natgillin/translations-raw huggingface dataset:
In addition, severe cases of peripheral vasoconstrictive symptoms were reported in the literature.
Poleg tega so v literaturi navedeni hudi primeri simptomov periferne vazokonstrikcije.
In such cases, administration of dihydroergotoxine may delay the administration of an appropriate treatment for dementia.
V takih primerih lahko dajanje dihidroergotoksina zakasni dajanje ustreznega zdravila za demenco.
• The Committee considered the overall submitted data and grounds provided by the MAHs and the outcome of the scientific advisory groups.
• odbor je upošteval vse predložene podatke in utemeljitve, ki so jih podali imetniki dovoljenj za promet z zdravili, ter ugotovitve znanstveno svetovalnih skupin;
From the approved indications of the dihydroergotoxine containing medicinal products the ones that are in the scope of this referral procedure and are approved in at least one Member State are the following (specific wording of the indication may vary from product to product):
Od odobrenih indikacij za zdravila, ki vsebujejo dihidroergotoksin, so indikacije, ki spadajo v sklop tega napotitvenega postopka in so odobrene v vsaj eni državi članici, naslednje (natančno besedilo za indikacijo se lahko med zdravili razlikuje):
The CHMP reiterated that the studies presented in support of the efficacy of dihydroergotoxine were published in the seventies and eighties, with the consequent risk for publication bias, and have several limitations.
Ponovno je poudaril, da so bile študije, predložene v podporo učinkovitosti dihidroergotoksina, objavljene v sedemdesetih in osemdesetih letih, zaradi česar obstaja možnost pristranskosti publikacij, študije pa so imele tudi več omejitev.
Based on the overall documentation provided, the CHMP concluded that the studies suffer from substantial methodological deficiencies which preclude any conclusion on the efficacy of the product.
Na podlagi vse predložene dokumentacije je CHMP zaključil, da imajo študije velike metodološke pomanjkljivosti, ki onemogočajo zaključek o učinkovitosti zdravila.
Therefore, the group was of the opinion that there is not a clearly defined population, which unsatisfactorily responds to standard migraine prophylaxis treatment, where there is a therapeutic need for this substance as alternative/last line treatment.
Skupina je zato zaključila, da ni jasno opredeljene populacije, ki se nezadostno odzove na standardno zdravljenje za preprečevanje migrene in pri kateri torej obstaja terapevtska potreba po uporabi te učinkovine kot alternativnega/zadnjega zdravljenja.
The CHMP was therefore requested to give its opinion on whether the marketing authorisations for ergot derivatives containing medicinal products should be maintained, varied, suspended or withdrawn in relation to the below mentioned indications:
Odbor CHMP so zato zaprosili, naj poda svoje mnenje o tem, ali je treba dovoljenja za promet z zdravili, ki vsebujejo derivate ergot-alkaloidov, ohraniti, spremeniti, začasno umakniti ali razveljaviti za spodaj navedene indikacije:
In order to lift the suspension, MAHs must identify a specific patient population for which the benefits of the medicinal product outweigh the risk.
Za preklic začasnega umika morajo imetniki dovoljenja za promet z zdravilom opredeliti specifično populacijo bolnikov, pri kateri koristi zdravila odtehtajo tveganja.
The CHMP has considered the totality of the available data on the safety and efficacy of dihydroergotoxine.
CHMP je proučil vse razpoložljive podatke o varnosti in učinkovitosti dihidroergotoksina.
The marketing authorisation holders (MAHs) submitted all available efficacy data from clinical trials and observational studies, including data that became available since the granting of the initial marketing authorisation.
Imetniki dovoljenj za promet z zdravili so predložili vse razpoložljive podatke o učinkovitosti iz kliničnih preskušanj in opazovalnih študij, vključno s podatki, ki so bili pridobljeni po odobritvi prvotnega dovoljenja za promet z zdravilom.
The SAG unanimously agreed that there is no distinct clinical entity for cognitive impairment no dementia (CIND), the diagnostic criteria and definitions have changed over time and this wording does not correspond to a current clinically defined group.
Znanstveno svetovalna skupina se je soglasno strinjala, da ni jasne klinične entitete za kognitivno okvaro brez demence (cognitive impairment no dementia - CIND), da so se diagnostična merila in definicije v tem času spremenile in da omenjena ubeseditev ne ustreza sedanji klinično opredeljeni skupini.
Five were uncontrolled, open designed, without any well-defined primary efficacy objective, and they were conducted in patients with heterogeneous ocular disorders.
Pet študij je bilo nenadzorovanih, odprtega tipa in brez natančno opredeljenega primarnega cilja za oceno učinkovitosti, izvedli pa so jih pri bolnikih z raznovrstnimi očesnimi boleznimi.
Dihydroergotoxine modulates synaptic neurotransmitter levels and increases blood flow to the brain; at one time, it was believed that the latter mechanism was the primary mode of action by which dihydroergotoxine exerts clinical effects.
Dihidroergotoksin uravnava koncentracijo živčnih prenašalcev v sinapsi in povečuje dotok krvi v možgane; nekoč je veljalo, da je slednji mehanizem glavni način delovanja, s katerim dihidroergotoksin povzroči klinične učinke.
Scientific conclusions and grounds for variation to the terms of the marketing authorisations or suspension of the marketing authorisations, as applicable, taking into consideration the approved indications for each product
Znanstveni zaključki in podlaga za spremembo pogojev dovoljenj za promet z zdravili ali začasni umik dovoljenj za promet z zdravili, kot je primerno, ob upoštevanju odobrenih indikacij za posamezno zdravilo
Following the adoption of the CHMP opinion during the June 2013 CHMP meeting, a re-examination request was received from one of the MAH involved in the procedure.
Potem ko je odbor CHMP med zasedanjem junija 2013 sprejel mnenje, je eden od imetnikov dovoljenj za promet z zdravili, udeleženih v postopku, zahteval ponoven pregled mnenja.
• The suspension of the marketing authorisation for dihydroergotoxine containing medicinal products referred to in Annex I if no other indications are approved as part of their marketing authorisation.
• začasni umik dovoljenj za promet z zdravili iz Priloge I, ki vsebujejo dihidroergotoksin, če v sklopu njihovega dovoljenja za promet z zdravilom ni drugih odobrenih indikacij.
However, the CHMP also noted that the MAH provided information only for their product (Hydergine) and that underreporting is likely.
Vendar pa je CHMP prav tako upošteval, da je imetnik dovoljenja za promet z zdravilom predložil samo podatke za svoje zdravilo (Hydergine) in da obstaja verjetnost pomanjkljivega poročanja.
The CHMP considered that these studies did not provide robust evidence supporting the efficacy of dihydroergotoxine in the proposed target population.
CHMP je menil, da te študije niso zagotovile trdnih dokazov o učinkovitosti dihidroergotoksina pri predlagani ciljni populaciji.
No data were submitted in support of the indication “symptomatic treatment of veno-lymphatic insufficiency” and consequently no conclusion on efficacy could be drawn by the CHMP.
V podporo indikaciji „simptomatsko zdravljenje veno-limfatične insuficience“ niso bili predloženi nobeni podatki, zato CHMP ni mogel podati nobenih zaključkov glede učinkovitosti.
It acts as an agonist to dopaminergic and serotonergic receptors and an antagonist for alpha-adrenoreceptors.
Dihidroergotoksin deluje kot agonist dopaminergičnih in serotonergičnih receptorjev ter antagonist adrenoreceptorjev alfa.
In view of the above, the CHMP was of the opinion that the studies submitted could not demonstrate that dihydroergotoxine has a clinically relevant effect on patients with cognitive impairment.
Na podlagi zgoraj omenjenega je CHMP menil, da predložene študije niso uspele dokazati, da ima dihidroergotoksin klinično pomemben učinek na bolnike s kognitivno okvaro.
Based on these data and based on the pharmacological plausibility, dihydroergotoxine is considered to be associated with fibrotic reactions.
Na podlagi teh podatkov in farmakološke verjetnosti se ocenjuje, da je dihidroergotoksin povezan s fibrotičnimi reakcijami.
Overall, the CHMP was of the opinion that no situation could justify exposing a patient to risk of fibrosis and ergotism considering the very limited data on efficacy.
Na splošno je CHMP menil, da nobene okoliščine ne upravičujejo izpostavitve bolnika tveganju za fibrozo in ergotizem, saj so podatki o učinkovitosti zelo omejeni.
The CHMP noted that patients included in studies presented various symptoms or putative diagnosis, effect was mainly assessed with subjective scores, symptoms observed were very heterogeneous and results were not consistent across studies and long-term data are not in favour of an effect of dihydroergotoxine as compared to placebo.
CHMP je upošteval, da so pri bolnikih v študijah zabeležili različne simptome in domnevne diagnoze, da so učinek v glavnem ocenjevali s subjektivnimi ocenami, da so bili opaženi simptomi zelo raznovrstni in da se rezultati študij med seboj niso ujemali, dolgoročni podatki pa niso pokazali, da bi bil učinek dihidroergotoksina večji kot učinek placeba.
In the view of the SAG, it is not excluded a priori that the drug might be efficacious in a subgroup of well- defined patients according to current criteria, but this cannot be determined based on the information provided, which includes highly heterogeneous patient population and study outcome parameters.
Po mnenju znanstveno svetovalne skupine ni vnaprej izključeno, da bi zdravilo lahko bilo učinkovito pri podskupini bolnikov, natančno opredeljeni v skladu s trenutno veljavnimi merili, vendar tega ni mogoče ugotoviti na podlagi predloženih podatkov, ki opisujejo zelo heterogeno skupino bolnikov in parametre rezultatov študij.
For the indication “ancillary treatment of visual acuity decrease and visual field disturbances presumably of vascular origin”, seven clinical studies have been submitted.
V podporo indikaciji „dodatno zdravljenje zmanjšane ostrine vida in motenj vidnega polja, za katere se domneva, da so žilnega izvora,“ je bilo predloženih sedem kliničnih študij.
The CHMP highlighted that “chronic cognitive impairment excluding Alzheimer's disease and other dementia” is not considered a generally accepted definition of a pathological condition aimed to benefit from treatment.
CHMP je izpostavil, da „kronična kognitivna okvara, izključujoč Alzheimerjevo bolezen in druge oblike demence,“ ni splošno veljavna definicija patološkega stanja, pri katerem naj bi zdravilo imelo koristi.
These studies were of poor methodological quality: uncontrolled, open designed and without any well-defined primary efficacy endpoint.
Metodološka kakovost študij je bila slaba: študije so bile nenadzorovane, odprtega tipa in brez natančno opredeljenega primarnega opazovanega dogodka za oceno učinkovitosti.
• The Committee maintained its opinion that the benefit-risk balance of dihydroergotoxine containing products:
• odbor je potrdil prejšnje mnenje, da razmerje med tveganji in koristmi zdravil, ki vsebujejo dihidroergotoksin:
Fibrotic reactions have been associated to chronic use of ergot derivatives and although the reporting rate for dihydroergotoxine is low, the risk is sufficiently serious not to be dismissed particularly when considering its potential use in long-term treatment in a broad patient population.
Fibrotične reakcije so povezane s kronično uporabo derivatov ergotalkaloidov in čeprav je stopnja poročanja za dihidroergotoksin majhna, je tveganje dovolj resno, da ga ni mogoče spregledati, zlasti ob upoštevanju dejstva, da se dihidroergotoksin lahko uporablja za dolgotrajno zdravljenje pri široki populaciji bolnikov.
Therefore, other mechanisms inducing fibrosis cannot be excluded, which suggests a causal link between fibrosis and agonism of 5-HT2A and 5-HT1B receptors and also plausible effect on serotonin transporter.
Posledično ni mogoče izključiti drugih mehanizmov, ki povzročajo fibrozo, kar kaže na vzročno povezavo med fibrozo in agonizmom receptorjev 5-HT2A ter 5HT1B in tudi na verjeten učinek na prenašalce serotonina.
In spite of the fact that propranolol and flunarizine are recognized in migraine prophylaxis, the absence of a placebo group does not allow to conclude on the efficacy of dihydroergotoxine in the prophylaxis of migraine.
Kljub dejstvu, da sta propranolol in flunarizin odobrena za preprečevanje migrene, zaradi odsotnosti skupine s placebom ni mogoče podati zaključkov o učinkovitosti dihidroergotoksina pri preprečevanju migrene.
For the indication “prophylaxis of migraine headache”, two publications describe a double-blind, active, not placebo-controlled study on the effect of dihydroergocryptine (dihydroergotoxine is composed of a third of dihydroergocryptine) as compared to propranolol and flunarizine.
V zvezi z indikacijo „preprečevanje migrenskega glavobola“ dve publikaciji opisujeta dvojno slepo študijo, ki je bila nadzorovana z zdravilno učinkovino, namesto s placebom, v njej pa so primerjali učinek dihidroergokriptina (dihidroergotoksin je sestavljen iz tretjine dihidroergokriptina) z učinkom propranolola in flunarizina.
These included changing the prescription status, limiting treatment duration in certain conditions, contraindicating the product in patients with pre-existing fibrosis or in association with other drugs, the issuing of a DHPC highlighting the risk, a checklist for prescribers, and a pharmacological in vitro study for 5-HT subclass receptors affinity to the product.
Ti so vključevali spremembo načina izdajanja zdravil, omejitev trajanja zdravljenja pri nekaterih boleznih, kontraindikacijo zdravila pri bolnikih z obstoječo fibrozo ali kontraindikacijo za sočasno uporabo z drugimi zdravili, izdajo neposrednega obvestila zdravstvenim delavcem, ki opozarja na tveganje, kontrolni seznam za predpisovalce ter izvedbo farmakološke študije in vitro za afiniteto podrazreda receptorjev 5-HT za zdravilo.
Ergot derivatives are recognised as being capable of inducing fibrosis, in particular heart valve fibrosis.
Znano je, da lahko derivati ergot-alkaloidov povzročijo fibrozo, še zlasti fibrozo srčne zaklopke.
The CHMP reviewed all available data in support of the benefit and safety on dihydroergotoxine and considered the above restricted indication proposed by the MAH.
CHMP je pregledal vse razpoložljive podatke, predložene v podporo koristi in varnosti dihidroergotoksina, ter proučil zgoraj omenjeno omejeno indikacijo, ki jo je predlagal imetnik dovoljenja za promet z zdravilom.
Overall, the varying affinity for serotoninergic receptors with the different ergot derivatives and the therapeutic doses used may explain the differences observed for notification rates for the fibrotic reactions.
Na splošno lahko spreminjajoča se afiniteta za serotoninergične receptorje pri različnih derivatih ergotalkaloidov in terapevtskih odmerkih pojasni razlike, opažene pri poročanih deležih fibrotičnih reakcij.
• The Committee is of the opinion that the evidence for clinically significant efficacy of dihydroergotoxine in the currently assessed indications as well as in the indication proposed by the MAH in the re-examination is very limited, and therefore the potential benefit for patients in these indications is outweighed by the above identified risk.
• odbor meni, da so dokazi o klinično pomembni učinkovitosti dihidroergotoksina pri ocenjenih indikacijah in indikacijah, ki jih je imetnik dovoljenja za promet z zdravilom predlagal med ponovnim pregledom, izredno omejeni, zato zgoraj omenjeno tveganje odtehta morebitne koristi za bolnike pri teh indikacijah;
Dihydroergotoxine mesilate is an ergot alkaloid, known also as codergocrine mesilate and ergoloid mesilate, which is composed of equal parts of mesilates of dihydroergocornine, dihydroergocristine, and dihydroergocryptine.
Dihidroergotoksinijev mesilat je ergot-alkaloid, ki ga poznamo tudi pod imenoma kodergokrinijev mesilat in ergoloidijev mesilat, sestavljen pa je iz enakih delov dihidroergokorninijevega, dihidroergokristinijevega in dihidroergokriptinijevega mesilata.
In addition, dihydroergotoxine is composed of dihydroergocryptine and dihydroergocristine which are also considered to be associated with the induction of fibrotic reactions.
Poleg tega dihidroergotoksin sestoji iz dihidroergokriptina in dihidroergokristina, ki naj bi bila prav tako povezana s pojavom fibrotičnih reakcij.
Overall, the SAG disagreed with the indication and the target population definitions proposed by the MAH.
Na splošno se znanstveno svetovalna skupina ni strinjala z opredelitvijo indikacije in ciljne populacije, ki jo je predlagal imetnik dovoljenja za promet z zdravilom.
The MAHs also submitted their own overviews and critical summaries of all spontaneous reports of fibrotic reactions (cardiac with or without pulmonary arterial hypertension, pulmonary, pleural, peritoneal, retroperitoneal, etc) and ergotism with their ergot derivatives-containing medicinal products.
Imetniki dovoljenj za promet z zdravili so prav tako predložili svoje preglede in kritične povzetke vseh spontanih poročil o fibrotičnih reakcijah (srčnih s pljučno arterijsko hipertenzijo ali brez nje, pljučnih, plevralnih, peritonealnih, retroperitonealnih itd.) in ergotizmu pri svojih zdravilih, ki vsebujejo derivate ergot-alkaloidov.
In addition, a scientific advisory group (SAG) was convened in December 2012 at the request of the CHMP during which the experts discussed, based on their clinical experience, whether this substance plays a role in the prophylaxis of migraine headache.
Znanstveno svetovalna skupina je na pobudo odbora CHMP decembra 2012 sklicala sestanek, na katerem so strokovnjaki na podlagi svojih kliničnih izkušenj razpravljali o tem, ali ima ta učinkovina pomembno vlogo pri preprečevanju migrenskega glavobola.
• The variation to the terms of the marketing authorisation for dihydroergotoxine containing medicinal products referred to in Annex I, to delete the below indications from the Product Information (specific wording of the indication may vary from product to product and from country to country) as well as any relevant reference to these indications, when there are other therapeutic indications approved as part of their marketing authorisation:
• spremembo pogojev dovoljenj za promet z zdravili iz Priloge I, ki vsebujejo dihidroergotoksin, tako da se iz informacij o zdravilu izbrišejo spodaj navedene indikacije (natančno besedilo za indikacijo se lahko med zdravili in državami razlikuje) in druga zadevna sklicevanja na te indikacije, kadar so v sklopu dovoljenja za promet z zdravilom druge odobrene terapevtske indikacije:
More specifically, the CHMP stated that apart from “ergotism” other preferred terms are also related to symptoms of ergotism (i.e paraesthesia, formication, tingling, intestinal/cerebrovascular/peripheral/tongue ischaemia, angina pectoris, coronaropathy, thoracic pain, nausea, vomiting, diarrhoea, abdominal pain, cold sensation, thrombosis, stroke, gangrene, necrosis, vasoconstriction/vasospasm, cyanosis, myalgia, muscular cramps, pain in extremities, vertigo, hypoaesthesia, numbness, headache, confusion, hallucinations).
CHMP je zlasti izpostavil, da je poleg izraza „ergotizem“ še nekaj drugih priporočenih izrazov, ki so prav tako povezani s simptomi ergotizma (parestezija, mravljinčenje, ščemenje, intestinalna/cerebrovaskularna/periferna ishemija, ishemija jezika, angina pektoris, koronaropatija, bolečina v prsnem košu, navzea, bruhanje, diareja, bolečina v trebuhu, občutek mrazenja, tromboza, možganska kap, gangrena, nekroza, vazokonstrikcija/vazospazem, cianoza, mialgija, mišični krči, bolečina v okončinah, vertigo, hipoestezija, otopelost, glavobol, zmedenost, halucinacije).
For the indication “ancillary treatment of Raynaud's syndrome” the CHMP noted that the indication claimed by the MAH is peripheral vascular disease and that in some Members States the ancillary treatment of Raynaud's syndrome is approved for dihydroergotoxine as part of this more general indication (i.e. “peripheral vascular disease”).
V zvezi z indikacijo „dodatno zdravljenje Raynaudovega sindroma“ je CHMP upošteval, da je indikacija, ki jo zahteva imetnik dovoljenja za promet z zdravilom, periferna vaskularna bolezen in da je v nekaterih državah članicah dodatno zdravljenje Raynaudovega sindroma za dihidroergotoksin odobreno v okviru omenjene širše indikacije (tj. „periferna vaskularna bolezen“).
Overall, the CHMP reiterated that the risk minimisation measures proposed by the MAH are not considered by the Committee to effectively reduce the risk of fibrotic reactions and ergotism.
Na splošno je CHMP ponovno poudaril, da meni, da ukrepi za zmanjšanje tveganja, ki jih je predlagal imetnik dovoljenja za promet z zdravilom, ne zadoščajo za učinkovito zmanjšanje tveganja za fibrotične reakcije in ergotizem.
The risk minimisation measures proposed were not considered by the Committee to effectively reduce the risk for the two highlighted reactions (fibrosis and ergotism) in the broad indication proposed by the MAH.
Predlagani ukrepi za zmanjšanje tveganja po mnenju odbora ne morejo učinkovito zmanjšati tveganja za izpostavljeni reakciji (fibrozo in ergotizem) pri široki indikaciji, ki jo je predlagal imetnik dovoljenja za promet z zdravilom.
The CHMP considered that, although the risk of fibrotic reactions and ergotism associated with dihydroergotoxine is rare, it is established and these are severe adverse events with a possible fatal outcome.
CHMP je menil, da je tveganje za fibrotične reakcije in ergotizem, povezane z dihidroergotoksinom, sicer majhno, vendar dokazano, pri čemer gre za hude neželene dogodke z možnim smrtnim izidom.
Consequently, it was not possible for the CHMP to draw scientific conclusions regarding the benefit of dihydroergotoxine in peripheral vascular disease based on these study results and subsequently no conclusions could be drawn for the ancillary treatment of Raynaud's syndrome.
Zaradi tega CHMP na podlagi rezultatov teh študij ni mogel podati znanstvenih zaključkov v zvezi s koristmi dihidroergotoksina pri periferni žilni bolezni in posledično tudi zaključkov glede dodatnega zdravljenja Raynaudovega sindroma.
The Committee concluded that the benefit-risk balance of dihydroergotoxine containing products is not favourable pursuant to Article 116 of Directive 2001/83/EC for symptomatic treatment of chronic pathological cognitive and neurosensorial impairment in elderly (excluding Alzheimer's disease and other dementia), for ancillary treatment of Raynaud's syndrome, for ancillary treatment of visual acuity decrease and visual field disturbances presumably of vascular origin, for prophylaxis of migraine headache and for symptomatic treatment of veno-lymphatic insufficiency.
Odbor je zaključil, da skladno s členom 116 Direktive 2001/83/ES razmerje med tveganji in koristmi zdravil, ki vsebujejo dihidroergotoksin, ni ugodno za simptomatsko zdravljenje kronične patološke kognitivne in nevrosenzorične okvare pri starejših (izključujoč Alzheimerjevo bolezen in druge oblike demence), dodatno zdravljenje Raynaudovega sindroma, dodatno zdravljenje zmanjšane ostrine vida in motenj vidnega polja, za katere se domneva, da so žilnega izvora, preprečevanje migrenskega glavobola ter simptomatsko zdravljenje veno-limfatične insuficience.
In addition, a scientific advisory group (SAG) was convened in December 2012 at the request of the CHMP during which the experts discussed, based on their clinical experience, whether this substance plays a role in the symptomatic treatment of chronic pathological cognitive and neurosensorial impairment in elderly (excluding Alzheimer's disease and other dementia).
Znanstveno svetovalna skupina je na pobudo odbora CHMP decembra 2012 sklicala sestanek, na katerem so strokovnjaki na podlagi svojih kliničnih izkušenj razpravljali o tem, ali ima ta učinkovina pomembno vlogo pri simptomatskem zdravljenju kronične patološke kognitivne in nevrosenzorične okvare pri starejših (izključujoč Alzheimerjevo bolezen in druge oblike demence).