natgillin/translations-raw huggingface dataset:
Der er foretaget en gennemgang af de oprindelige dossierer for Sandimmun fra større markeder såsom Frankrig, USA og Det Forenede Kongerige med de kliniske resultater af i alt 15 globale undersøgelser. 
The review of the original Sandimmun Dossiers from major markets such as France, the U.S. and UK which contains the clinical results from a total of 15 global studies has been performed.
Punkt 4.7 - Virkning på evnen til at føre motorkøretøj og betjene maskiner 
Section 4.7 - Effects on Ability to Drive and Use Machines
Endvidere var CHMP af den opfattelse, at det ville være værdifuldt at supplere listerne over interaktioner på grundlag af en opdateret undersøgelse. 
Lastly the CHMP was of the view that further additions to the lists of interactants would be of value, based on an updated survey.
CHMP var enig i, at det var relevant at medtage generelle oplysninger for alle disse indikationer. 
The CHMP agreed that general information applicable to all these indications was relevant to include.
Indehaveren af markedsføringstilladelsen foreslog to forskellige versioner af ordlyden til hvert afsnit om transplantation: 
The MAH proposed two different wordings for each of the paragraphs on transplantation:
Desuden medfører Sandimmun Neoral en mere ensartet eksponering for ciclosporin i løbet af døgnet og fra dag til dag på et vedligeholdelsesregime. 
In addition, Sandimmun Neoral produces a more uniform exposure to ciclosporin throughout the day and from day to day on a maintenance regimen.
Disse afsnit indgik ikke i de centrale sikkerhedsoplysninger. 
These paragraphs were not included in the CSP.
Dette blev godkendt af CHMP, og den endelige ordlyd til punkt 4.2 og 4.4 blev fastsat i overensstemmelse hermed. 
This approach was acceptable to the CHMP and final wordings in sections 4.2 and 4.4.were agreed accordingly.
Indikationen aplastisk anæmi er kun godkendt i Frankrig. 
The indication aplastic anemia is only approved in France.
I EU er Sandimmun og Sandimmun Neoral registreret via nationale procedurer. 
In the European Union (EU), Sandimmum and Sandimmun Neoral are registered via national procedures.
CHMP er af den opfattelse, at indikationen bør begrænses til tilfælde af primær glomerulonefritis som angivet ovenfor. 
The CHMP is of the view that the indication should be limited to primary glomerulonephritis cases as specified above.
I det følgende gennemgås de enkelte underafsnit i hele punkt 4.2. 
In the following, the entire section 4.2 is reviewed, sub-section by sub-section.
Ud over disse 9 gennemførte undersøgelser er 2 dobbeltblindede, placebokontrollerede multicenterundersøgelser og 1 multicenterundersøgelse, der sammenlignede ciclosporin med cyclophosphamid hos steroidresistente patienter, ophørt før tid på grund af mangel på egnede patienter, der samtykkede i at få placebo eller et cytostatisk middel. 
In parallel of these 9 performed studies, 2 double-blind placebo controlled multicenter studies and 1 multicenter study comparing ciclosporin with cyclophosphamide in steroidresistant patients had to be stopped prematurely because of a lack of suitable patients consenting to receive placebo or a cytostatic agent.
Syv undersøgelser vedrørte forebyggelse af graft-versus host disease (GVHD), og én undersøgelse vedrørte behandling af akut GVHD. 
Seven trials were conducted for the prevention of graft-versus host disease (GVHD), one trial for the treatment of acute GVHD.
CHMP er af den opfattelse, at de foreliggende data underbygger anvendelsen af ciclosporin til følgende indikation: “Behandling af svær, aktiv reumatoid arthritis.” 
The CHMP is of the opinion that the available data confirms the use of ciclosporin in the following indication: “Treatment of severe, active rheumatoid arthritis.”
Generel monitorering af doseringen. 
General monitoring of posology.
Indehaveren af markedsføringstilladelsen aftalte med CHMP, at specifikke organtransplantationer ikke nævnes i punkt 4.1, medmindre anvendelsen er uegnet. 
The MAH agreed with the CHMP that no specific organ transplantations should be mentioned in section 4.1 unless not appropriate to use.
CHMP havde dog betænkeligheder ved, at den nuværende indikation var for bred, da anvendelsen ved sekundær glomerulonefritis er kontroversiel. 
However the CHMP had concerns over the fact that current indication was too broad as use in secondary glomerulonephritis is controversial.
I de oprindelige undersøgelser med Sandimmun var initialdosis i området 14-18 mg/kg/dag, der efterfølgende blev reduceret til en vedligeholdelsesdosis i området 6-10 mg/kg/dag. 
In the original Sandimmun studies, initial doses in the range 14-18 mg/kg/day have been used and these were subsequently reduced to a maintenance dose in the range 6-10 mg/kg/day.
CHMP rejste desuden spørgsmål om risikoen for, at ciclosporin kan forværre de neurologiske manifestationer af Behçets sygdom. 
The CHMP also raised questions regarding the risk of aggravation of the neurological manifestations of Behcet's disease by Ciclosporin.
Endelig foreslog indehaveren af markedsføringstilladelsen to tilføjelser til dette afsnit i form af to nye underafsnit om Akut og kronisk nefrotoksicitet og Pædiatrisk population. 
Finally in this section, the MAH proposed two additions to this section, under the format of two new sub-sections on Acute and chronic nephrotoxicity and Paediatric population.
Markedsføringstilladelsesindehaverens rationale for den foreslåede indikation byggede på følgende data: Ved den indledende pilotundersøgelse ved aktiv reumatoid arthritis anvendtes en dosering på 10 mg/kg/dag, dvs. det halve af den dosis, der på daværende tidspunkt blev anvendt ved organtransplantation. 
The rationale given by the MAH for the proposed indication was based on the following data: the initial pilot study in active rheumatoid arthritis used a dose of 10 mg/kg/day, half the dose used in solid organ transplantation at that time.
Der blev udført to typer undersøgelser, åbne og kontrollerede maskerede, til vurdering af virkningen af ciclosporin til behandling af svær, synstruende intermediær og posterior uveitis. 
Two types of studies, open and controlled masked, were carried out in order to evaluate the efficacy of ciclosporin in the treatment of severe sight-threatening intermediate and posterior uveitis.
Desuden anvendte virksomheden de vedtagne centrale sikkerhedsoplysninger (CSP) fra den seneste PSUR 13-arbejdsdelingsprocedure (EE/H/PSUR/0007/001) og den offentlige vurderingsrapport fra den pædiatriske artikel 45-procedure (CZ/W/04/pdWS/01, 2010). 
The agreed Core Safety profile (CSP) from the last PSUR 13 work sharing procedure (EE/H/PSUR/0007/001) and the public AR from the paediatric article 45 procedure (CZ/W/04/pdWS/01, 2010) were also used.
Ciclosporin er grundigt undersøgt i flere kliniske undersøgelser hos patienter med reumatoid arthritis, hos hvem sædvanlig behandling er ineffektiv eller uegnet, foruden i mange publicerede undersøgelser, der beskriver anvendelsen af ciclosporin til denne indikation. 
ciclosporin has been extensively studied in several clinical trials in patients with rheumatoid arthritis in whom conventional therapy is ineffective or inappropriate, as well as in many published studies reporting the use of ciclosporin in this indication.
Indehaveren af markedsføringstilladelsen foreslog en ordlyd til underafsnittene “Absorption, Fordeling, Biotransformation, Udskillelse, Særlige populationer og Pædiatrisk population” baseret på en harmoniseret tekst, der i forvejen var godkendt i 13 EU-lande. 
The MAH proposed wordings for the sub-sections “Absorption, Distribution, Biotransformation and Elimination, Special populations and Paediatric population.” based on a harmonized text already approved in 13 EU countries.
Angivelsen “Den daglige dosis af Sandimmun Neoral bør altid fordeles på to separate doser” blev delvis godkendt af CHMP, da ordet “altid” bør udelades (i nogle tilfælde kan administration tre gange dagligt være nødvendig). 
However the statement “The daily doses of Neoral should always be given in two divided doses” was partly endorsed by the CHMP since the word “always” should be omitted (in some cases, three times daily administration may be needed).
Som resultat af denne gennemgang blev begge sæt centrale datablade afsluttet og frigivet den 13. februar 2012. 
As an outcome of this full review, both CDSs were finalized with a release date of 13 February 2012.
I de europæiske dobbeltblindede undersøgelser anvendtes 5 mg/kg/dag, hvilket gav mulighed for nedtitrering til fastlæggelse af den maksimale tolererede dosis. 
European controlled double-blind trials used 5 mg/kg/d that allowed a downward titration to find the maximum tolerated dose.
Psoriasis er en godkendt terapeutisk indikation i alle EU-lande. 
The Psoriasis is an approved therapeutic indication in all EU countries.
På tidspunktet for ansøgningen for den oliebaserede formulering af ciclosporin, Sandimmun, i 1987, forelå der en komplet sammenfatning af kliniske data om endogen uveitis (Nussenblatt 1987). 
At the time of the submission of the oil-based formulation of ciclosporin, Sandimmun, in 1987, a comprehensive clinical data summary on endogenous uveitis was available (Nussenblatt 1987).
Endelig drøftedes anvendelsen af betegnelsen “cellulær” afstødning, da diagnosen humorale afstødningsepisoder er kontroversiel. 
Finally the inclusion of the term “cellular” rejection was also discussed since the diagnosis of humoral rejection episodes is controversial.
Hvad angår HMG CoA-reduktasehæmmere (statiner) fandt CHMP derimod, at en streng kontraindikation ikke nødvendigvis er påkrævet, men at oplysningerne i punkt 4.4 bør skærpes. 
However concerning HMG CoA reductase inhibitors (statins), the CHMP agreed that a strict contraindication may not be warranted, however, information in section 4.4 should be strengthened.
Tilsammen resulterer i disse egenskaber i mindre intraindividuel variabilitet i farmakokinetikken af ciclosporin og stærkere korrelation mellem dalkoncentrationer og total eksponering. 
Overall, these properties result in lower within-patient variability in the pharmacokinetics of ciclosporin and a stronger correlation between trough concentrations and total exposure.
CHMP fandt dog, at dette afsnit burde udvides med anbefalinger om yderligere kontroller, f.eks. leverfunktion, bilirubin, serumelektrolytter og blodtryk, og at bestemmelse af glomerulær filtrationshastighed ved en pålidelig og reproducerbar metode må foretrækkes frem for serumkreatinin. 
However the CHMP considered that this paragraph should be complemented with recommendations for further controls to be made, e.g. of liver function, bilirubin, serum electrolytes and blood pressure and that it is preferred to use glomerular filtration rate determined by a reliable and reproducible method rather than serum creatinine.
På grund af de divergerende nationale afgørelser, der var truffet af medlemsstaterne ved godkendelsen af Sandimmun Neoral (og relaterede navne), anmeldte EuropaKommissionen til EMA/CHMP's sekretariat en officiel indbringelse i henhold til artikel 30, stk. 2, i direktiv 2001/83/EF, som ændret, med henblik på at få ophævet divergenserne mellem de nationalt godkendte produktresuméer for Sandimmun Neoral i hele EU/EØS. 
Due to the divergent national decisions taken by Member States (MS) concerning the authorization of Sandimmun Neoral (and associated names), the European Commission (EC) notified the EMA/CHMP secretariat of an official referral under Article 30(2) of Directive 2001/83/EC as amended, to resolve divergences amongst the nationally authorised Sandimmun Neoral SmPCs across the EU/EEA region.
Indehaveren af markedsføringstilladelsen forelagde først det kliniske udfald af de amerikanske og canadiske undersøgelser, derefter de europæiske undersøgelser. 
The MAH presented respectively the clinical efficacy outcome of the US and Canada studies and then the European studies.
Punkt 4.6 - Graviditet og amning 
Section 4.6 - Pregnancy and Lactation
Indehaveren af markedsføringstilladelsen foreslog en ordlyd, der var godkendt i mellem 18 og 24 medlemsstater, afhængigt af underafsnittene. 
The MAH proposed a wording that was approved in between 18 an 24 MS, depending on subsections.
CHMP anmodede indehaveren af markedsføringstilladelsen om at sammenstille alle foreliggende data om skift til ciclosporin i tilfælde af afstødning med alle andre immunosuppressiva, ikke kun tacrolimus. 
The CHMP requested the MAH to compile all available data on switch to ciclosporin in case of rejection with any other immunosuppressive agent, not only tacrolimus.
Indehaveren af markedsføringstilladelsen fastslog, at opbevaringsbetingelserne i produktresuméerne for Sandimmun Neoral, bløde gelatinekapsler og orale opløsninger, i forvejen er rettet ind efter kravene i “Guideline on Declaration of Storage Conditions” (CPMP/QWP/609/96/Rev 2, dateret den 19. november 2007). 
The MAH confirmed that the storage conditions in the SmPCs of Sandimmun Neoral soft gelatin capsules and oral solutions are already aligned with the requirements set in the Guideline on Declaration of Storage Conditions (CPMP/QWP/609/96/Rev 2 dated 19 Nov 2007).
Sandimmun Neoral er en mikroemulsionsformulering af ciclosporin. 
Sandimmun Neoral is a microemulsified formulation of ciclosporin.
Foruden skærpet overvågning af nyrefunktionen fandt CHMP desuden, at lejlighedsvis overvågning af blodkoncentrationen af ciclosporin er relevant ved disse indikationer. 
Furthermore, in addition to a strengthening of the monitoring of renal function, the CHMP was of the view that occasional monitoring of ciclosporin blood levels were also relevant in these indications.
Som følge af de højere Cmax- og AUC-værdier, der opnås med Sandimmun Neoral end med Sandimmun, var de resulterende individualiserede doser af Sandimmun Neoral gennemsnitligt lavere end med Sandimmun. 
Based on the higher Cmax and AUC values achieved with Sandimmun Neoral compared to Sandimmun, the resulting individualized doses of Sandimmun Neoral were on average lower compared to Sandimmun.
Der blev desuden foretaget andre ændringer, herunder flere foreslåede nedgraderede placeringer; CHMP anmodede om begrundelser, som efterfølgende blev givet af indehaveren af markedsføringstilladelsen. 
Other changes were also introduced including several proposed downgraded positions; justifications were requested by the CHMP and provided by the MAH subsequently.
Ciclosporin er et potent immunosuppressivt middel, der anvendes ved organ- og knoglemarvstransplantation til at forhindre transplantatafstødning samt ved Graft Versus Host Disease (GVHD). 
Ciclosporin is a potent immunosuppressive agent used in human solid organ and bone marrow transplantation to prevent graft rejection and in Graft Versus Host Disease (GVHD).
Registreringen af Sandimmun Neoral byggede på data vedrørende virkning og sikkerhed fra kliniske undersøgelser med den oliebaserede formulering (Sandimmun), der første gang blevet registreret i Schweiz i december 1982. 
The registration of Sandimmun Neoral was based on efficacy and safety data from clinical studies performed with the oilbased formulation (Sandimmun), first registered in Switzerland in December 1982.
Indehaveren af markedsføringstilladelsen drøftede behovet for at gøre statiner kontraindiceret ved behandling med ciclosporin og behovet for andre kontraindikationer for andre lægemidler/plantelægemidler. 
The MAH discussed the need of a contraindication of statins for cyclosporin and the need of further contraindications for other medicinal products/herbals.
Indehaveren af markedsføringstilladelsen fremlagde forslag til ordlyden af underafsnittene “Interaktion med fødeindtagelse, Lægemiddelinteraktioner, Lægemidler, der nedsætter niveauet af ciclosporin, Lægemidler, der øger niveauet af ciclosporin, Andre relevante lægemiddelinteraktioner, Anbefalinger, Den pædiatriske population og Andre relevante lægemiddelinteraktioner”. 
The MAH proposed wordings for the sub-sections “Food interactions, Drug interactions, Drugs that decrease ciclosporin levels, Drugs that increase ciclosporin levels, Other relevant drug interactions, Recommendations, Paediatric population and Other relevant drug interactions.”
Men da undersøgelserne i den oprindelige dokumentation for Sandimmun er gamle, vil en dosering baseret på disse data være forældet i forhold til nutidige transplantationsregimer, hvorfor CHMP fandt, at doseringen også burde styres ved overvågning af blodkoncentrationerne af ciclosporin. 
However, since the studies in the original Sandimmun dossier are old and the posology based on those data is therefore obsolete in comparison with the different transplantation regimens used today, the CHMP was of the view that the dosage should also be guided by monitoring of ciclosporin blood levels.
Disse yderligere fordele bevirker, at Sandimmun Neoral kan administreres uafhængigt af måltider. 
As a consequence of these additional advantages, Sandimmun Neoral can be administered independently of mealtimes.
Desuden fandt CHMP, at stoffer, der er substrater for CYP3A4 og/eller P-gp og i høje plasmakoncentrationer er forbundet med alvorlige sikkerhedsproblemer, ikke bør anvendes i kombination med ciclosporin (f.eks. dabigatranetexilat, bosentan og aliskiren). 
In addition, the CHMP considered that substrates for CYP3A4 and/or P-gp and for which elevated plasma levels are associated with serious safety concerns should not be combined with ciclosporin (e.g. dabigatran etexilate, bosentan, aliskiren).
I november 2011 blev der indledt en fuldstændig gennemgang af virksomhedens produktoplysninger (centrale datablade for de to produkter Sandimmun og Sandimmun Neoral). 
In November 2011, a full review of the company label (CDSs for both products Sandimmun and Sandimmun Neoral) was initiated.
Af de forelagte data og andre publicerede data konkluderede CHMP, at benefit/risk-forholdet for ciclosporin er positivt til behandling af endogen refraktær uveitis, herunder Behçets uveitis. 
From the data provided and other published data the CHMP concluded that benefit-risk ratio for ciclosporin in treatment of endogenous refractory uveitis, including Behçet uveitis, is positive.
Virkningen af ciclosporin er påvist hos recipienter af knoglemarvstransplantater i otte undersøgelser i Europa og USA hos i alt 227 patienter. 
The efficacy of ciclosporin has been demonstrated in bone marrow transplant (BMT) recipients in eight studies carried out in Europe and US with a total of 227 patients.
Punkt 4.4 - Særlige advarsler og forsigtighedsregler vedrørende brugen 
Section 4.4 - Special Warnings and Precautions for Use
Den af indehaveren af markedsføringstilladelsen foreslåede ordlyd er i forvejen godkendt i 24 lande og ligner meget i flere andre lande. 
The wording proposed by the MAH is already approved in 24 countries and several other countries have very similar information.
Skønt nogle patienter fik bivirkninger, hovedsagelig nefrotoksicitet, hypertension og metaboliske forstyrrelser, konstaterede CHMP, at disse bivirkninger er velkendte og kunne behandles på dosisafhængig måde. 
Although some patients experienced adverse reactions, mostly nephrotoxicity, hypertension and metabolic disorders, the CHMP noted that these adverse reactions are well known and could be managed in dose dependent manner.
Indehaveren af markedsføringstilladelsen imødekom CHMP's synspunkt; CHMP finder, at de kliniske erfaringer støtter de foreslåede tilføjelser i indikationen. 
The MAH addressed the CHMP's concerns; the CHMP is of the view that clinical experience supports the proposed additions in the indication.
Indehaveren af markedsføringstilladelsen foreslog følgende ordlyd til denne indikation: “Sandimmun Neoral er indiceret til patienter med svær atopisk dermatitis, når systemisk behandling er påkrævet.” Indikationen atopisk dermatitis er godkendt i 15 EU-lande med den ordlyd, der er foreslået af indehaveren af markedsføringstilladelsen. 
The MAH proposed the following wording for this indication: “Sandimmun Neoral is indicated in patients with severe atopic dermatitis when systemic therapy is required.” The MAH's proposed indication wording for the Atopic dermatis is approved in 15 EU countries.
Vedrørende underafsnittet Sammenfatning af sikkerhedsprofilen foreslog indehaveren af markedsføringstilladelsen, at der medtoges en overordnet sammenfatning af de vigtigste bivirkninger, der oftest blev indberettet i kliniske undersøgelser. 
With regards to the sub-section Summary of the safety profile, the MAH proposed the inclusion of an overall summary of the principal adverse reactions which were most frequently reported in clinical trials.
CHMP anmodede derfor indehaveren af markedsføringstilladelsen om at begrunde det positive benefit/risk-forhold for alle nefrotiske sygdomme bortset fra de primære minimale forandringer ved glomerulonefritis, primær fokal segmental glomerulosklerose og primær membranøs glomerulonefritis. 
The CHMP therefore requested the MAH to justify the positive benefit risk for all nephrotic conditions except the primary minimal change glomerulonephritis, primary focal segmental glomerulosclerosis, or primary membranous glomerulonephritis.
Den foreslåede ordlyd blev revideret og vedtaget i overensstemmelse hermed. 
The proposed wording was reviewed and agreed accordingly.
Ligesom for punkt 4.2 blev ordlyden for hvert underafsnit vedrørende de forskellige andre indikationer end transplantation drøftet og aftalt mellem CHMP og indehaveren af markedsføringstilladelsen. 
Similarly to the section 4.2, wordings for each of the sub-sections for the different non-transplantation indications were discussed and agreed between the CHMP and MAH.
I sin besvarelse fastslog indehaveren af markedsføringstilladelsen, at dataene fra disse undersøgelser samt omfattende kliniske erfaringer støtter indikationen “Forebyggelse af transplantatafstødning” for ciclosporin. 
In their response the MAH confirmed that the data from these studies as well as extensive clinical experience are supportive of the indication “Prevention of graft rejection” for Ciclosporin.
Dossieret for Sandimmun dannede grundlag for gennemgangen, da dossieret til ansøgningen for den nye formulering af ciclosporin (Sandimmun Neoral) byggede på en farmakokinetisk vurdering, som viste ækvivalens mellem de to former af ciclosporin (oliebaseret formulering versus mikroemulgeret formulering). 
Sandimmun was used as a basis of the review as the dossier supporting the approval of the new ciclosporin formulation (Sandimmun Neoral) was based on pharmacokinetics evaluation that demonstrated equivalence between the 2 forms of ciclosporin (oil-based formulation versus microemulsified formulation).
Indehaveren af markedsføringstilladelsen forklarede, at opbevaringstiderne ikke var harmoniseret, og foreslog at følge den sikreste tilgang for Sandimmun (fastsættelse af en 36-måneders opbevaringstid) og for Sandimmun Neoral den seneste reducerede opbevaringstid, der er godkendt i EU-landene ved ændringsansøgninger. 
The MAH explained that shelf life periods were not harmonised and proposed to follow the safest approach to Sandimmun (to fix 36 months period) and the last reduced period for Sandimmun Neoral that is approved in EU countries via variation procedure.
Ciclosporin er kontraindiceret sammen med visse HMG-CoA reduktasehæmmere (statiner) på grund af ciclosporins potentiale for at hæmme CYP3A4 og/eller Pgp. 
Ciclosporin is contraindicated for some HMG-CoA reductase inhibitors (statins) due to the CYP3A4 and/or Pgp inhibitory potential of ciclosporin.
Punkt 5.3 - Prækliniske sikkerhedsdata 
Section 5.3 - Preclinical Safety Data
Indehaveren af markedsføringstilladelsen anførte i sin svarpakke, at de absolutte ændringer kan betragtes som små, men at standardiseret indtagelse i relation til måltider på baggrund af ciclosporins snævre terapeutiske vindue vil være at foretrække for at nedsætte den intraindividuelle variabilitet. 
The MAH stated in their response package that the absolute changes may be considered small, but in view of the narrow therapeutic window for ciclosporin, standardised intake in relation to food intake would be preferable to reduce intra-individual variability.