natgillin/translations-raw huggingface dataset:
Considering all available data on the safety and efficacy of cilostazol as well as the conclusions of the ad-hoc expert group meeting, the CHMP has agreed on a number of measures including the restriction of the indication to “second-line use, in patients in whom lifestyle modifications (including stopping smoking and [supervised] exercise programs) and other appropriate interventions have failed to sufficiently improve their intermittent claudication symptoms”, and the introduction of three new contraindications, in patients with history of severe tachyarrhythmia, patients treated concomitantly with two or more additional anti-platelet/anticoagulant agents and patients with unstable angina pectoris, myocardial infarction within the last 6 months, or a coronary intervention in the last 6 months.
Na podlagi pregleda vseh razpoložljivih podatkov o varnosti in učinkovitosti cilostazola ter zaključkov s sestanka ad hoc strokovne skupine je CHMP predlagal več ukrepov, ki vključujejo omejitev indikacije na „zdravljenje druge izbire pri bolnikih, pri katerih spremembe življenjskega sloga (vključno s prenehanjem kajenja in [nadzorovanimi] programi telesne dejavnosti) in drugi primerni ukrepi niso zadovoljivo izboljšali simptomov intermitentne klavdikacije ter tri nove kontraindikacije - pri bolnikih, ki imajo v anamnezi hudo tahiaritmijo, pri bolnikih, ki sočasno uporabljajo dva ali več drugih antiagregacijskih/antikoagulacijskih zdravil, in pri bolnikih z nestabilno angino pektoris, srčnim infarktom v zadnjih šestih mesecih ali koronarno intervencijo v zadnjih šestih mesecih.
However, the pharmacological effects of cilostazol suggest that it may cause more serious cardiac arrhythmias in some patients.
Vendar pa obstaja možnost, da bi lahko farmakološki učinki cilostazola pri nekaterih bolnikih povzročili resnejše srčne aritmije.
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.
Med vrednotenjem zdravil so upoštevali podatke v zvezi z ocenami kakovosti življenja in analizami odziva, ki bi lahko pomagali razjasniti klinični pomen učinka zdravljenja, ki ga je težko opredeliti zaradi dejstva, da bo zdravilo pri bolnikih verjetno izkazalo različne stopnje koristi, odvisno od resnosti simptomov intermitentne klavdikacije (IK).
The experts acknowledged that minor adverse events were commonly seen in some patients but no major side effects were recorded by any of the experts.
Strokovnjaki so potrdili, da so pri nekaterih bolnikih pogosto opazili blažje neželene dogodke, noben strokovnjak pa ni opazil resnejših neželenih učinkov.
The primary analysis, pre-specified in the protocols, demonstrated a statistically significant longer walking distance in patients receiving cilostazol 100mg bid over placebo.
Primarna analiza, vnaprej določena v protokolih, je pokazala statistično pomembno podaljšanje prehojene razdalje pri bolnikih, ki so prejemali 100 mg cilostazola dvakrat na dan, v primerjavi s placebom.
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.
Metaanaliza združenih podatkov iz teh preskušanj, pri kateri so za beleženje razlik med cilostazolom in placebom uporabili geometrične srednje vrednosti (ACD ob zadnjem obisku/ACD ob izhodišču), je pokazala učinek zdravljenja, ki je znašal 1,15 (95-odstotni IZ: 1,11-1,19) za ACD.
Direct Healthcare Professional Communication (DHPC), to rapidly communicate the outcome of the present review.
CHMP je odobril neposredno obvestilo zdravstvenim delavcem (DHPC - Dear Healthcare Professional Communication), da se jim v najkrajšem možnem času sporoči izid tega pregleda.
In addition, a phase IV double-blind placebo-controlled efficacy study (PACE study), was performed also with pentoxifylline as active comparator.
Izvedli so tudi dvojno slepo, s placebom nadzorovano študijo učinkovitosti IV. faze (študija PACE), v kateri so prav tako uporabili pentoksifilin kot primerjalno zdravilno učinkovino.
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).
Po drugi strani je menil, da zaviralno delovanje cilostazola na encim fosfodiesterazo (PDE-3) predstavlja morebitno varnostno tveganje zaradi srčnih aritmij, ki so lahko posledica povišanja srčne frekvence med mirovanjem (cilostazol dokazano poviša srčno frekvenco za ~5,1 in ~7,4 utripa na minuto pri odobrenih odmerkih).
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.
Preskušanja so vključevala osem dvojno slepih nadzorovanih preskušanj III. faze; v dveh od njih so primerjali učinkovitost cilostazola in primerjalne zdravilne učinkovine (pentoksifilina) ter placeba v 24-tedenskem obdobju.
However, concomitant aspirin and clopidogrel treatment together increased the risk of bleeding in the cilostazol group compared with the placebo patients.
Po drugi strani pa je sočasna uporaba aspirina in klopidogrela povečala tveganje za krvavitve v skupini s cilostazolom v primerjavi s skupino s placebom.
However, causality and magnitude of this risk is difficult to quantify given the lack of a clear signal in clinical trials and given the level of confounding due to the background concomitant medication used by these patients.
Vendar pa je vzročnost in stopnjo omenjenega tveganja težko opredeliti zaradi pomanjkanja trdnih dokazov iz kliničnih preskušanj in zelo različnih zdravil, ki jih ti bolniki sočasno uporabljajo.
The study will also aim to quantify off-label use, describe dosage patterns and identify the medical specialties of physicians prescribing cilostazol.
Cilj študije bo tudi količinsko opredeliti uporabo, ki ni skladna z odobrenimi indikacijami, opisati vzorce odmerjanja in opredeliti specializacije zdravnikov, ki predpisujejo cilostazol.
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.
Zato je CHMP menil, da bi morala biti uporaba cilostazola kontraindicirana pri bolnikih z nestabilno angino pektoris, srčnim infarktom v zadnjih šestih mesecih ali koronarno intervencijo v zadnjih šestih mesecih, in da bi morali v informacije o zdravilu vključiti dodatna opozorila.
• 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.
• na podlagi naštetega je Odbor zaključil, da je razmerje med tveganji in koristmi za zdravila, ki vsebujejo cilostazol, v normalnih pogojih uporabe pozitivno samo za zdravljenje druge izbire pri bolnikih, pri katerih spremembe življenjskega sloga in drugi primerni ukrepi niso zadovoljivo izboljšali simptomov intermitentne klavdikacije, in samo če so upoštevani odobreni ukrepi za zmanjšanje tveganja, ki vključujejo spremembe informacij o zdravilu.
Although clinical trial data did not substantiate safety concerns raised from spontaneous ADR reporting, the CHMP concluded that the risk of bleeding and some cardiovascular events including tachyarrhythmias cannot be excluded in at-risk patients.
Čeprav podatki iz kliničnih preskušanj niso potrdili upravičenosti zadržkov glede varnosti, ki so jih sprožila spontana sporočila o neželenih učinkih, je CHMP zaključil, da tveganja za krvavitve in nekatere kardiovaskularne dogodke, ki vključujejo tahiaritmije, pri bolnikih s povečanim tveganjem ni mogoče izključiti.
Secondary efficacy endpoints included painfree walking distance (initial claudication distance - ICD) measured by treadmill exercise; and Quality of Life assessments.
Sekundarni opazovani dogodki učinkovitosti so vključevali razdaljo, prehojeno brez bolečin (začetna klavdikacijska razdalja - ICD), izmerjeno med preskusom s hojo po tekočem traku, in ocene kakovosti življenja.
Grounds for the variation to the terms of the marketing authorisation
Podlaga za spremembo pogojev dovoljenja za promet z zdravilom
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.
Rezultati iz kliničnih preskušanj niso razkrili nobenih resnih neželenih učinkov, povezanih s srčnimi aritmijami, obstaja pa majhno število poročil o resnih dogodkih (ventrikularni tahikardiji, podaljšanju intervala QT na elektrokardiogramu, vključno s Torsade de Pointes)) iz spontanih virov/neintervencijskih študij; nekateri dogodki so bili skladni s kronotropnimi učinki cilostazola.
The expert group noted the spontaneous reports of haemorrhage when used with one or two antiplatelet drugs, but were reassured by the absence of evidence from the published placebo-controlled studies.
Strokovna skupina je upoštevala spontana poročila o krvavitvah pri sočasni uporabi z enim ali več antiagregacijskimi zdravili, vendar je zaradi odsotnosti dokazov iz objavljenih s placebom nadzorovanih študij menila, da ni razloga za skrb.
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.
V študiji CASTLE so opazili nekoliko večje število primerov srčnega popuščanja (cilostazol: 2,9 %, placebo: 2,4 %) in hipotenzije (cilostazol: 0,7 %, placebo: 0,1 %).
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.
Med pregledom so upoštevali podatke o varnosti cilostazola, pridobljene med preskušanji učinkovitosti (srednjeročnimi preskušanji), dolgoročno študijo varnosti CASTLE in študijami za preprečevanje možganskih kapi, ter tudi poročila o primerih iz spontanih virov in neintervencijskih študij.
The most common adverse events included headache, diarrhoea, abnormal stools, dizziness, palpitations and tachycardia, already listed in the Product Information.
Med najpogostejšimi neželenimi dogodki so bili glavobol, driska, nenormalno blato, omotica, palpitacije in tahikardija, ki so že vključeni v informacije o zdravilu.
The hazard ratio for mortality (cilostazol vs. placebo) was 0.94, 95% CI [0.63-1.39].
Razmerje tveganja za smrt (cilostazol v primerjavi s placebom) je bilo 0,94, s 95odstotnim IZ [0,63-1,39].
The CHMP considered that causality was difficult to assess in these reports, especially given the level of confounding due to the background conditions in these patients.
CHMP je menil, da je iz teh poročil težko oceniti vzročnost, predvsem zaradi zelo različnih predhodnih zdravstvenih stanj bolnikov.
Palpitations and tachycardia were well-documented in clinical trials.
V kliničnih študijah so bile izčrpno dokumentirane palpitacije in tahikardija.
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)
Ob upoštevanju majhnih koristi cilostazola in obstoječih zadržkov glede varnosti Odbor meni, da je treba uporabo cilostazola omejiti na tiste bolnike, ki bi imeli od zdravljenja največ koristi, tj. na bolnike, pri katerih spremembe življenjskega sloga (prenehanje kajenja in programi telesne dejavnosti) ter drugi primerni ukrepi niso imeli zadovoljivega učinka.
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).
Glede na WMD naj bi bilo povprečno izboljšanje prehojene razdalje glede na izhodišče 87,4 m pri uporabi 100 mg cilostazola dvakrat na dan in 43,7 m pri uporabi placeba (p < 0,0001) pri povprečni izhodiščni prehojeni razdalji 133 m (66-odstotno izboljšanje s cilostazolom).
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.
V študiji CASTLE so v skupini s cilostazolom opazili manjšo pogostnost krvavitev kot v skupini s placebom in tudi sočasna uporaba aspirina v podskupini, zdravljeni s cilostazolom, ni povečala pogostnosti krvavitev.
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;
Poleg tega je Odbor odobril tudi študijo uporabe zdravila za opredelitev značilnosti novih uporabnikov cilostazola in trajanja uporabe ter vzorcev prekinitve zdravljenja ter nadaljnjo študijo za oceno učinkovitosti sprejetih ukrepov za zmanjšanje tveganja;
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.
Cilostazol je derivat dihidrokinolinona, ki zavira fosfodiesterazo, specifično za ciklični adenozin monofosfat (cAMP), s čimer zavira razgradnjo cAMP in posledično zvišuje njegove ravni v trombocitih in krvnih žilah.
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).
Terapevtska indikacija, ki je bila v Evropi odobrena za zdravila, ki vsebujejo cilostazol, je izboljšanje najdaljše prehojene razdalje in razdalje, prehojene brez bolečin, pri bolnikih z intermitentno klavdikacijo (IK), ki nimajo bolečin med mirovanjem in ne kažejo znakov odmiranja perifernih tkiv (periferne arterijske bolezni (PAB) v II.
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.
Kljub post hoc analizi je dejstvo, da je bila stopnja resnih neželenih srčnih dogodkov, ki so trenutno odobreni v študijah novih zdravil (kardiovaskularna smrt, srčni infarkt brez smrtnega izida in možganska kap), statistično znatno nižja v skupini, ki je prejemala zdravilo, močan dokaz o kardiovaskularni varnosti.
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.
V vseh študijah učinkovitosti cilostazola so opazili višji odstotek izboljšanja absolutne klavdikacijske razdalje v primerjavi s placebom, ki je bil statistično pomemben v šestih od devetih preskušanj.
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.
Med tistimi, ki so dokončali zdravljenje, je bil delež „bolnikov z odzivom večji v skupini s cilostazolom kot v skupini s placebom (39,6 % v primerjavi s 26,3 %), pri čemer so „bolniki z odzivom tisti, pri katerih se je prehojena razdalja glede na izhodišče podaljšala za 50 % ali več.
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.
Strokovnjaki so menili, da ima cilostazol koristne učinke pri bolnikih z intermitentno klavdikacijo, ki jim preprečuje izvajanje programa telesne dejavnosti, tako da jim pomaga prek „prve ovire , da lahko nato s telesno dejavnostjo nadalje podaljšujejo prehojeno razdaljo.
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.
Poleg tega se je imetnik dovoljenja za promet z zdravilom strinjal, da bo izvedel študijo mehanizma delovanja za razjasnitev vpliva cilostazola v kombinaciji z aspirinom ali klopidogrelom na agregacijo trombocitov in posledično na čas krvavitev.
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.
Zato je CHMP menil, da ima cilostazol majhen, vendar statistično pomemben učinek na podaljšanje prehojene razdalje pri bolnikih z IK in da ima lahko pri nekaterih bolnikih klinično pomembne koristi.
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.
Metaanalize združenih izidov, ki so jih bolniki navedli v vprašalniku o kakovosti življenja (SF-36) in vprašalniku o težavah pri hoji (Walking Impairment Questionnaire - WIQ), so pokazale pomembne klinične učinke cilostazola v primerjavi s placebom na telesno zmogljivost in izboljšanje rezultatov telesne komponente vprašalnika SF-36 ter tudi pomembno izboljšanje rezultatov na WIQ, povezanih s hitrostjo in razdaljo.
The increase in walking distance over baseline walking distance with cilostazol treatment was 35% higher than with placebo.
Stopnja izboljšanja prehojene razdalje v primerjavi z izhodiščno je bila pri zdravljenju s cilostazolom za 35 % višja kot pri placebu.
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.
Zaradi dejstva, da se pri sočasni uporabi zaviralcev CYP3A4 in CYP2C19 (na primer eritromicina, ketokonazola in omeprazola) poveča izpostavljenost cilostazolu, je CHMP menil, da obstaja velika verjetnost za medsebojno delovanje z drugimi zdravili, kar bi lahko povečalo tveganja, povezana s cilostazolom, zato je zaključil, da bi bilo treba okrepiti opozorila v poglavju 4.5 v povzetku glavnih značilnosti zdravila.
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.
Glede varnosti zdravila so podatki iz kliničnih preskušanj pokazali, da so bili neželeni dogodki, o katerih so največkrat poročali, glavobol, driska, omotica, palpitacije, periferni edem in tahikardija, in da so ti neželeni dogodki že vključeni v informacije o zdravilu.
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.
Poleg tega lahko cilostazol predpišejo samo zdravniki, ki imajo izkušnje z zdravljenjem bolnikov z intermitentno klavdikacijo, potem ko skrbno preučijo ustreznost zdravljenja s cilostazolom in druge možnosti zdravljenja, kot je na primer revaskularizacija.
The experts considered that the included patients were a reasonable representation of real-life and it was hard to argue that the study was not reassuring and agreed that cilostazol has shown a consistent trend for being as safe as placebo across the major cardiovascular endpoints.
Strokovnjaki so menili, da so bolniki, ki so bili vključeni v študijo, dobro odražali populacijo v resničnem življenju, zato so jih rezultati študije povsem pomirili, strinjali pa so se tudi, da je cilostazol izkazal stabilen trend varnosti, ki je bila primerljiva s placebom pri vseh pomembnejših kardiovaskularnih opazovanih dogodkih.
Cilostazol is a dihydro-quinolinone derivative that belongs to the pharmacotherapeutic group antithrombotic agents, platelet aggregation inhibitor excluding heparin.
Cilostazol je derivat dihidrokinolinona, ki spada v farmakoterapevtsko skupino, imenovano antitrombotiki, zaviralci agregacije trombocitov brez heparina.
The pharmacovigilance measures should be increased by submitting 6-monthly PSURs including safety reports focused on cardiovascular adverse events, haemorrhagic adverse events and off-label use.
Okrepiti je treba farmakovigilančne dejavnosti, v okviru katerih je treba vsakih šest mesecev predložiti posodobljeno poročilo o varnosti zdravila (PSUR) s poudarkom na kardiovaskularnih neželenih dogodkih in krvavitvah ter uporabi, ki ni skladna z odobrenimi indikacijami.
No major safety concerns were identified from the clinical trials.
Podatki iz kliničnih preskušanj niso povzročili nobenih večjih zadržkov glede varnosti.
No signal for increased mortality was observed in clinical trials, including the CASTLE study.
V kliničnih preskušanjih, vključno s študijo CASTLE, niso opazili znakov, ki bi kazali na povečano smrtnost.
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.
Zato je CHMP menil, da bi morala biti uporaba cilostazola kontraindicirana pri bolnikih, ki imajo v anamnezi hudo tahiaritmijo, in da bi morali v informacije o zdravilu vključiti dodatna opozorila.
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.
Španski pristojni organi so bili zaskrbljeni zlasti zaradi poročil o kardiovaskularnih neželenih učinkih (vključno s primeri srčnega infarkta s smrtnim izidom, angino pektoris in aritmijami) in hemoragičnih neželenih učinkih ter tudi medsebojnem delovanju z drugimi zdravili.
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.
Ocenjene vrednosti v vseh devetih preskušanjih so bile v korist cilostazola v odmerku 100 mg dvakrat na dan, analiza pa je pokazala, da je bil cilostazol od placeba statistično boljši v šestih od devetih preskušanj.