsvæske, opløsning.
The PRAC concluded that the claimed clinical utility for these products does not outweigh the risk of mortality and renal failure to the proportion of patients with critical illness or sepsis that continues to be exposed to HES solutions for infusion.
PRAC konkluderede, at der ikke kan identificeres yderligere risikominimerende foranstaltninger eller kombinationer heraf til opnåelse af en tilstrækkelig sikker og effektiv anvendelse af HESopløsninger til infusion.
The PRAC concluded that no additional risk minimisation measure or combination of risk minimisation measures, to sufficiently ensure safe and effective use of HES solutions for infusion could be identified.
• Betydningen for klinisk praksis af en eventuel suspendering af markedsføringstilladelserne for HES-infusionsvæske, opløsning
• Impact on the clinical practice of potential suspension of MA for HES solutions for infusion
- Indehaveren af markedsføringstilladelsen forvalter akkrediteringen af hospitaler/centre og sikrer, at alle relevante sundhedspersoner, der er bestemt til at ordinere/administrere HESinfusionsvæske, opløsning, er tilstrækkelig oplært.
- The MAH should manage the accreditation of the hospitals / centres, ensuring that all relevant HCPs intended to prescribe/ administer HES solutions for infusion have been adequately trained.
PRAC overvejede yderligere risikominimeringsforanstaltninger, som potentielt kunne minimere denne eksponering tilstrækkeligt, herunder begrænsning af adgangen/distributionen til hospitaler og læger, ændringer i produktinformationen, et direkte brev til sundhedspersoner, oplysningsmateriale, der distribueres i samarbejde med visse videnskabelige samfund, en advarsel på produktets primære emballage, en medicinformular og et opfølgende spørgeskema.
The PRAC considered further risk minimisation measures which could potentially sufficiently minimise this exposure, including restricted access / distribution to hospitals and physicians, changes to the product information, direct health care professional communication, educational materials to be distributed in cooperation with some learned societies, warning on the primary container of the products, medication form and follow-up questionnaire.
• PRAC gennemgik alle nytilkomne data, herunder resultater fra studier af lægemiddelanvendelsen, kliniske studier, metaanalyser af kliniske studier, erfaring efter markedsføring, data fra EudraVigilance, litteraturgennemgang, skriftlige og mundtlige svar fra indehaverne af markedsføringstilladelse, interessentsvar samt ekspertudtalelser fra et ad hocekspertmøde.
• The PRAC reviewed all newly available data, including results from Drug Utilisation Studies (DUS), clinical studies, meta-analyses of clinical studies, post-marketing experience, Eudravigilance data, literature review, responses submitted by the marketing authorisation holders (MAHs) in writing and at oral explanations, stakeholders' submissions and views expressed by experts during an ad-hoc experts meeting.
CMDh vedtog derfor, at sundhedspersoner i et direkte brev skulle informeres om resultaterne af studierne af lægemiddelanvendelse, betingelserne i markedsføringstilladelserne og risikoen ved brug af HES-infusionsvæske, opløsning, uden for disse vilkår, samt de nye supplerende risikominimeringsforanstaltninger.
Therefore, the CMDh adopted a DHPC to inform HCPs of the results from the DUSs, the terms of the MA and the risks related to the use of HES solutions for infusion outside these terms, as well as the new additional risk minimisation measures.
Detaljeret videnskabelig begrundelse for afvigelserne fra PRAC's anbefaling
Detailed explanation of the scientific grounds for the differences from the PRAC recommendation
Resultaterne af studierne af lægemiddelanvendelse viste, at ca. 9 % af de patienter, der blev udsat for HES-infusionsvæske, opløsning, var kritisk syge, ca. 5-8 % havde nedsat nyrefunktion, og ca. 3-4 % havde sepsis.
Amendments to be included in the product information The DUSs results showed that approximately 9% of patients exposed to HES solutions for infusion were critically ill, approximately 5-8% of patients had renal impairment and approximately 3-4% of patients had sepsis.
• Desuden overvejede PRAC andre mulige foranstaltninger til yderligere minimering af disse risici, herunder ændringer i produktinformationen, direkte breve til sundhedspersoner, oplysningsmateriale, advarsel på den primære produktemballage, udfyldelse af medicinblanketter og receptlister/checklister og begrænsning af adgangs- og distributionssystemet til akkrediterede hospitaler/læger.
• Furthermore, the PRAC considered options for measures to further mitigate these risks, including changes to the product information, direct health care professional communication, educational materials, warning on the primary container of the products, sign-in for medication form, prescription sheet/checklists, restricted access and distribution system to accredited hospitals/physicians.
CMDh tog stilling til PRAC's reviderede anbefaling om at suspendere markedsføringstilladelserne for infusionsvæsker, opløsninger, der blev vedtaget på PRAC's plenarmøde i maj. CMDh tog desuden hensyn til besvarelserne af Europa-Kommissionens spørgsmål og de elementer, der var indsamlet af PRAC, samt oplysningerne fremlagt af indehaveren af markedsføringstilladelse ved de mundtlige redegørelser den 28. maj 2018 og 25. juni 2018.
The CMDh took also into consideration the responses to the questions raised by the European Commission and the elements collected by the PRAC, as well as the information provided by the MAH during the oral explanations held on 28 May 2018 and 25 June 2018.
Fordelen ved HES-infusionsvæske, opløsning, er påvist som volumenbesparende effekt, og der er i nogen grad holdepunkt for kortvarige hæmodynamiske virkninger, dog med nogen usikkerhed om, hvordan dette omsættes til mere patientrelevante udfald.
The benefit of HES solutions for infusion has been demonstrated in terms of volume-sparing effect, and there is some support for effects on short-term hemodynamic effects, although there is some uncertainty to what extent this translates into more patient-relevant outcomes.
Resultaterne af to studier af lægemiddelanvendelse vedrørende effektiviteten af de gennemførte risikominimerende foranstaltninger, blev tilgængelige 5. juli 2017 og 9. oktober 2017.
On 5th July 2017 and 9th October 2017, results from two DUSs on the effectiveness of the implemented risk minimisation measures have become available.
Som resultat af henvisningen i 2013 blev indehaveren af markedsføringstilladelsen pålagt at udføre studier efter markedsføring under disse kliniske betingelser som et vilkår for markedsføringstilladelserne for HESinfusionsvæske, opløsning.
As an outcome of the 2013 referral, post-authorisation studies were imposed to the MAHs in these clinical settings and are a condition to the terms of the MAs for HES solutions for infusion.
CHMP henstiller derfor ændring af betingelserne for markedsføringstilladelserne for HESinfusionsvæske, opløsninger.
Therefore the CMDh recommends the variation to the terms of the marketing authorisations for HES solutions for infusion.
• Det vedgås, at der er vanskeligheder ved efteruddannelse, men de vil kunne imødegås ved centraliseret tilrettelæggelse og overvågning fra indehaveren af markedsføringstilladelsen.
• Whilst acknowledging the difficulties of continuous training, centralising such organisation and monitoring by the MAH will address the challenges raised.
- Indehaveren af markedsføringstilladelsen afholder regelmæssigt oplæring i korrekt brug af HES-infusionsvæske, opløsning, for relevante sundhedspersoner efter aftale med de nationale kompetente myndigheder.
- The MAH should deliver the training on the appropriate use of HES solutions for infusion to relevant HCPs on a regular basis, as agreed with the national competent authorities.
PRAC konkluderede, at det ikke vil være effektivt eller realistisk at indføre yderligere risikominimerende foranstaltninger til opnåelse af sikker og effektiv anvendelse af HES-opløsninger til infusion inden for en rimelig tid, og at et stort antal højrisikopatienter stadig ville blive eksponeret.
The PRAC concluded that no additional risk minimisation measures to ensure safe and effective use of HES solutions for infusion would be effective or feasible in a reasonable timeframe, where important number of patients at high risk would continue to be exposed.
Begrundelse for afvigelserne fra PRAC's anbefaling
Grounds for differences with the PRAC recommendation
Det kan også være problematisk at skulle udfylde medicinblanketter/checklister i nødsituationer.
The medication form/checklists would also raise feasibility issues in an emergency setting.
PRAC vurderede også, at anvendelsen af HES-infusionsvæske, opløsning, hos patienter med sepsis eller kritisk sygdom er kontraindiceret.
The PRAC also contraindicated the use of HES solutions for infusion in patients with sepsis or who are critically ill.
PRAC var navnlig bekymret over, at ca. 9 % af de patienter, der blev eksponeret for HES-opløsninger til infusion, havde kritisk sygdom, ca. 5-8 % havde nedsat nyrefunktion, og ca. 3-4 % havde sepsis.
Overall non-adherence to the revised product information was reported to be high, and PRAC was particularly concerned that approximately 9% of patients exposed to HES solutions for infusion were critically ill, approximately 5-8% of patients had renal impairment and approximately 3-4% of patients had sepsis.
Disse studier såvel som igangværende frivillige kliniske studier (f.eks. FLASH-studiet) ville nærmere karakterisere virknings- og sikkerhedsprofilen ved elektiv kirurgi og for traumepatienter.
FLASH study) would further characterise the efficacy and safety profile in elective surgery and trauma patients.
PRAC henstillede også til, at anvendelsen af disse lægemidler bør undersøges med henblik på at vurdere effektiviteten af de risikominimerende foranstaltninger.
The PRAC also required that drug utilisation should be studied to evaluate the effectiveness of the risk minimisation measures.
CMDh noterede sig navnlig resultaterne af en høring af medlemsstaterne, hvor suspenderingen af markedsføringstilladelsen for HES-infusionsvæske, opløsning, ville få indflydelse på klinisk praksis, hvor HES beskrives som en egnet behandlingsmulighed.
• In particular, the CMDh noted the results of a consultation of Member States where the suspension of the marketing authorisation for HES solutions for infusion would have an impact on the clinical practice and concerns raised by those EU Member States about a potential medical need.
PRAC overvejede yderligere risikominimerende foranstaltninger for at opnå tilstrækkelig minimering af eksponeringen, herunder ændringer i produktinformationen, et brev direkte til sundhedspersoner, oplysningsmateriale, advarsel på den primære produktemballage, udfyldelse af medicinblanketter, receptlister/checklister.
The PRAC considered other further risk minimisation measures to sufficiently minimise this exposure, including changes to the product information, direct health care professional communication, educational materials, warning on the primary container of the products, sign-in for medication form, prescription sheet/checklists.
fortsat er gunstigt, forudsat at de vedtagne ændringer af produktinformationen og betingelser for markedsføringstilladelsen gennemføres.
As a consequence, the CMDh is of the position that the benefit-risk balance of HES solutions for infusion remains favourable subject to the agreed amendments to the product information and the conditions to the marketing authorisation.
- Indehaveren af markedsføringstilladelsen udarbejder uddannelsesmaterialet til de pågældende sundhedspersoner, der forventes at ordinere/administrere HES-infusionsvæske, opløsning, og aftaler dette materiales nøjagtige indhold og format med de pågældende nationale kompetente myndigheder.
Therefore, the CMDh is of the position that each MAH shall be responsible for the implementation and the supervision of the access controlled program as follows: - The MAH should develop the training materials for relevant HCPs expected to prescribe / administer HES solutions for infusion and agree the exact content and format of these materials with the relevant national competent authorities.
CMDh anmodede om, at programmet for kontrolleret adgang var faktisk implementeret senest 9 måneder efter Kommissionens afgørelse, idet CMDh tog hensyn til forskellighederne mellem de nationale systemer foruden nødvendigheden af en aftale med de nationale kompetente myndigheder om de nærmere enkeltheder ved gennemførelsen af den kontrollerede adgang, og den tid, det tager at gennemføre tilstrækkelig oplæring af alle sundhedspersoner, der er bestemt til at anvende HESprodukter, samt akkrediteringen af hospitaler/centre.
Having considered the specificities of the national systems and the need for agreement with the national competent authorities on the details on the implementation of the controlled access and the time required to complete the adequate training to all HCPs intended to use HES products and the accreditation of the hospitals/ centres, the CMDh requested that the controlled access program should be effectively implemented at the latest 9 months after Commission Decision.
Den tilgængelige evidens viser imidlertid, at den manglende overholdelse ikke kun skyldes de ordinerende lægers manglende bevidsthed om begrænsningerne, men også i nogle tilfælde kan tilskrives bevidste valg.
However, the available evidence shows that the non-adherence is not only due to a lack of awareness of the restrictions by prescribers but also due in some cases to deliberate choice, rendering further communication and education unlikely to be sufficiently effective to address the risks identified.
Forslagene om at ændre indikationerne og kontraindikationerne vurderes ikke at kunne påvirke de ordinerende lægers adfærd i tilstrækkelig grad. PRAC bemærkede også, at aktuel klinisk erfaring viser, at det er vanskeligt at foretage en klar sondring mellem de patientpopulationer, hvor der i randomiserede kliniske studier er set alvorlig skade, og de populationer, der er omfattet af den godkendte indikation.
The PRAC also noted that the current clinical experience suggests that it is difficult to clearly separate patient populations where randomised clinical trials have shown serious harm from populations targeted by the approved indication.
Den tilgængelige evidens viser imidlertid, at den manglende overholdelse ikke kun skyldes de ordinerende lægers manglende bevidsthed om begrænsningerne.
However, the available evidence shows that the non-adherence is not only due to a lack of awareness of the restrictions by prescribers, rendering further communication and education unlikely to be sufficiently effective.
• CMDh hæftede sig navnlig ved resultaterne af en høring af medlemsstaterne, hvor suspenderingen af markedsføringstilladelsen for HES-infusionsvæske, opløsning.
In particular, the CMDh noted the results of a consultation of Member States where the suspension of the
På baggrund af CMDh's indblik i de nationale sundhedssystemer fandt det, at følgende supplerende risikominimeringsforanstaltninger er gennemførlige og må forventes effektivt at ville minimere risikoen for, at HES-infusionsvæske, opløsning.
In view of the insight that the CMDh has on the national healthcare systems, it agreed that the following additional risk minimisation measures are feasible and likely to be effective to minimise the risk of using HES solutions for infusion in contraindicated populations: the inclusion of an emphasised warning on the SmPC, PL, primary and secondary packaging, the circulation of a targeted DHPC and the implementation of a controlled access program.