natgillin/translations-raw huggingface dataset:
Udvalget fandt desuden, at de konstaterede kortikosteroide virkninger af Flutiform ikke er mindre end af GSK fluticasonpropionatinhalatoren, og at formoterolfumarat ikke i nævneværdigt omfang ”maskerer” en eventuel nedsat kortikosteroid effekt.
Committee was also of the opinion that the corticosteroid effects seen with Flutiform are no less than those seen with GSK fluticasone propionate pMDI and that formoterol fumarate does not appreciably “mask” any lesser corticosteroid effect.
Den klart lavere systemiske tilgængelighed af fluticasonpropionat i Flutiform end i GSK fluticasonpropionat-inhalatoren synes ikke at medføre ringere klinisk virkning.
The apparent lower systemic availability of fluticasone propionate in Flutiform compared with GSK fluticasone propionate pMDI would not appear to result in a lesser clinical effect.
Disse resultater må ses i sammenhæng med dem, der viser, at de kliniske virkninger af Flutiform er sammenlignelige med de kliniske virkninger af GSK fluticasonpropionat og Novartis formoterolfumarat indgivet samtidigt.
These findings should be taken together with the results that show that the clinical effects of Flutiform are comparable with the clinical effects of GSK fluticasone propionate and Novartis formoterol fumarate given concomitantly.
Forholdet mellem de årlige eksacerbationsrater var 0,98, dvs. meget tæt på 1, for Flutiform 500µg/20µg versus fluticasonpropionat 500µg + formoterolfumarat 24µg, hvilket således tyder på non-inferioritet, som dog ikke er statistisk sikker.
An annual exacerbation rate ratio of 0.98, i.e. very close to unity for the comparison of Flutiform 500µg/20µg versus fluticasone propionate 500µg + formoterol fumarate 24µg was therefore suggestive of non-inferiority but was not statistically definitive.
På grundlag af den langsigtede prædiktive værdi af FEV1, de konstante FEV1-værdier efter 8-12-ugers behandling og det iagttagne mønster af FEV1-dataene i de fem hovedundersøgelser konkluderede CHMP, at der ikke er grund til at forvente, at den langsigtede eksacerbationsrisiko med Flutiform er større end med fluticasonpropionat alene (“optrapningsindikationen”) eller med fluticasonpropionat kombineret med formoterolfumarat “substitutionsindikationen”).
In conclusion, given the long-term predictive value of FEV1, given the static nature of FEV1 after 8 to 12 weeks of treatment, and given the pattern of the FEV1 data observed in the five pivotal studies, the CHMP considers there to be no reason to anticipate that the long-term exacerbation risk with Flutiform may exceed that with fluticasone propionate alone (the “Step-up” indication) or fluticasone propionate in combination with formoterol fumarate (the “Switch” indication).
Ansøgeren angav nogle eventuelle årsager til sådanne overensstemmelser: De kan være betinget af inhalationsprodukters særlige pulmonale farmakokinetik, idet blodkoncentrationen af inhalationsprodukter (modsat f.eks. tabletter) er et “post-event” (snarere end “preevent”) surrogat for virkning, og idet sædvanlig farmakokinetisk analyse ikke nødvendigvis beskriver lægemidlets tilstedeværelse på det pulmonale virkningssted.
The Applicant presented some reasons which could potentially explain such discordance: this could be a function of the deviation of orally inhaled product (OIP) pulmonary PK from standard PK principles, i.e. unlike conventional PK analysis (e.g. for tablets) blood concentrations of OIPs are a “post-event” (rather than “pre-event”) surrogate for efficacy and standard PK analysis does not necessarily define drug residence at the pulmonary site of action.
CHMP fandt ikke, at der er behov for kliniske undersøgelser af 6-12 måneders varighed til yderligere belysning af graden af astmakontrol eller fastlæggelse af eksacerbationsraterne med Flutiform sammenlignet med fluticasonpropionat alene eller kombineret med formoterolfumarat.
The CHMP was of the view that clinical data generated over 6 to 12 months to further elucidate the level of asthma control and to further assess exacerbation rates seen with Flutiform compared with fluticasone propionate administered concomitantly with formoterol fumarate or administered alone, are not required.
CHMP bemærkede, at forskellen i biotilgængelighed mellem Flutiform og GSK fluticasonpropionat i undersøgelse FLT1501 (67 % relativ biotilgængelighed) ligger inden for den variation, der iagttages for samme patient (fra inhalation til inhalation) mellem forskellige batcher af samme produkt og mellem forskellige inhalatorer indeholdende samme aktive stof(fer).
The CHMP noted that the differences of the magnitude observed between Flutiform and GSK fluticasone propionate in Study FLT1501 (67% relative bioavailability) are within the same range of variance as observed within patients (from inhalation to inhalation), between different batches of the same product and between different inhalers containing the same or more than one of the same active substances and are without adverse clinical consequences, and therefore are likely to be clinically irrelevant.
Det er et multidimensionalt begreb, der indbefatter symptomer, natlige opvågninger,
It is a multidimensional concept incorporating symptoms, night time awakenings, use of rescue medication, lung function and activity limitation.
Desuden tyder uoverensstemmelsen mellem de farmakokinetiske og farmakodynamiske data for Flutiform på, at de farmakokinetiske data ikke afspejler den relative afsætning i lungerne nøjagtigt og ikke er et gyldigt surrogat for klinisk virkning.
Furthermore, the discordance between the PK and PD data for Flutiform suggests that the PK data do not accurately reflect comparative pulmonary deposition and are not a valid surrogate for clinical effect.
Hvad angår “substitutionsbehandling” accepterede CHMP den af ansøgeren fremlagte analyse og var af den opfattelse, at de kliniske virkninger af Flutiform på astmakontrol og eksacerbationsrisiko er sammenlignelige eller identiske med de kliniske virkninger af GSK fluticasonpropionat og Novartis formoterolfumarat givet samtidigt.
With regard to the “Switch” therapy, the CHMP accepted the discussions presented by the Applicant and was of the view that the clinical effects of Flutiform in respect of asthma control and exacerbation risk are comparable with/similar to the clinical effects of GSK fluticasone propionate and Novartis formoterol fumarate given concomitantly.
Langtidsvirkende β-agonister virker modulerende på flere endepunkter, der afspejler disse forskellige facetter af astmakontrol.
Several endpoints which reflect these different facets of asthma control are modulated by long-acting β-agonists.
Den relative steady state-biotilgængelighed af fluticasonpropionat efter administration af Flutiform var 67 % af biotilgængeligheden ved brug af GSK fluticasonpropionat-inhalator.
The relative bioavailability of fluticasone propionate at steady state was 67% following Flutiform administration compared with GSK fluticasone propionate pMDI.
• Udvalget konkluderede derfor, at benefit/risk-forholdet for Flutiform til de ansøgte indikationer er gunstigt anbefalede CHMP udstedelse af markedsføringstilladelse, for hvilken produktresuméet, etiketteringen og indlægssedlen er uændrede svarende til endelige version, der er fastlagt ved behandlingen i koordinationsgruppen som anført i bilag III for Flutiform og relaterede navne (se bilag I).
the CHMP has recommended the granting of the marketing authorisation for which the summary of product characteristics, labelling and package leaflet remain as per the final versions achieved during the Coordination group procedure as mentioned in Annex III for Flutiform and associated names (see Annex I).
Dataene fra ansøgeren viser, at der opnås bedre astmakontrol med Flutiform end med fluticasonpropionatinhalator alene, og at der opnås samme astmakontrol med Flutiform som med fluticasonpropionatinhalator + formoterolfumarat-inhalator.
Data submitted by the Applicant demonstrated that asthma control with Flutiform is superior to that with fluticasone propionate pMDI alone and that asthma control with Flutiform is similar to that with fluticasone propionate pMDI + formoterol fumarate pMDI.
Disse farmakokinetiske og farmakodynamiske undersøgelser omfattede begge de samme styrker og doseringer af Flutiform, GSK fluticasonpropionatinhalator og Novartis formoterolfumarat-inhalator, og der blev anvendt samme afstandsstykke til alle produkter i de to undersøgelser.
These PK and PD studies both included the same strengths/doses of Flutiform, GSK fluticasone propionate pMDI and Novartis formoterol fumarate pMDI, and all products in both studies were administered via the same spacing device, so allowing a valid comparison of PK and PD data.
En analyse af den årlige eksacerbationsrate i denne undersøgelse gjorde det imidlertid muligt at differentiere virkningerne af højdosis-ICS-LABA - (inhaleret kortikosteroid + langtidsvirkende β2-agonist) (Flutiform 500µg/20µg og fluticasonpropionat 500µg + formoterolfumarat 24µg) - fra lavdosis-ICS-LABA (fluticasonpropionat 100µg/10µg) og fra fluticasonpropionat 500µg som monoterapi.
However, an analysis of annualised exacerbation rates in this study was able to differentiate the effects of high dose ICS-LABA (inhaled corticosteroid - long-acting β2 agonist) treatments (Flutiform 500µg/20µg and fluticasone propionate 500µg + formoterol fumarate 24µg) from low dose ICS-LABA treatment (fluticasone propionate 100µg/10µg) and fluticasone propionate 500µg monotherapy.
Ca. 20 personer i hver arm af dette parallelgruppeforsøg fik enten Flutiform, 500/20 (fluticasonpropionat 500µg og formoterolfumarat 20µg) eller GSK fluticasonpropionat-inhalator, 500µg, + Novartis formoterolfumarat-inhalator, 24µg.
Approximately 20 subjects in each arm of this parallel group study were administered Flutiform 500/20 (fluticasone propionate 500µg and formoterol fumarate 20µg) or GSK fluticasone propionate 500µg pMDI + Novartis formoterol fumarate 24µg pMDI.
Ansøgerens undersøgelser viser, at med henblik på “optrapning” var odds for “enhver” eksacerbation 33 % højere på fluticasonpropionat end på Flutiform (p=0,019), og den årlige eksacerbationsrate 49 % højere på fluticasonpropionat end på Flutiform (p=0,004).
Turning to the available data in the Applicant's studies, for the “Step-up” comparison the odds of “any” exacerbation were 33% higher in fluticasone propionate- than Flutiform-treated patients (p=0.019) whilst the annual exacerbation rate was 49% higher in fluticasone propionate- than Flutiform-treated patients (p=0.004).
Denne undersøgelses FEV1-data før dosering var igen bestemt af en påviseligt inhalationskortikosteroid-medieret virkning og gav ikke holdepunkt for, at Flutiform skulle resultere i ringere inhalationskortikosteroid-virkning end fluticasonpropionat + formoterolfumarat.
The pre-dose FEV1 data in this study which were again a demonstrably inhaled corticosteroid-mediated effect provided no evidence of a lesser inhaled corticosteroid effect with Flutiform than seen with fluticasone propionate + formoterol fumarate.
For “optrapningsindikationen” accepterede CHMP ligeledes ansøgerens analyse og fandt, at Flutiform udviser superioritet med hensyn til astmakontrol i forhold til GSK fluticasonpropionat administreret alene.
With regard to the “Step-up” indication, again the CHMP accepted the discussions presented by the Applicant and was of the view that the clinical effects of Flutiform in respect of asthma control are superior to the clinical effects of GSK fluticasone propionate administered alone.
De kliniske resultater indikerer non-inferioritet af den kliniske virkning af fluticasonpropionat i Flutiform i forhold til GSK fluticasonpropionat.
The clinical findings suggest that fluticasone propionate in Flutiform is non-inferior in respect of clinical effects to GSK fluticasone propionate.
Selv hvis de farmakokinetiske data for Flutiform nøjagtigt afspejler lægemidlets relative afsætning i lungerne i forhold til GSK fluticasonpropionat-inhalator, viser litteraturdata, at denne forskel ikke er klinisk relevant.
Literature data indicate that even if the PK data accurately reflect comparative pulmonary drug deposition for Flutiform versus GSK fluticasone propionate pMDI, such differences are not of clinical relevance.
Flutiform i den lave dosis (100µg/10µg) havde samme virkning på FEV1 før dosering som den høje dosis af GSK fluticasonpropionat, 500µg (alene eller kombineret med formoterolfumarat, 24µg).
Effects with the low dose of Flutiform (100µg/10µg) upon pre-dose FEV1 were similar to those with the high dose of GSK fluticasone propionate 500µg (alone or in combination with formoterol fumarate 24µg).
Denne sammenligning viste, at trods den mindre relative biotilgængelighed af fluticasonpropionat var virkningen på FEV1 før dosering (som påviseligt blev medieret af fluticasonpropionat alene i undersøgelse FLT3503) i absolutte tal større med Flutiform, 500µg/20µg, end med GSK fluticasonpropionat, 500µg (enten alene eller kombineret med Novartis formoterolfumarat, 24µg).
This comparison showed that despite a lower relative fluticasone propionate bioavailability, the effect upon pre-dose FEV1 (which was demonstrably mediated by fluticasone propionate alone in Study FLT3503) was numerically greater with Flutiform 500µg/20µg than with GSK fluticasone propionate 500µg (either alone or in conjunction with Novartis formoterol fumarate 24µg).
For “substitutionsindikationen” var den andel af patienterne, der fik eksacerbationer i hovedundersøgelsen vedrørende “substitution” (undersøgelse FLT3503), den samme på Flutiform og fluticasonpropionat + formoterolfumarat (henholdsvis 36,4 % og 35,3 %).
With regard to the “Switch” indication, the proportion of patients experiencing exacerbations in the pivotal “Switch” study (Study FLT3503) was similar in Flutiform and fluticasone propionate + formoterol fumarate treated patients (36.4% and 35.3%, respectively) although this analysis lacked discriminative capacity as the proportion of fluticasone propionate monotherapy-treated patients experiencing exacerbations was similar (37.4%).
Ved sammenholdelse af disse farmakokinetiske data med de farmakodynamiske data fra undersøgelse FLT3503 ses, at uanset at biotilgængeligheden af fluticasonpropionat i det nye faste kombinationsprodukt var relativt mindre, var virkningen på FEV1 inden dosering (påviseligt medieret af fluticasonpropionat alene i undersøgelse FLT3503) numerisk større med Flutiform, 500µg/20µg, end med GSK fluticasonpropionat, 500µg (hvad enten dette blev administreret alene eller sammen med Novartis formoterolfumarat, 24µg).
In addition, the comparison of these PK data with PD data, Study FLT3503, shows that despite the lower relative bioavailability of fluticasone propionate in this new fixed-dose combination product the effect upon predose FEV1 (which was demonstrably mediated by fluticasone propionate alone in Study FLT3503) was numerically greater with Flutiform 500µg/20µg than with GSK fluticasone propionate 500µg (either administered alone or administered together with Novartis formoterol fumarate 24µg).
Det var instruktivt, at den farmakodynamiske undersøgelse desuden omfattede en lavere dosis af Flutiform (100µg/10µg).
The inclusion of a second, lower dose of Flutiform (100µg/10µg) in the PD study was also instructive.
Odds for forekomst af enhver eksacerbation var således 33 % højere og den årlige eksacerbationsrate 49 % højere for patienter på GSK fluticasonpropionat end på Flutiform (p= henholdsvis 0,019 og 0,004).
The data presented in respect of exacerbations demonstrate an increased protective benefit of Flutiform compared with GSK fluticasone propionate administered alone - the odds of any exacerbation occurring were 33% higher and the annual exacerbation rate was 49% higher in patients receiving GSK fluticasone propionate than in patients receiving Flutiform, p=0.019 and p=0.004, respectively.
I den tredje undersøgelse havde formoterol nogen resterende virkning på FEV1-værdierne før dosering, dog ikke tilstrækkelig til at forklare forskellen mellem Flutiform og fluticasonpropionatinhalator hvad angår behandlingseffekten på FEV1-værdierne før dosering.
Assessment of the pre-dose FEV1 data in the three specified studies demonstrated that in two of the three studies formoterol fumarate has no effect upon pre-dose FEV1 whilst in the third study there was some residual formoterol effect upon pre-dose FEV1 but it was insufficient to explain the magnitude of the predose FEV1 treatment effect difference between Flutiform and fluticasone propionate pMDI.
For “substitutionsindikationen” var virkningerne på FEV1 både før og efter dosering i absolutte tal gunstigere med Flutiform end med fluticasonpropionat + formoterolfumarat (både for Per Protocol- og Intention-toTreat-populationen).
Turning to the data in the Applicant's clinical studies: For the “Step-up” indication both pre-dose and post-dose FEV1 effects at 8 to 12 weeks were significantly greater with Flutiform than with fluticasone propionate; for the “Switch” indication both pre-dose and post-dose FEV1 effects numerically favoured Flutiform over fluticasone propionate + formoterol fumarate (in both Per Protocol and Intention-to-Treat population comparisons).
Virkningen bør aftage gradvist inden for nogle få dage i de fleste tilfælde.
The effect should gradually disappear within a few days in most cases.
CEA og PSA blev defineret som følger:
CEA and PSA were defined as follows:
Se også afsnit 2 under 'Advarsler og forholdsregler'.
See also section 2 under ‘Warnings and precautions'.
Børn under 2 år.
Children aged less than 2 years.
I nogle tilfælde kan symptomerne strække sig ud over det behandlede område.
In some cases, symptoms may extend beyond the treatment area.
Mirvaso kan også give følgende andre bivirkninger:
Mirvaso may also cause the following other side effects:
Det skyldes, at medicinens virkning på dit ufødte barn ikke kendes.
This is because its effects on your unborn baby are unknown.
Hvis dine symptomer forbliver de samme eller bedres lidt, kan du gradvist øge mængden af gel.
If your symptoms remain the same or improve only slightly, you may then gradually increase the amount of gel.
En potentiel konsekvens ved at stoppe behandlingen inden afslutningen af behandlingsforløbet er, at sygdommen kommer tilbage til sin oprindelige tilstand.
A potential consequence of stopping the treatment before finishing the course of treatment is the disease to come back to its initial state.
Der blev rapporteret om fuldstændig remission hos begge børn i løbet af 24 timer.
Both children were reported to have made a full recovery within 24 hours.
Hvis du får gel på disse områder, skal du straks vaske dem med rigelige mængder vand.
Should any gel get onto these areas, wash them immediately with plenty of water.
Dette er særligt vigtigt, når det gælder børn under 2 år (se 'Brug ikke Mirvaso').
This is particularly important in children under the age of 2 years (see ‘Do not use Mirvaso').
Bradykardi og hypotension
Bradycardia and hypotension
- du har problemer med hjerte eller kredsløb eller din blodcirkulation.
- you have problems with your heart or your blood circulation.
Pakningsstørrelse: 1 tube eller 1 pumpe.
Pack size of 1 tube or 1 pump.
Der er ingen eller utilstrækkelige data fra anvendelse af brimonidin til gravide kvinder.
There are no or limited amount of data from the use of brimonidine in pregnant women.
Du må ikke tage en dobbeltdosis som erstatning for den glemte dosis og fortsæt din behandling som foreskrevet.
Do not use a double dose to make up for a forgotten dose and continue your treatment as prescribed.
Mirvaso bør ikke anvendes til børn eller unge i alderen 2-18 år.
Mirvaso should not be used in children or adolescents aged 2 to 18 years.
Mængden af gel kan derefter øges gradvist på basis af tolerabiliteten og patientens reaktion.
The amount of gel can then be increased gradually based on tolerability and patient response.
Træk dernæst hætten af.
Then pull the cap off.
Du bør ikke anvende dette lægemiddel under amning, da det ikke er kendt, om dette lægemiddel passerer ind i modermælken.
You should not use this medicine during breast-feeding, as it is unknown whether this medicine passes into the breast milk.
Der blev ikke observeret nogen meningsfulde forskelle i sikkerhedsprofilerne mellem den ældre patientgruppe og patienter fra 18 til 65 år.
No meaningful differences in the safety profiles were observed between the elderly subject population and subjects 18 to 65 years of age.
Studie 1 + Studie 2
Study 1 + Study 2
Giv ikke dette lægemiddel til børn og unge under 18 år, da sikkerhed og virkning hos denne aldersgruppe ikke er klarlagt.
Do not give this medicine to children and adolescents under the age of 18 years because the safety and efficacy has not been established for this age group.
Fordeling Brimonidins proteinbinding er ikke undersøgt.
Distribution The protein binding of brimonidine has not been studied.
- til børn under 2 år, som de kan have en øget risiko for bivirkninger af det lægemiddel, der optages gennem huden.
- in children below 2 years of age, as they may be at greater risk of side effects from any of the medicine absorbed through the skin.
Pumpen er igen børnesikret.
The pump is child-resistant again.
Almindeligvis falder den til ro af sig selv, efter at behandlingen er stoppet.
Generally, it resolves spontaneously after treatment is stopped.
Kravene for fremsendelse af periodiske, opdaterede sikkerhedsindberetninger for dette lægemiddel fremgår af listen over EU-referencedatoer (EURD list), som fastsat i artikel 107c, stk. 7, i direktiv 2001/83/EF, og alle efterfølgende opdateringer offentliggjort på den europæiske webportal for lægemidler.
The requirements for submission of periodic safety reports for this medicinal product are set out in the list of Union reference dates (EURD list) provided for under Article 107c(7) of Directive 2001/83/EC and any subsequently updates published on the European medicines web-portal.
Kontakt lægen, som kan rådgive dig om, hvad du skal gøre.
Please contact your doctor, who will advise you on what action to take.
Enhver øgning af den daglige påførte mængde ud over 5 mængder på størrelse med en ært og/eller øgning af hyppigheden af den daglige applikation af lægemidlet skal undgås, eftersom sikkerheden ved højere daglige doser eller gentagne daglige applikationer ikke er undersøgt.
Any increase in the daily amount applied above 5 pea sized amounts and/or increase in frequency of daily application of the medicinal product should be avoided, since the safety of higher daily doses or repeated daily application has not been assessed.
Brug ikke Mirvaso: - hvis du er allergisk over for brimonidin eller et af de øvrige indholdsstoffer i dette lægemiddel (angivet i punkt 6).
Do not use Mirvaso: - if you are allergic to brimonidine or any of the other ingredients of this medicine (listed in section 6).
Mirvaso virker på et dagligt grundlag allerede fra den første behandlingsdag.
Mirvaso works on a daily basis, starting with the first day of treatment.
Tag medicinpakningen med dig, så lægen ved, hvilken medicin det drejer sig om.
Take the medicine pack with you, so the doctor knows what was swallowed.
Det er ukendt, om brimonidin/metabolitter udskilles i human mælk.
It is unknown whether brimonidine/metabolites are excreted in human milk.
92927 La Défense Cedex Frankrig
92927 La Défense Cedex France
Forbedring dag 29
Success day 29
I tilfælde af svær irritation eller kontaktallergi skal behandlingen med lægemidlet seponeres.
In case of severe irritation or contact allergy, the treatment with the medicinal product should be discontinued.
Bemærk: Når hætten er taget af, er pumpen ikke børnesikret.
Note: when the cap is removed, the pump is not child-resistant.
ADMINISTRATIONSMETODE Må ikke sluges.
METHOD OF ADMINISTRATION Do not swallow.
Hvis dette sker, skal du kassere den overskydende gel, så du ikke påfører mere end den anbefalede dosis.
If this occurs, you should discard the excess gel so as not to apply more than the recommended dose.
Behandlingen skal indledes med en mindre mængde gel (mindre end den maksimale mængde) i mindst en uge.
Treatment should be initiated with a smaller amount of gel (less than the maximum) for at least one week.