natgillin/translations-raw huggingface dataset:
Most of the arguments refer to the use of HES solutions for infusion outside the terms of the MA or to claimed benefits that are not clinically significant or supported by robust data.
Večina argumentov se nanaša na uporabo raztopin HES za infundiranje zunaj pogojev dovoljenja za promet z zdravilom ali na domnevne koristi, ki niso klinično pomembne oziroma jih ne podpirajo tehtni podatki.
The CMDh discussed whether measures to mitigate the risks associated with HES solutions for infusion, including in particular the risk of increased mortality and renal failure in critically ill patients and patients with sepsis would be effective and feasible, taking into account new elements provided by the MAHs and Member States.
Skupina CMDh je razpravljala o tem, ali bi bili ukrepi za zmanjšanje tveganj, povezanih z raztopinami HES za infundiranje, vključno zlasti s tveganjem za povečano umrljivost in ledvično odpoved pri kritično bolnih bolnikih in bolnikih s sepso, učinkoviti in izvedljivi, in sicer z upoštevanjem novih elementov, ki so jih predložili imetniki dovoljenj za promet z zdravilom in države članice.
• The emergency setting in which the products are used does not impede the implementation of a controlled access program based on the delivery of appropriate training to the relevant HCPs as the educational program can be organised and delivered well in advance of the use of the products.
• Nujno zdravljenje, v sklopu katerega se uporabljajo ta zdravila, ne onemogoča izvajanja programa nadzorovanega dostopa, saj se ustrezno usposabljanje za zadevne zdravstvene delavce v obliki izobraževalnega programa lahko organizira in izvede precej pred uporabo zdravil.
- The MAH should ensure that HES solutions for infusion are only delivered to accredited hospitals/centres.
- Imetnik dovoljenja za promet z zdravilom mora zagotoviti, da se raztopine HES za infundiranje dobavljajo samo akreditiranim bolnišnicam/centrom.
The CMDh noted that eight EU Member States have shared concerns about a medical need created in case of suspension of the marketing authorisation for HES solutions for infusion.
Skupina CMDh je upoštevala, da je osem držav članic EU izrazilo pomisleke o medicinski potrebi, ki bi nastala v primeru začasnega umika dovoljenj za promet z zdravilom za raztopine HES za infundiranje.
The DUS protocol to be submitted by the MAHs should include clear objectives, focusing on prescribing decisions, especially adherence to indications and contraindications.
Protokol študije o uporabi zdravil, ki ga morajo predložiti imetniki dovoljenj za promet z zdravilom, mora vključevati jasne cilje, usmerjene na odločitve o predpisovanju, zlasti upoštevanje indikacij in kontraindikacij.
As a consequence, the CMDh is of the position that the benefit-risk balance of HES solutions for infusion remains favourable subject to the agreed amendments to the product information and the conditions to the marketing authorisation.
Posledično skupina CMDh meni, da je razmerje med tveganji in koristmi raztopin HES za infundiranje še naprej ugodno, če se upoštevajo dogovorjene spremembe informacij o zdravilu in pogoji dovoljenja za promet z zdravilom.
Annex II Scientific conclusions and CMDh's detailed explanation on the scientific grounds for differences with the PRAC recommendation
Znanstveni zaključki in podrobna obrazložitev znanstvene podlage skupine CMDh za odstopanja od priporočila odbora PRAC
In 2013, following a review of the risk of kidney injury and mortality related to hydroxyethyl starch (HES) solutions for infusion when administered in patients with sepsis or critical illness, the Pharmacovigilance and Risk Assessment Committee (PRAC) recommended risk minimisation measures such as restrictions in use of these medicinal products.
Leta 2013 je Odbor za ocenjevanje tveganja na področju farmakovigilance (PRAC) po pregledu tveganja za poškodbo ledvic in umrljivost, povezanega z raztopinami hidroksietil škroba (HES) za infundiranje pri bolnikih s sepso ali kritično boleznijo, priporočil ukrepe za zmanjševanje tveganja, kot so omejitve uporabe teh zdravil.
However, the CMDh considered that this assumption is not supported by sufficient evidence and might not be representative of a significant portion of the prescribers population and that in any case, the learned societies will have an important role in channelling the messages of the DHPC.
Vendar je menila, da ta domneva ni podprta z zadostnimi dokazi in morda ni reprezentativna za velik delež populacije predpisovalcev ter da bodo imela strokovna združenja v vsakem primeru pomembno vlogo pri posredovanju sporočil neposrednih obvestil za zdravstvene delavce.
PRAC confirmed that the available information, including more recent submitted clinical data, do not change the established risk of increased mortality and renal failure related to the use of HES solutions for infusion in these patients.
Odbor PRAC je potrdil, da razpoložljive informacije, vključno z novejšimi predloženimi kliničnimi podatki, ne spreminjajo ugotovljenega tveganja za povečano umrljivost in ledvično odpoved, povezano z uporabo raztopin HES za infundiranje pri teh bolnikih.
The CMDh took into consideration the revised PRAC recommendation to suspend the marketing authorisations for solutions for infusion adopted at May PRAC plenary meeting.
Skupina CMDh je upoštevala revidirano priporočilo odbora PRAC za začasni umik dovoljenj za promet z zdravilom za raztopine za infundiranje, ki ga je odbor PRAC sprejel na svojem majskem plenarnem zasedanju.
The conduct of this study will be a condition to the marketing authorisations for HES solutions for infusion.
Izvedba te študije bo pogoj za dovoljenja za promet z zdravilom za raztopine HES za infundiranje.
• With regards to the two separate DUSs conducted to assess the effectiveness of the risk minimisation measures imposed as an outcome of the 2013 referral, PRAC concluded that these studies, despite limitations due to possible misclassification, are representative of the clinical usage in the European Union and that key results are reliable.
• kar zadeva dve ločeni študiji o uporabi zdravil, v katerih so ocenjevali učinkovitost ukrepov za zmanjšanje tveganja, uvedenih kot izid napotitve iz leta 2013, je odbor PRAC zaključil, da sta ti študiji kljub omejitvi zaradi morebitne napačne razvrstitve reprezentativni za klinično uporabo v Evropski uniji in da so glavni rezultati zanesljivi.
• This controlled access program is a key measure to ensure adherence of HCPs to the terms of the MA by increasing both the awareness of the relevant HCPs to the risks associated to the use of HES solutions for infusions and ensuring that they have received appropriate training before they can use HES solutions for infusion.
• ta program nadzorovanega dostopa je ključni ukrep za zagotavljanje, da bodo zdravstveni delavci upoštevali pogoje dovoljenj za promet z zdravilom, in sicer s povečevanjem ozaveščenosti zadevnih zdravstvenih delavcev o tveganjih, povezanih z uporabo raztopin HES za infundiranje, in zagotavljanjem, da so ti pred uporabo raztopin HES za infundiranjem deležni ustreznega usposabljanja.
Besides, the CMDh acknowledged the PRAC's concern that non-adherence would not only be due to a lack of awareness by prescribers of the restrictions imposed to HES solutions for infusion.
Skupina CMDh je tudi sprejela pomislek odbora PRAC, da neupoštevanje ni le posledica dejstva, da predpisovalci ne poznajo omejitev, ki veljajo za raztopine HES za infundiranje.
In 2012 and 2013, PRAC reviewed the benefits and risks of HES solutions for infusion in the treatment and prophylaxis of hypovolaemia, within Article 311 and 107i2 referral procedures.
Leta 2012 in 2013 je odbor PRAC v okviru napotitvenih postopkov v skladu s členoma 311 in 107i2 pregledal koristi in tveganja raztopin HES za infundiranje pri zdravljenju in profilaksi hipovolemije.
In conclusion, no risk minimisation measures or combination of measures have been identified which would be sufficiently effective or feasible to implement in a reasonable timeframe, when an important number of patients at high risk for serious harm, would continue to be exposed.
Prepoznali torej niso nobenih ukrepov za zmanjšanje tveganja ali kombinacije ukrepov, ki bi bili dovolj učinkoviti ali izvedljivi za izvedbo v razumnem časovnem okviru, pri čemer bi bili številni bolniki z velikim tveganjem za resne škodljive posledice še naprej izpostavljeni.
Revision of PRAC recommendation
Revizija priporočila odbora PRAC
In view of the insight that the CMDh has on the national healthcare systems, it agreed that the following additional risk minimisation measures are feasible and likely to be effective to minimise the risk of using HES solutions for infusion in contraindicated populations: the inclusion of an emphasised warning on the SmPC, PL, primary and secondary packaging, the circulation of a targeted DHPC and the implementation of a controlled access program.
Glede na vpogled, ki ga ima skupina CMDh v nacionalne zdravstvene sisteme, se je strinjala, da so naslednji dodatni ukrepi za zmanjševanja tveganja izvedljivi in verjetno učinkoviti za zmanjšanje tveganja za uporabo raztopin HES za infundiranje pri kontraindiciranih populacijah: vključitev poudarjenega opozorila v povzetek glavnih značilnosti zdravila, navodilo za uporabo, primarno in sekundarno ovojnino, pošiljanje ciljno usmerjenih neposrednih obvestil za zdravstvene delavce in izvedba programa nadzorovanega dostopa;
Controlled access program The objective of such program is to ensure the delivery of HES solutions for infusion to only hospitals/centres where HCPs expected to prescribe or administer (hereinafter ‘relevant HCPs') have been trained adequately on the appropriate use of HES solutions for infusion, irrespective of the department(s) where they operate,.
Namen tovrstnega programa je zagotoviti dobavo raztopin HES za infundiranje samo tistim bolnišnicam/centrom, v katerih so bili zdravstveni delavci, ki naj bi zdravilo predpisovali ali dajali (v nadaljevanju „zadevni zdravstveni delavci“), ustrezno usposobljeni za primerno uporabo raztopin HES za infundiranje, ne glede na oddelek, kjer delajo.
• Whilst acknowledging the difficulties of continuous training, centralising such organisation and monitoring by the MAH will address the challenges raised.
• Ob upoštevanju težav s stalnim usposabljanjem pa bi te izzive lahko obravnavali s centralizacijo njihove organizacije in spremljanjem s strani imetnikov dovoljenj za promet z zdravilom.
The PRAC carefully considered all the information provided in relation to a potential unmet medical need at national level should the marketing authorisations for HES solutions for infusion be suspended.
Odbor PRAC je skrbno preučil vse predložene informacije v povezavi z morebitnimi neizpolnjenimi medicinskimi potrebami na nacionalni ravni v primeru umika dovoljenj za promet z zdravilom za raztopine HES za infundiranje.
Amongst other data related to safety, the PRAC reviewed the results from two separate DUSs conducted to assess the effectiveness of the risk minimisation measures imposed as an outcome of the 2013 referral, and concluded that these studies despite a potential limitation of possible misclassification, are representative of the clinical usage in the European Union and that key results are reliable.
Med drugimi podatki, povezanimi z varnostjo, je odbor PRAC pregledal rezultate dveh ločenih študij o uporabi zdravil, v katerih so ocenjevali učinkovitost ukrepov za zmanjšanje tveganja, uvedenih kot izid napotitve iz leta 2013, in zaključil, da sta ti študiji kljub potencialni omejitvi zaradi morebitne napačne razvrstitve reprezentativni za klinično uporabo v Evropski uniji in da so glavni rezultati zanesljivi.
The PRAC also contraindicated the use of HES solutions for infusion in patients with sepsis or who are critically ill.
Odbor PRAC je tudi kontraindiciral uporabo raztopin HES za infundiranje pri bolnikih s sepso in kritično bolnih bolnikih.
A medication form to be filled before administration would also raise feasibility issues in an emergency setting.
Tudi glede obrazca za zdravilo, ki bi ga bilo treba izpolniti pred dajanjem, bi se porodilo vprašanje o izvedljivosti v nujnih primerih.
These reviews were triggered by the results from large randomised clinical studies3,4,5 which showed an increased risk of mortality in patients with sepsis and an increased risk of kidney injury requiring dialysis in critically ill patients following treatment with HES solutions for infusion.
Te preglede so sprožili rezultati večjih randomiziranih kliničnih študij3, 4, 5, ki so pokazali, da imajo bolniki s sepso povečano tveganje za umrljivost po zdravljenju z raztopinami HES za infundiranje, kritično bolni bolniki pa povečano tveganje za ledvične poškodbe, zaradi katerih je potrebna dializa.
Furthermore, the PRAC requested that, as conditions to the marketing authorisations of these medicinal products, further studies should be carried out on the use of these medicines in elective surgery and in trauma patients.
Nadalje je zahteval, da se kot pogoj za pridobitev dovoljenj za promet s temi zdravili opravijo dodatne študije o njihovi uporabi pri elektivnih kirurških posegih in poškodovancih.
The CMDh is of the position that the proposed additional measures described below would be feasible and effective to sufficiently minimise the risks by increasing awareness of HCPs, as well as ensuring that access to HES solutions for infusion is reserved to HCPs that have received adequate training.
Skupina CMDh meni, da bi bili predlagani spodaj opisani dodatni ukrepi izvedljivi in učinkoviti za zadostno zmanjšanje tveganja s povečanjem ozaveščenosti zdravstvenih delavcev ter zagotavljanjem, da je dostop do raztopin HES za infundiranje omejen na zdravstvene delavce, ki so prestali ustrezno usposabljanje.
Overall, taking into account the divergences amongst the experts on some important issues, the position from the PRAC members on the national situation regarding the clinical use of these products and the stakeholders submissions, PRAC did not consider the clinical utility of these products to outweigh the risk of mortality and renal failure to the proportion of patients with critical illness or sepsis that continue to be exposed to HES solutions for infusion.
Z upoštevanjem razhajanj med strokovnjaki glede nekaterih pomembnih vprašanj, stališča članov odbora PRAC o nacionalnih razmerah glede klinične uporabe teh zdravil in predložitev deležnikov je odbor PRAC presodil, da klinična uporabnost teh zdravil ne odtehta tveganja za umrljivost in ledvično odpoved pri deležu bolnikov s kritično boleznijo ali sepso, ki so še naprej izpostavljeni raztopinam HES za infundiranje.
In order to optimise the uptake by HCPs and their adherence to the adequate conditions of use of HES solutions for infusion, the learned societies should be involved in the development and distribution of such training materials.
Da bi zdravstveni delavci bolje sprejemali ustrezne pogoje za uporabo raztopin HES za infundiranje in jih upoštevali, je treba v pripravo in razdeljevanje tovrstnega gradiva za usposabljanje vključiti strokovna združenja.
The focus for the drug utilisation studies (DUSs) has been to evaluate the adherence to the restrictions in use, implemented in the product information, concerning the indication, posology, and contraindication for HES solutions for infusion.
Študije o uporabi zdravil so se osredotočale na ovrednotenje upoštevanja omejitev uporabe, navedenih v informacijah o zdravilu, kar zadeva indikacijo, odmerjanje in kontraindikacijo za raztopine HES za infundiranje.
In addition, the CMDh is of the view that the MAHs shall perform a Drug Utilisation Study, in order to assess the effectiveness of the new measures recommended.
Skupina CMDh tudi meni, da morajo imetniki dovoljenj za promet z zdravilom izvesti študijo o uporabi zdravil, s katero bodo ocenili učinkovitost novih priporočenih ukrepov.
Consequently, a direct correlation is to be expected between the indication for treatment with HES solutions for infusion, the dose of HES solutions for infusion required and with the risk for renal injury and death.
Posledično je mogoče pričakovati neposredno povezavo med indikacijo za zdravljenje z raztopinami HES za infundiranje, potrebnim odmerkom raztopin HES za infundiranje ter tveganjem za ledvično poškodbo in smrt.
The PRAC concluded that the claimed clinical utility for these products does not outweigh the risk of mortality and renal failure to the proportion of patients with critical illness or sepsis that continues to be exposed to HES solutions for infusion.
Odbor PRAC je zaključil, da domnevna klinična uporabnost teh zdravil ne odtehta tveganja za umrljivost in ledvično odpoved pri deležu bolnikov s kritično boleznijo ali sepso, ki so še vedno izpostavljeni raztopinam HES za infundiranje.
The PRAC concluded that no additional risk minimisation measure or combination of risk minimisation measures, to sufficiently ensure safe and effective use of HES solutions for infusion could be identified.
Odbor PRAC je zaključil, da ni mogoče določiti nobenih dodatnih ukrepov za zmanjšanje tveganja oziroma kombinacije ukrepov za zmanjšanje tveganja, s katerimi bi lahko zagotovili varno in učinkovito uporabo raztopin HES za infundiranje.
Detailed explanation of the scientific grounds for the differences from the PRAC recommendation
Podrobna obrazložitev znanstvene podlage za odstopanja od priporočila odbora PRAC
In view of the above, the PRAC concluded that pursuant to Article 116 of Directive 2001/83/EC the risks related to the use of HES outweigh their benefits and thus the benefit-risk balance of HES solutions for infusion is no longer favourable.
Direktive 2001/83/ES tveganja, povezana z uporabo HES, presegajo njegovo korist, zato razmerje med tveganji in koristmi raztopin HES za infundiranje ni več ugodno.
As an overall conclusion, the CMDh considered that the risk minimisation described above would be feasible and effective and will have a synergistic effect as they allow targeting specific HCPs at all the steps of the prescription and administration of HES solutions for infusion.
Skupina CMDh je sprejela končni zaključek, da bo zgoraj opisano zmanjševanje tveganja izvedljivo in učinkovito ter bo imelo sinergističen učinek, saj bo ciljno usmerjeno v določene zdravstvene delavce v vseh fazah predpisovanja in dajanja raztopin HES za infundiranje.
The PRAC concluded that no additional risk minimisation measures to ensure safe and effective use of HES solutions for infusion would be effective or feasible in a reasonable timeframe, where important number of patients at high risk would continue to be exposed.
Odbor PRAC je zaključil, da nobeni dodatni ukrepi za zmanjševanje tveganja za zagotavljanje varne in učinkovite uporabe raztopin HES za infundiranje ne bi bili učinkoviti ali izvedljivi v razumnem časovnem okviru, pri čemer bi bili številni bolniki z velikim tveganjem še naprej izpostavljeni.
For this protocol, the MAH should take into account the experience gathered from the previously conducted DUS.
Pri tem protokolu morajo imetniki dovoljenj za promet z zdravilom upoštevati zbrane izkušnje predhodno opravljenih študij o uporabi zdravil.
The PRAC has considered all elements expressed in relation to the impact of a suspension of the marketing authorisation for HES solutions for infusion on a potential unmet medical need at national level, including comments submitted by the MAHs in writing and at oral explanations, responses from Member States and other stakeholders' views.
Odbor PRAC je upošteval vse elemente, izražene v povezavi z vplivom začasnega umika dovoljenj za promet z zdravilom za raztopine HES za infundiranje glede morebitnih neizpolnjenih medicinskih potreb na nacionalni ravni, vključno s pripombami, ki so jih imetniki dovoljenj za promet z zdravilom predložili pisno in med ustno obrazložitvijo, odgovori držav članic ter stališči drugih deležnikov.
• The PRAC further acknowledged that the current clinical experience suggests that it is difficult to clearly separate patient populations where randomised clinical trials have shown serious harm from populations targeted by the approved indication.
• odbor PRAC je nadalje priznal, da dosedanje klinične izkušnje kažejo, da je populacije bolnikov, pri katerih so randomizirana klinična preskušanja pokazala resne škodljive posledice, težko ločevati od populacij, ki jim je namenjena odobrena indikacija.
Amendments to be included in the product information The DUSs results showed that approximately 9% of patients exposed to HES solutions for infusion were critically ill, approximately 5-8% of patients had renal impairment and approximately 3-4% of patients had sepsis.
Spremembe, ki jih je treba vključiti v informacije o zdravilu Rezultati študij o uporabi zdravil so pokazali, da je približno 9 % bolnikov, izpostavljenih raztopinam HES za infundiranje, kritično bolnih, da ima približno 5-8 % bolnikov ledvično okvaro in približno 3-4 % bolnikov sepso.
"Guideline on the Readability of the labelling and package leaflet on medicinal products for human use", to be submitted within 1 month from the Commission Decision.
Opozorilo in njegove vizualne značilnosti morajo prestati uporabniški test v skladu s „Smernicami o berljivosti označevanja zdravil za uporabo v humani medicini in navodila za njihovo uporabo“, ki ga je treba predložiti v enem mesecu po sklepu Komisije.
The DUS protocol should be submitted for assessment to the PRAC within 3 months of the Commission Decision.
Protokol študije o uporabi zdravil je treba predložiti odboru PRAC v oceno v treh mesecih po sklepu Komisije.
Therefore, the CMDh adopted a DHPC to inform HCPs of the results from the DUSs, the terms of the MA and the risks related to the use of HES solutions for infusion outside these terms, as well as the new additional risk minimisation measures.
Zato je skupina CMDh sprejela neposredno obvestilo za zdravstvene delavce, s katerim bodo zdravstveni delavci obveščeni o rezultatih študij o uporabi zdravil, pogojih dovoljenj za promet z zdravilom in tveganjih, povezanih z uporabo raztopin HES za infundiranje zunaj teh pogojev, ter o novih, dodatnih ukrepih za zmanjšanje tveganja.
- The MAH should manage the accreditation of the hospitals / centres, ensuring that all relevant HCPs intended to prescribe/ administer HES solutions for infusion have been adequately trained.
- Imetnik dovoljenja za promet z zdravilom mora voditi akreditacije bolnišnic/centrov in zagotoviti, da so vsi zadevni zdravstveni delavci, ki naj bi predpisovali/dajali raztopine HES za infundiranje, ustrezno usposobljeni.
PRAC also recommended a drug utilisation study to evaluate the effectiveness of these risk minimisation measures.
Odbor PRAC je priporočil tudi študijo o uporabi zdravil za ovrednotenje učinkovitosti teh ukrepov za zmanjševanje tveganja.
In its assessment, the PRAC considered the totality of evidence which includes all newly available data since the previous referral procedures, including results from DUSs, clinical studies, meta-analyses of clinical studies, post-marketing experience, Eudravigilance data, literature review, responses submitted by the marketing authorisation holders (MAHs) in writing and at oral explanations as well as stakeholders' submissions and views expressed by experts during an ad-hoc experts meeting, taking into account also the characterisation of benefits and risks concluded in the previous referral procedures.
Odbor PRAC je pri svoji oceni upošteval vse dokaze, kar vključuje vse nove podatke, pridobljene od prejšnjih napotitvenih postopkov, vključno z rezultati študij o uporabi zdravil, kliničnih študij, metaanaliz kliničnih študij, izkušnjami iz obdobja trženja, podatki Eudravigilance, pregledom literature, odgovori, ki so jih imetniki dovoljenj za promet z zdravilom predložili pisno in med ustno obrazložitvijo, predložitvami deležnikov ter stališči strokovnjakov, ki so jih ti izrazili na ad-hoc sestanku, pri čemer je upošteval tudi opredelitev koristi in tveganj iz predhodnih napotitvenih postopkov.