natgillin/translations-raw huggingface dataset:
For the indication “symptomatic treatment of veno-lymphatic insufficiency” very few studies have been conducted.
Za indikacijo „simptomatsko zdravljene veno-limfatične insuficience“ je bilo opraviljenih zelo malo študij.
This reaction occurred in young patients (mean age among cases reported: 41 years-old), with a short time to onset after dihydroergotamine initiation (less than 2 months, mean: 2 days).
Ta reakcija se je pojavila pri mladih bolnikih (povprečna starost pri poročanih primerih: 41 let), in sicer kmalu po uvedbi dihidroergotamina (manj kot 2 meseca, povprečje: 2 dneva).
The studies presented are old and of poor methodological quality: uncontrolled, open designed, with a low number of patients (n=12 in Wenzel, 1989, the most recent study).
Predstavljene študije so stare, kakovost njihove metodologije pa je slaba: nenadzorovane, odprtega načrta, z majhnim številom bolnikov (n = 12 v najnovejši študiji Wenzel 1989).
• The Committee considered the overall submitted data provided by the MAHs and the outcome of the scientific advisory group.
• odbor je upošteval celotne predložene podatke, ki so jih predložili imetniki dovoljenj za promet z zdravilom, in ugotovitve znanstveno svetovalne skupine;
A review of all other available data (i.e. literature data, pre-clinical data, and other clinical data including epidemiological studies) that were relevant to evaluate the risk of fibrosis was provided where possible.
Če je bilo mogoče, so predložili pregled vseh drugih razpoložljivih podatkov (tj. podatkov iz literature, predkliničnih podatkov in drugih kliničnih podatkov, vključno z epidemiološkimi študijami), primernih za oceno tveganja fibroze.
These included restricting the therapeutic indications, recommending close monitoring of patients and the issuing of a DHPC.
Ti so vključevali omejitev terapevtskih indikacij, priporočila za skrbno spremljanje bolnikov in izdajo neposrednega obvestila zdravstvenim delavcem.
Dihydroergotamine mesilate (dihydroergotamine - DHE) is a semi-synthetic derivative of ergotamine.
Dihidroergotaminijev mesilat (dihidroergotamin - DHE) je polsintetični derivat ergotamina.
As expected, fibrosis occurred mostly in female patients (68%) after long time of treatment with dihydroergotamine (9.1 years on average) and the most frequent type of fibrosis reaction reported was retroperitoneal (36%), followed by cardiac (30%) and pleural (18%).
Kot je bilo pričakovati, se je fibroza večinoma pojavila pri bolnicah (68 %) po dolgotrajnem zdravljenju z dihidroergotaminom (povprečno 9,1 leta), najpogostejše vrste poročanih fibrotičnih reakcij pa so bile retroperitonealne (36 %), srčne (30 %) in plevralne (18 %).
The Committee therefore pointed out that the proposed measures are insufficient to avoid that some patients develop fibrosis and ergotism during treatment.
Odbor je zato izpostavil, da predlagani ukrepi niso zadostni, da bi med zdravljenjem preprečili razvoj fibroze in ergotizma pri nekaterih bolnikih.
Under-notification can be suspected given that:
Sum na preredko poročanje je prisoten, saj:
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 preprečevanje migrene, kadar obstaja terapevtska potrebna po uporabi te učinkovine kot alternativnega/zadnjega zdravljenja.
• The Committee is of the opinion that the evidence for clinically significant efficacy of oral dihydroergotamine in the currently assessed indications 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 peroralnega dihidroergotamina v zvezi s trenutno odobrenimi indikacijami izredno omejeni, zato je zgoraj omenjeno tveganje večje od morebitne koristi za bolnike v zvezi s temi indikacijami;
In addition, patients were included if they displayed a reduction of systolic blood pressure of more than 10 mmHg, which does not comply with the established definition of orthostatic hypotension (at least 20 mm Hg below baseline).
Poleg tega so se vključili bolniki, pri katerih se je sistolični krvni tlak znižal za več kot 10 mmHg, kar ni skladno z uveljavljeno opredelitvijo ortostatske hipotenzije (vsaj 20 mmHg pod izhodiščno vrednostjo).
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 prosili, naj poda svoje mnenje o tem, ali je treba dovoljenja za promet z zdravili, ki vsebujejo derivate ergot-alkaloidov, ohraniti, spremeniti, začasno umakniti ali ukiniti za spodaj navedene indikacije:
Ergotism is a serious reaction, which leads in rare cases reported to important sequelae following amputation or colon resection for example.
Ergotizem je resna reakcija, ki v redkih primerih povzroči pomembne posledice, ki med drugim zahtevajo amputacijo ali resekcijo kolona.
From the approved indications of the dihydroergotamine 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 dihidroergotamin, 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):
However, the CHMP noted that for most of these patients an improvement or recovering had been observed after corticosteroid treatment or surgery (valve replacement), and in most cases the improvement is stated based on clinical symptoms (no scan).
Vendar je odbor CHMP ugotovil, da so pri večini teh bolnikov izboljšanje ali okrevanje opazili po zdravljenju s kortikosteroidi ali kirurškem posegu (zamenjavi zaklopke) in da izboljšanje pri večini bolnikov temelji na kliničnih simptomih (brez slikanja).
Following a national pharmacovigilance review held in 2011 new spontaneous notifications reported with some of those products identified serious cases of fibrosis and ergotism and France considered that this safety concern is not outweighed by the limited evidence of efficacy.
Po nacionalnem farmakovigilančnem pregledu leta 2011 so pri nekaterih od teh zdravil poročali o novih spontanih prijavah, pri katerih so ugotovili resne primere fibroze in ergotizma, zato je Francija presodila, da ta varnostna težava ne odtehta omejenih dokazov o učinkovitosti.
Moreover, safety data provided by some MAHs are incomplete (gap between reviewing period and marketing period of the product) and it cannot be excluded that cases reported with their products are lacking.
Poleg tega so varnostni podatki, ki so jih predložili nekateri imetniki dovoljenj za promet z zdravilom (presledek med obdobjem pregleda zdravila in obdobjem njegovega trženja), nepopolni, zato ni mogoče izključiti, da so primeri, poročani pri njihovih zdravilih, pomanjkljivi.
• The Committee considered the procedure under Article 31 of Directive 2001/83/EC for ergot derivatives containing medicinal products in the concerned indications.
• odbor je v skladu s členom 31 Direktive 2001/83/ES obravnaval napotitveni postopek za zdravila, ki vsebujejo derivate ergot-alkaloidov, pri zadevnih indikacijah;
Some symptoms related to ergotism may be confounded with migraine symptoms and thus not reported as an adverse drug reaction.
Nekateri simptomi, povezani z ergotizmom, se lahko zamenjajo s simptomi migrene, zato se niso poročali kot neželeni učinek na zdravilo.
In these studies, dihydroergotamine seems to have some efficacy only by injection route or at doses higher than the authorised dose.
Videti je, da ima dihidroergotamin v teh študijah nekaj učinkovitosti samo pri injiciranju ali odmerkih, večjih od odobrenega odmerka.
Overall, 8 cases of fibrotic adverse reactions from a French survey conducted in 2011 and 50 cases among the 75 cases reported by the MAHs have been considered as potentially related to dihydroergotamine including 24 with no confounding factor.
Na splošno se je 8 primerov fibrotičnih neželenih učinkov iz francoske raziskave, opravljene leta 2011, in 50 od 75 primerov, o katerih so poročali imetniki dovoljenj za promet z zdravilom, obravnavalo kot morebitno povezanih z dihidroergotaminom, vključno s 24 primeri brez sočasnega dejavnika.
• Fibrosis is also an insidious reaction that occurs after a long period of treatment and thus with often a delayed diagnosis.
• je fibroza zahrbtna reakcija, ki se pojavi dolgo časa po zdravljenju, diagnoza pa je zato navadno zapoznela.
In some published literature, they are considered as aetiology of retroperitoneal fibrosis (P. Meier et al, La fibrose rétropéritonéale, une maladie inflammatoire méconnue.
Nekatera objavljena literatura navaja, da so domnevni vzrok za retroperitonealno fibrozo (P. Meier in sod., La fibrose rétropéritonéale, une maladie inflammatoire méconnue.
• Symptomatic treatment of chronic pathological cognitive and neurosensorial impairment in elderly
• simptomatsko zdravljenje kronične patološke kognitivne in nevrosenzorične okvare pri starejših
In order to lift the suspension, MAHs must identify a specific patient population for which the benefits of the product outweigh the risk.
Za preklic začasnega umika morajo imetniki dovoljenja za promet z zdravilom ugotoviti specifično populacijo bolnikov, pri kateri so koristi zdravila večje od tveganja.
• Ancillary treatment of intermittent claudication in symptomatic peripheral arterial occlusive disease
• dodatno zdravljenje intermitentne klavdikacije pri simptomatski periferni arterijski okluzivni bolezni
Moreover, given the seriousness of ergotism and its consequences (sequelae, need for surgery, amputation), the young age of the patients with symptoms of ergotism and the short time to onset of the reaction, the safety profile of dihydroergotamine is highly questionable.
Poleg tega je zaradi resnosti ergotizma in njegovih posledic (potrebe po kirurškem posegu, amputacije), majhne starosti bolnikov s simptomi ergotizma ter hitrega pojava reakcije varnostni profil dihidroergotamina zelo vprašljiv.
Twelve patients suffering from peripheral venous insufficiency were treated first with intravenous dihydroergotamine followed by oral dihydroergotamine administration for one week.
Dvanajst bolnikov s periferno vensko insuficienco so najprej zdravili z intravenskim dihidroergotaminom, čemur je sledilo enotedensko peroralno dajanje dihidroergotamina.
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 zdravilom ali začasni umik dovoljenj za promet z zdravilom, kot je ustrezno, pri čemer so bile upoštevane odobrene indikacije za posamezno zdravilo
Moreover, the 8 new spontaneous notifications reported during the French survey conducted in 2011 show that the risk minimisation measures that are currently in place are not sufficient to prevent the risk of fibrotic reactions.
Poleg tega so v francoski raziskavi, opravljeni leta 2011, odkrili 8 novih, spontano poročanih primerov, kar kaže, da trenutni ukrepi za zmanjševanje tveganja niso zadostni za preprečevanje tveganja fibrotičnih reakcij.
Symptoms of ergotism are listed in the sections 4.8, 4.9 of all the SmPCs and ergotism is identified in section 4.4 as a consequence of a prolonged use of dihydroergotamine or high dosage.
Simptomi ergotizma so navedeni v poglavjih 4.8 in 4.9 vseh povzetkov glavnih značilnosti zdravila, ergotizem kot posledica dolgotrajne uporabe ali velikega odmerka dihidroergotamina pa je naveden v poglavju 4.4.
Based on the clinical experience the group considered that dihydroergotamine has only been used rarely for the treatment of orthostatic hypotension with no clear benefit to the patients.
Na podlagi kliničnih izkušenj je skupina menila, da se je dihidroergotamin le redko uporabljal za zdravljenje ortostatske hipotenzije, pri čemer ni bilo jasnih koristi za bolnike.
The literature data indicate a possible efficacy of oral dihydroergotamine in migraine prophylaxis, but definite scientific proof remains weak.
Podatki iz literature kažejo na morebitno učinkovitost peroralnega dihidroergotamina pri preprečevanju migrene, vendar so potrjeni znanstveni dokazi šibki.
The patients disease is not well defined, nor the efficacy endpoints.
Bolezen bolnikov in opazovani dogodki za učinkovitost niso dobro opredeljeni.
The CHMP considered the MAHs' proposals for risk minimisation measures.
Odbor CHMP je obravnaval predloge imetnikov dovoljenj za promet z zdravilom glede ukrepov za zmanjšanje tveganja.
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 zdravilom 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 ipd.) in ergotizmu pri svojih zdravilih, ki vsebujejo derivate ergot-alkaloidov.
Some of them were conducted with the intravenous administration which is not in the scope of this referral procedure for dihydroergotamine.
Nekatere od njih so izvedli z injiciranjem, ki ne spada v sklop tega napotitvenega postopka za dihidroergotamin.
• The suspension of the marketing authorisation for dihydroergotamine containing medicinal products referred to in Annex I in the event that no other indications are approved as part of their marketing authorisation.
• začasni umik dovoljenja za promet z zdravili iz Priloge I, ki vsebujejo dihidroergotamin, če se kot del njihovega dovoljenja za promet z zdravilom ne odobrijo druge indikacije.
One case was confounded by medical history and in 25 cases co-suspected drugs were reported: benfluorex (4 cases), dexflenfuramine (4 cases), pergolide (1 case), beta blockers (9 cases), fenofibrate (2 cases) and ergot derivative drug (8 cases).
Pri enem primeru so si pomagali z zdravstveno anamnezo, pri 25 primerih pa so poročali o sumu učinka sočasnih zdravil: benfluoreks (4 primeri), deksflenfuramin (4 primeri), pergolid (1 primer), zaviralci betaadrenergičnih receptorjev (9 primerov), fenofibrat (2 primera) in derivati ergot-alkaloidov (8 primerov).
The double-blind, randomised, placebo-controlled studies were old and generally not carried out with the current up-to-date methodology.
Dvojno slepe, randomizirane, s placebom nadzorovane študije so bile stare in navadno niso vključevale sodobne metodologije.
Systolic blood pressure of the placebo and the dihydroergotamine group differed already at baseline.
Sistolični krvni tlak v skupinah s placebom in dihidroergotaminom se je razlikoval že v izhodišču.
The seriousness of such adverse effects and their possible fatal outcome is underlined.
Odbor je izpostavil resnost teh neželenih učinkov in njihov morebitni smrtni izid.
The efficacy of dihydroergotamine in the acute treatment of migraine attack is not within the scope of this referral and will not be discussed.
Učinkovitost dihidroergotamina pri akutnem zdravljenju migrenskega napada je zunaj sklopa tega napotitvenega postopka in se ne bo obravnavala.
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 odbor CHMP menil, da nobene okoliščine ne upravičujejo izpostavitve bolnika tveganju za fibrozo in ergotizem, saj so podatki o učinkovitosti zelo omejeni.
In the acute treatment of migraine, it is administered parenterally or in the form of a nasal spray because of the low bioavailability of the unchanged drug by the oral route.
Pri akutnem zdravljenju migrene se daje parenteralno ali v obliki pršila za nos, saj je biološka uporabnost nespremenjenega zdravila, ki se daje peroralno, majhna.
In addition, it was the IV formulation of the product that was used and not the oral formulation that is in the scope of this referral procedure.
Poleg tega se je uporabila intravenska formulacija zdravila in ne peroralna, ki jo zajema ta napotitveni postopek.
Only one study, Thulesius (1986), demonstrated a significant decrease of immediate drop in blood pressure after standing up with 10mg per day dihydroergotamine compared to placebo, in patients with hypotension induced by treatment with psychotropic drugs and it became available after the initial marketing authorisation was granted.
Samo ena študija, Thulesius (1986), je pokazala pomembno zmanjšanje nenadnega padca krvnega tlaka po vstajanju ob uporabi 10 mg dihidroergotamina na dan v primerjavi s placebom, in sicer pri bolnikih s hipotenzijo, ki so jo povzročila psihotropna zdravila.
These co-suspected drugs are known to induce fibrosis.
Za ta zdravila je znano, da povzročajo fibrozo.
Agonism to 5-HT2B receptors induces a proliferative response and mitogenicity of the cells expressing this receptor leading to fibrogenesis.
Agonizem za receptorje 5-HT2B sproži proliferativni odziv in mitogenost celic, ki izražajo ta receptor, kar povzroči fibrogenezo.
After 4 months of treatment, the attack frequency decreased by 2.0 ± 1.6 (-60.0%) with dihydroergotamine versus 1.7 ± 1.5 (-48.8%) with placebo (p = 0.014 for the relative variations).
Po 4 mesecih zdravljenja se je pogostnost napadov zmanjšala za 2,0 ± 1,6 (-60,0 %) v skupini z dihidroergotaminom v primerjavi z 1,7 ± 1,5 (-48,8 %) v skupini s placebom (p = 0,014 za relativne variacije).
• Ancillary treatment of visual acuity decrease and visual field disturbances presumably of vascular origin
• dodatno zdravljenje zmanjšane ostrine vida in motenj vidnega polja, za katere se domneva, da so žilnega izvora;
The frequency of attacks of migraine (the primary efficacy criteria) was not statistically significant (dihydroergotamine group (-1.84 ± 1.55) vs. placebo group (-1.67 ± 1.49) (p=0.220)).
Razlika v pogostnosti napadov migrene (primarno merilo za učinkovitost) ni bila statistično pomembna (skupina z dihidroergotaminom (-1,84 ± 1,55) v primerjavi s skupino s placebom (-1,67 ± 1,49) (p = 0,220)).
A post-hoc analysis was performed in the sub-group of patients (n=288) with functional handicap and quality of life (QOL) decrease (defined by Migraine Specific Quality of Life, MSQ<80).
Pri podskupini bolnikov (n = 288) s funkcionalno oviranostjo in poslabšano kakovostjo življenja (opredeljeno z rezultatom MSQ < 80; Migraine Specific Quality of Life - z migreno povezana kakovost življenja).
To conclude, ergotism is an adverse reaction of ergot derivative drugs well-known to occur in a context of overdose or interaction.
Če povzamemo, je ergotizem neželeni učinek zdravil, ki vsebujejo derivate ergot-alkaloidov, za katerega je dobro znano, da se pojavi v sklopu prevelikega odmerjanja ali interakcije.
In the only recent, large study with appropriate design (double-blind, placebo-controlled, 5-month treatment study) (PROMISE study) that became available after the granting of the initial marketing authorisation, the evidence for efficacy of dihydroergotamine in the prevention of migraine has not been demonstrated as there was no statistically significant difference between dihydroergotamine and placebo.
V edini nedavni veliki študiji z ustreznim načrtom (dvojno slepi, s placebom nadzorovani, 5-mesečni študiji zdravljenja) (študiji PROMISE), ki je bila objavljena po odobritvi prvotnega dovoljenja za promet z zdravilom, niso ugotovili dokazov za učinkovitost dihidroergotamina pri preprečevanju migrene, saj ni bilo statistično pomembne razlike med dihidroergotaminom in placebom.
Therefore, even if it is highly pharmacologically plausible that ergot derivatives acting as 5HT2B receptor agonists may induce "serotonergic" valve disease similar to that induced by carcinoid tumours or fibrotic lesions of other tissues, it must be remembered that some ergot derivatives are not 5-HT2B receptor agonists.
Čeprav je farmakološko zelo verjetno, da lahko derivati ergot-alkaloidov, ki delujejo kot agonisti receptorjev 5-HT2B, povzročijo „serotoninergično“ bolezen zaklopke, podobno tisti, ki jo povzročajo karcinoidni tumorji ali fibrotične lezije v drugih tkivih, je treba izpostaviti, da nekateri derivati ergotalkaloidov niso agonisti receptorjev 5-HT2B.
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 zdravilom 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.
Moreover, the number of cases reported with a contraindicated concomitant drug reveals that information in the SmPC is not sufficient to avoid an exposition of the patient to the serious risk of ergotism.
Poleg tega število poročanih primerov s kontraindiciranim sočasnim zdravilom kaže, da informacije v povzetku glavnih značilnosti zdravila niso zadostne, da bi se izognili izpostavljenosti bolnika resnemu tveganju ergotizma.
For all products the concomitant use of CYP3A inhibitors is contraindicated with dihydroergotamine (section 4.5) and for others the concomitant use of vasonconstrictive agent is also contraindicated.
Pri vseh zdravilih z dihidroergotaminom je sočasna uporaba z zaviralci CYP3A kontraindicirana (poglavje 4.5), pri nekaterih pa je prav tako kontraindicirana sočasna uporaba z vazokonstriktivnimi učinkovinami.
Based on the clinical experience the group considered that no special population exists that could benefit from the treatment with this active substance in the prophylaxis of migraine headache.
Na podlagi kliničnih izkušenj je skupina menila, da ne obstaja nobena posebna populacija, ki bi ji lahko zdravljenje s to učinkovino koristilo pri preprečevanju migrenskega glavobola.
On the efficacy side for the indication “prophylaxis of migraine headache” data derive from a few randomised, double-blind, placebo-controlled studies or double-blind non placebo-controlled and open label studies, the majority of which was conducted after the granting of the initial marketingauthorisation.
Za učinkovitost pri indikaciji „preprečevanje migrenskega glavobola“ so bili predloženi podatki iz nekaj randomiziranih, dvojno slepih, s placebom nadzorovanih študij ali dvojno slepih, s placebom nenadzorovanih, odprtih študij, od katerih je bila večina izvedenih po odobritvi prvotnega dovoljenja za promet z zdravilom.
With regard to the reported cases, the CHMP noted the problem of under-reporting for this product considering the period that it is on the market.
Pri poročanih primerih je odbor CHMP opazil težavo s preredkim poročanjem za to zdravilo glede na to, da je že dolgo v prometu.
Likewise, the efficacy of dihydroergotamine administered by subcutaneous, intramuscular or intravenous injection or intranasal spray is not within the scope of this referral and will be not discussed.
Učinkovitost dihidroergotamina, ki se daje s subkutanim, intramuskularnim ali intravenskim injiciranjem ali pršilom za nos, je prav tako zunaj sklopa tega napotitvenega postopka in se ne bo obravnavala.
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 afiniteta za serotoninergične receptorje pri različnih derivatih ergotalkaloidov in terapevtskih odmerkih razloži razlike, opažene pri poročanih deležih fibrotičnih reakcij.