natgillin/translations-raw huggingface dataset:
Poolede metaanalyser af patientrapporterede udfald i short-form health survey (SF-36) og Walking Impairment Questionnaire (WIQ) viste betydeligt bedre virkning af cilostazol end placebo på fysisk funktion og fysisk komponentscore i SF-36 samt betydeligt bedre score for WIQ-hastighed og -distance.
Pooled meta-analyses of patient reported outcomes from the short-form health survey (SF-36) and the Walking Impairment Questionnaire (WIQ) demonstrated significant effects of cilostazol over placebo on physical functioning and the physical component score of the SF-36, as well as significant improvements in WIQ speed and distance scores.
Det blev dog bemærket, at cilostazols hæmmende virkning på fosfodiesterase (PDE-3) giver anledning til sikkerhedsmæssig betænkelighed ved potentialet for kardiale arytmier som følge af forhøjet hvilende hjertefrekvens (cilostazol er påvist at øge hjertefrekvensen med ~5,1 og ~7.4 slag/min ved den godkendte dosering).
However, it was noted that the activity of cilostazol as a phosphodiesterase enzyme (PDE-3) inhibitor raises a potential safety concern over cardiac arrhythmias that may result from the increase in resting heart rate (cilostazol has been demonstrated to increase heart rate by ~5.1 and ~7.4 beats per minute at the authorised doses).
På baggrund af den beskedne fordel ved cilostazol og de eksisterende sikkerhedsmæssige betænkeligheder er det udvalgets opfattelse, at anvendelsen af cilostazol bør begrænses til de patienter, der har størst gavn heraf, dvs. dem, hos hvem livsstilsændringer (rygestop og motionsprogrammer) og andre relevante interventioner ikke har haft tilfredsstillende virkning.
In view of the modest benefits of cilostazol and of the existing safety concerns, the Committee is of the view that the use of cilostazol should be restricted to those who would benefit the most from treatment, i.e. patients for whom life-style modifications (stopping smoking and exercise programs)
CHMP fandt derfor, at cilostazol bør være kontraindiceret hos patienter med ustabil angina pectoris, myokardieinfarkt inden for de seneste 6 måneder eller koronar intervention inden for de seneste 6 måneder, og at der skal indsættes supplerende advarsler herom i produktinformationen.
The CHMP therefore considered that cilostazol should be contraindicated in patients with unstable angina pectoris, myocardial infarction within the last 6 months, or a coronary intervention in the last 6 months, and that additional warning should be included in the PI.
For at minimere risikoen for metabolisk lægemiddelinteraktion er der indsat advarsler i produktresuméet, og der anbefales nu dosisreduktion til 50 mg to gange dagligt for patienter, som får medicin, der hæmmer CYP3A4 eller 2C19.
In order to minimise the risk of drug metabolism interaction, warnings have been introduced in the SmPC and it is now recommended to reduce the dose to 50mg bid in patients taking medicines that inhibit CYP3A4 or 2C19.
De spanske myndigheders hovedbetænkeligheder samlede sig om indberettede kardiovaskulære reaktioner (herunder fatale tilfælde af myokardieinfarkt, angina pectoris og arytmier) og hæmoragiske reaktioner samt lægemiddelinteraktioner.
The Spanish authority's main concerns centred on reports received of cardiovascular reactions (including fatal cases of MI, angina pectoris and arrhythmias) and haemorrhagic reactions as well as drug interactions.
Otte af dem var dobbeltblindede, kontrollerede fase IIIundersøgelser, hvoraf de to sammenlignede virkningen af cilostazol med et aktivt sammenligningsstof (pentoxifyllin) og med placebo i 24 uger.
These included eight double-blind controlled phase III trials, two of which compared the efficacy of cilostazol with an active comparator (pentoxifylline) and placebo over 24 weeks.
• udvalget finder, at fordelene ved cilostazol er beskedne, men at der er påvist statistisk signifikant forøgelse af gangdistancen i forhold til placebo ved claudicatio intermittens,
• The Committee considers that the benefit of cilostazol is modest but that a statistically significant increase in walking distance compared with placebo has been shown in patients with intermittent claudication;
Gennemgangen omfattede de foreliggende sikkerhedsdata for cilostazol fra undersøgelserne af virkning (mellemlange undersøgelser), den langsigtede sikkerhedsundersøgelse CASTLE og undersøgelserne vedrørende apopleksiforebyggelse samt case-rapporterne fra spontane indberetninger og ikkeinterventionelle undersøgelser.
Safety data for cilostazol available from the efficacy trials (mid-term trials), the long-term safety trial CASTLE and stroke prevention studies, as well as case reports from spontaneous sources and noninterventional studies were considered in this review.
Den terapeutiske indikation, der er godkendt i Europa for produkter indeholdende cilostazol, er forbedring af maksimal og af smertefri gangdistance hos patienter med claudicatio intermittens uden hvilesmerter og uden tegn på perifer vævsnekrose (perifer arteriel sygdom Fontaine stadie II).
The therapeutic indication that has been approved for cilostazol products in Europe is the improvement of the maximal and pain-free walking distances in patients with intermittent claudication (IC), who do not have rest pain and who do not have evidence of peripheral tissue necrosis (peripheral arterial disease (PAD) Fontaine stage II).
Også de vasodilaterende virkninger af cilostazol kan være medieret af en stigning i koncentrationen af cAMP.
The vasodilatory effects of cilostazol may also be mediated through an increase in cAMP.
Det hæmmer desuden proliferationen af glatmuskulaturceller, nedsætter triglyceridkoncentrationen og øger koncentrationen af HDL-kolesterol.
It also inhibits the vascular smooth muscle cell proliferation as well as decreases triglycerides and increases HDL-cholesterol.
På grund af den forhøjede eksponering for cilostazol ved samtidig brug af CYP3A4- og CYP2C19-hæmmere (såsom erythromycin, ketoconazol og omeprazol) fandt CHMP, at der er stort potentiale for interaktion med andre lægemidler, som kan øge risiciene ved cilostazol, hvorfor ordlyden af produktresuméets punkt 4.5 bør skærpes.
Given the increase in exposure to cilostazol resulting from concomitant use of CYP3A4 and CYP2C19 inhibitors (such as erythromycin, ketoconazole and omeprazole), the CHMP considered that there is a high potential for interactions with other medicinal products that could increase the risks associated with cilostazol and therefore considered that the SmPC wording in section 4.5 should be strengthened.
Betænkelighederne ved interaktioner med andre lægemidler (navnlig CYP3A4- og CYP2C19-hæmmere) og muligheden for øget bivirkningsrisiko er imødekommet gennem anbefalingen om dosisreduktion til 50 mg to gange dagligt for patienter, der samtidig får lægemidler, som hæmmer disse enzymer.
The concerns relating to interactions with other medications (in particular CYP3A4 and CYP2C19 inhibitors) and the possibility of an increased risk for adverse effects have been addressed by the recommendation of a dose reduction to 50mg bid in patients taking concomitant medicines that inhibit these enzymes.
Cilostazols virkning på absolut gangdistance i trædemølle, angivet som absolut forøgelse i forhold til baseline, var mellem +23 m og +109 m, sammenholdt med mellem -2 m og +65 m for placebo.
Cilostazol's effect on absolute walking distances on the treadmill, expressed as an absolute increase over baseline walking distance ranged from +23m to +109m, compared with -2m to +65m for placebo.
Den beregnede WMD viser en gennemsnitlig forbedring i gangdistance fra baseline på 87,4 m for cilostazol, 100 mg to gange dagligt, og 43,7 m for placebo (p<0,0001), hvor den gennemsnitlige gangdistance ved baseline var ca. 133 m (66 % forbedring med cilostazol).
The WMD estimates a mean improvement from baseline for walking distance of 87.4m for cilostazol 100mg bid and 43.7m for placebo (p<0.0001) with a mean baseline walking distance of about 133m (66% improvement with cilostazol).
Eksperterne var af den opfattelse, at cilostazol er til fordel for patienter, der har begrænsende claudicatio intermittens og ikke kan klare et motionsprogram, da de lettere vil kunne komme over “den første forhindring”, så de får mulighed for yderligere at forbedre deres gangdistance ved træning.
The experts were of the view that cilostazol has a beneficial effect in patients with limiting intermittent claudication who cannot manage an exercise program in getting such patients over “the first hurdle” that would then allow them to continue progression of their walking distance through exercise.
Desuden påtog indehaveren af markedsføringstilladelsen sig at udføre en mekanismeundersøgelse, der skal give bedre indblik i cilostazols virkninger på trombocytaggregationen med acetylsalicylsyre eller clopidogrel og indvirkningen heraf på blødningstiden.
In addition, the MAH agreed to perform a mechanistic study to provide further insight into the effects on platelet aggregation of cilostazol with aspirin or clopidogrel and their consequences on bleeding time.
De sekundære endepunkter for virkning var smertefri gangdistance (initial claudicatio-distance, ICD), målt ved motionstest i trædemølle, og livskvalitetsvurdering.
Secondary efficacy endpoints included painfree walking distance (initial claudication distance - ICD) measured by treadmill exercise; and Quality of Life assessments.
• udvalget konkluderede følgelig, at benefit/risk-forholdet for lægemidler indeholdende cilostazol under normale anvendelsesbetingelser kun er positivt til andetvalgsbehandling af patienter, hos hvem livsstilsændringer og andre hensigtsmæssige interventioner ikke har medført tilstrækkelig bedring i symptomerne på claudicatio intermittens, og under forudsætning af gennemførelse af de vedtagne risikominimeringsforanstaltninger, herunder ændringer i produktinformationen,
• The Committee, as a consequence, concluded that the benefit-risk balance of cilostazol-containing medicinal products is positive under normal conditions of use only for second-line use, in patients in whom lifestyle modifications and other appropriate interventions have failed to sufficiently improve their intermittent claudication symptoms, and subject to the agreed risk minimisation measures, including changes to the product information.
De hyppigste bivirkninger var hovedpine, diarré, abnorm afføring, svimmelhed, palpitationer og takykardi, hvilke i forvejen er anført i produktinformationen.
The most common adverse events included headache, diarrhoea, abnormal stools, dizziness, palpitations and tachycardia, already listed in the Product Information.
Cilostazol er et dihydroquinolinonderivat, der hæmmer nedbrydningen af cAMP ved at hæmme cyklisk adenosinmonofosfat- (cAMP-) fosfodiesterase og derved øger koncentrationen af cAMP i trombocytter og blodkar.
Cilostazol is a dihydroquinolinone derivative that inhibits cyclic adenosine monophosphate (cAMP) phosphodiesterase, suppressing cAMP degradation and thereby increasing cAMP levels in platelets and blood vessels.
Metaanalysen af vægtet middelforskel (WMD) for alle ni undersøgelser viste ligeledes konsistent virkning af cilostazol i alle undersøgelserne.
The meta-analysis of weighted mean difference (WMD) across the nine trials also demonstrated consistent efficacy of cilostazol across the trials.
I CASTLE-undersøgelsen bemærkedes en lille overhyppighed af hjertesvigt (cilostazol: 2,9 %, mod placebo: 2,4 %) og af hypotension (cilostazol: 0,7 %, mod placebo: 0,1 %).
It was noted that there was a small excess of cases of heart failure (cilostazol: 2.9%, vs. placebo: 2.4%) and hypotension (cilostazol: 0.7%, vs. placebo: 0.1%) in the CASTLE study.
I CASTLE-undersøgelsen var der færre blødningsepisoder i cilostazolarmen end i placeboarmen, og samtidig brug af acetylsalicylsyre øgede ikke blødningsfrekvensen i den undergruppe, der fik cilostazol.
In the CASTLE trial, a lower bleeding event rate was observed in the cilostazol arm than in the placebo arm and the use of concomitant aspirin did not increase the frequency of bleeding in the sub-group treated with cilostazol.
I den første undersøgelse indhentes baseline-data til karakterisering af nye brugere af cilostazol og mønsteret for anvendelsesvarighed og seponering.
The first DUS' will obtain baseline data with the objective to describe the characteristics of new users of cilostazol and the duration of the use of cilostazol and discontinuation patterns.
Overordnet var det gruppens opfattelse, at dette lægemiddel kan have berettigelse hos en lille patientgruppe, som har lav risiko for kardiovaskulær komorbiditet, som lider af begrænsende claudicatio intermittens, og som ikke kan klare den indledende rehabilitering med motion eller er uegnede til revaskularisering.
Overall, the group was of the view that for a small group of patients with low risk of cardiovascular co-morbidities, limiting intermittent claudication who cannot manage initial exercise rehabilitation, or who are unsuitable for revascularisation, this drug may have a role.
CHMP fandt derfor, at cilostazol har en statistisk signifikant, omend moderat virkning på gangdistancen hos patienter med claudicatio intermittens, og at nogle patienter kan have klinisk relevant gavn heraf.
The CHMP was therefore of the opinion that cilostazol has a statistically significant, albeit modest effect on walking distances in patients with IC and that some patients may benefit to a clinically relevant degree.
Cilostazol medfører en beskeden, men statistisk signifikant forøgelse i gangdistance i forhold til placebo hos patienter med claudicatio intermittens, og dette er også påvist ved livskvalitetsvurderinger.
Cilostazol is associated with a modest but statistically significant increase in walking distance compared with placebo in patients with IC, and this has also been demonstrated using quality of life measurements.
Hazard ratio for dødelighed (cilostazol mod placebo) var 0,94 med 95 % SI
The hazard ratio for mortality (cilostazol vs. placebo) was 0.94, 95% CI [0.63-1.39].
På denne baggrund fandt CHMP, at cilostazol bør være kontraindiceret hos patienter med svær takyarytmi i anamnesen, og at der bør indsættes yderligere advarsler i produktinformationen.
In view of this, the CHMP considered that cilostazol should be contraindicated in patients with a history of severe tachyarrhythmia and that additional warnings should be introduced in the PI.
Ved samtidig behandling med både acetylsalicylsyre og clopidogrel var der imidlertid større blødningsrisiko i gruppen på cilostazol end i placebogruppen.
However, concomitant aspirin and clopidogrel treatment together increased the risk of bleeding in the cilostazol group compared with the placebo patients.
Ligeledes bør behandlingen med cilostazol kun iværksættes af læger med erfaring i behandling af claudicatio intermittens, og kun efter forudgående nøje overvejelse af egnetheden af behandling med cilostazol sammenlignet med andre behandlingsmuligheder såsom revaskularisering.
Also, cilostazol should only be initiated by physicians experienced in the management of intermittent claudication after suitability of treatment with cilostazol has been carefully considered, alongside other treatment options such a revascularisation.
Undersøgelsen skal desuden søge at kvantificere ikke godkendt anvendelse, beskrive doseringsmønstrene og kortlægge, inden for hvilke specialer der ordineres cilostazol.
The study will also aim to quantify off-label use, describe dosage patterns and identify the medical specialties of physicians prescribing cilostazol.
I alle undersøgelser af virkning medførte cilostazol procentuelt større forbedring af ACD end placebo, og forskellen var statistisk signifikant i seks af de ni undersøgelser.
In all efficacy trials cilostazol showed a higher percentage improvement in ACD when compared with placebo and this was statistically significant in 6 of the 9 trials.
CHMP bemærkede, at der må forventes større forskel i gangdistance på vandret underlag end i trædemøllensom svarer til en opadskrånende flade.
It was noted by the CHMP that the increase in walking distance on flat ground is likely to be greater than the increase measured on the treadmill - which is set on an incline.
I betragtning af sine trombocytfunktionshæmmende egenskaber forventes cilostazol desuden at øge blødningsrisikoen.
In addition, considering its anti-platelet activity, cilostazol is expected to increase the risk of bleeding.
På denne baggrund fandt CHMP, at patienter, der er i samtidig behandling med to eller flere yderligere trombocytfunktionshæmmende midler eller antikoagulantia (f.eks. acetylsalicylsyre, clopidogrel, heparin,
In view of this, the CHMP considered that patients treated concomitantly with two or more additional antiplatelet or anticoagulant agents (e.g. aspirin acetylsalicylic acid, clopidogrel, heparin, warfarin, acenocoumarol, dabigatran, rivaroxaban or apixaban) should not be treated with cilostazol-containing products.
Den primære analyse, der var prædefineret i protokollerne, viste statistisk signifikant større gangdistance med cilostazol, 100 mg to gange dagligt, end med placebo.
The primary analysis, pre-specified in the protocols, demonstrated a statistically significant longer walking distance in patients receiving cilostazol 100mg bid over placebo.
Udvalget konkluderede, at benefit/risk-forholdet under normale omstændigheder fortsat er positivt for produkter indeholdende cilostazol til forbedring af maksimal gangdistance og maksimal smertefri gangdistance ved claudicatio intermittens uden hvilesmerter og uden tegn på perifer vævsnekrose (perifer arteriel sygdom Fontaine stage II), forudsat at der gennemføres de vedtagne begrænsninger, advarsler, ændringer i produktinformationen og risikominimeringsforanstaltninger.
The Committee concluded that the benefit-risk balance of cilostazol products for the improvement of the maximal walking distance and maximal pain-free walking distances in patients with intermittent claudication (IC), who do not have rest pain and who do not have evidence of peripheral tissue necrosis (peripheral arterial disease Fontaine stage II) remains positive under normal conditions of use, subject to restrictions, warning, changes to the product information and risk minimisation measures agreed.
I de spontane indberetninger/ikke-interventionelle undersøgelser var der imidlertid enkelte alvorlige hændelser (ventrikulær takykardi, QT-forlængelse i EKG (herunder Torsade de Pointes)), hvoraf nogle blev anset for forenelige med de kronotrope virkninger af cilostazol.
The results from clinical trials did not generate any signal of serious cardiac arrhythmic events, but a small number of serious events (ventricular tachycardia, electrocardiogram QT prolongation (including Torsade de Pointes)) were received from spontaneous sources/non-interventional studies and some of these were considered compatible with the chronotropic effects of cilostazol.
Cilostazol øgede gangdistancen i forhold til baseline 35 % mere end placebo.
The increase in walking distance over baseline walking distance with cilostazol treatment was 35% higher than with placebo.
Hvad sikkerheden angår, er de hyppigst indberettede bivirkninger i de kliniske undersøgelser hovedpine, diarré, svimmelhed, palpitationer, perifert ødem og takykardi, som i forvejen var nævnt i produktinformationen.
In terms of safety, clinical trial data showed that the most commonly-reported adverse events are headaches, diarrhoea, dizziness, palpitations, peripheral oedema and tachycardia, and these adverse events were listed in the product information.
Vedrørende den kardiovaskulære sikkerhed fandt de det meget betryggende, at den gældende vedtagne CV MACE for undersøgelse af nye lægemidler (kardiovaskulære dødsfald, ikke-fatalt myokardieinfarkt og apopleksi) var signifikant lavere i behandlingsgruppen, selv om dette var fundet ved post hoc-analyse.
Although a post-hoc analysis, the demonstration that the current accepted CV MACE in studies of new drugs (CV death, non-fatal MI and stroke) was statistically significantly lower in the treatment group was felt to give strong reassurance on CV safety.
Cilostazol er et dihydroquinolinonderivat i den farmakoterapeutiske klasse antitrombotiske midler, trombocytfunktionshæmmende midler, andre trombocytaggregationshæmmere end heparin.
Cilostazol is a dihydro-quinolinone derivative that belongs to the pharmacotherapeutic group antithrombotic agents, platelet aggregation inhibitor excluding heparin.
Gruppen tilsluttede sig anbefalingen om dosisnedsættelse til 50 mg to gange dagligt til visse patientundergrupper som foreslået af indehaveren af markedsføringstilladelsen.
The proposal from the MAHs to recommend a reduction to 50mg bid in some patient sub-groups was welcomed by the group.
I alle ni undersøgelser var punktestimaterne til fordel for cilostazol, 100 mg to gange dagligt, sammenlignet med placebo, og i seks af de ni undersøgelser påvistes statistisk superioritet af cilostazol, 100 mg to gange dagligt, over placebo.
Point estimates in all nine trials favoured cilostazol 100mg bid over placebo and the analysis demonstrated statistical superiority of cilostazol over placebo in six of the nine trials.
Den anden undersøgelse skal gennem sammenholdelse med baseline-data vurdere effektiviteten af de foreslåede ændringer af produktresuméet, efteruddannelsestiltagene og de øvrige gennemførte risikominimeringsforanstaltninger på undgåelse af ikke-godkendt brug og på de ordinerende lægers overholdelse af produktresuméet.
The second DUS will have the objective to evaluate the effectiveness of the proposed SmPC changes, educational initiatives and other implemented risk minimisation measures in terms of the mitigation of off-label use and adherence of prescribers to the SmPC, in comparison with baseline data.
CHMP
Whereas
Den trombocytfunktionshæmmende aktivitet af cilostazol gav desuden anledning til betænkelighed vedrørende blødningsepisoder.
The anti-platelet activity of cilostazol also raised a concern for haemorrhagic events.
Af de patienter, der gennemførte, var der flere respondenter blandt de cilostazol-behandlede end blandt de placebobehandlede (39,6 % mod 26,3 %).
A greater proportion of ‘completers' treated with cilostazol were classified as ‘responders' than those treated with placebo (39.6%, vs. 26.3% ) with ‘responders' defined as those patients whose walking distance had improved by 50% or more from baseline.
I vurderingen blev der taget hensyn til livskvalitets- og responderanalyse, da disse data giver nogen indsigt i den kliniske relevans af behandlingsvirkningen.
Data relating to quality of life assessments and responder analyses was considered in the assessment as these data give some insight into the issue of the clinical relevance of the treatment effect, which is complicated by the fact that patients are likely to have different levels of benefit depending on the severity of their intermittent claudication (IC) symptoms.
CHMP vedtog desuden foranstaltninger til at sikre, at sundhedspersoner informeres om anvendelsesbetingelserne for produktet, Endelig godkendte udvalget to undersøgelser af lægemiddelanvendelse, der skal karakterisere nye brugere af cilostazol og mønsteret i anvendelsen af cilostazol og dets seponering for derigennem at vurdere effektiviteten af de gennemførte risikominimeringsforanstaltninger,
Finally The Committee agreed to drug utilisation studies to describe the characteristics of new users of cilostazol and the duration of the use of cilostazol and discontinuation patterns, and thereby to evaluate the effectiveness of the implemented risk minimisation measures;
Analysen viste en behandlingsvirkning på 1,15 (95 % SI for ACD: [1,11; 1,19].
A pooled meta-analysis of these trials using the ratio of geometric means for LOG (ACD at last visit/ACD at baseline) for cilostazol vs. placebo demonstrated a treatment effect of 1.15 (95% CI: 1.11 - 1.19) for ACD.