natgillin/translations-raw huggingface dataset:
Overall, the CHMP considered the clinical data submitted in support of the efficacy of buflomedil to be limited.
Na splošno je bil CHMP mnenja, da so klinični podatki, predloženi v podporo učinkovitosti buflomedila, omejeni.
Serious cardiovascular and neurological adverse events in elderly patients and patients with renal impairment
Resni kardiovaskularni in nevrološki neželeni učinki pri starejših bolnikih in bolnikih z okvaro ledvic
The CHMP assessed the impact of the risk minimisation measures previously implemented in France, consisting mainly of revisions to the SmPC and communication and noted the proposed extension of these measures to other member states.
CHMP je ocenil vpliv ukrepov za zmanjšanje tveganj, ki so bili pred tem uvedeni v Franciji, in ki so bili v glavnem sestavljeni iz popravkov povzetka glavnih podrobnosti zdravila in komunikacij, ter predlagana podaljšanja teh ukrepov sporočil drugim državam članicam.
The MAH review of the ICSR database identified 5 cases with known dosage occurring in elderly patients for whom dosage adjustment was required.
Pregled podatkovne baze ICSR, ki ga je opravil imetnik dovoljenja za promet z zdravilom, je razkril 5 primerov z znanim odmerjanjem, ki so se pojavili pri starejših bolnikih, za katere je bilo treba odmerek prilagoditi.
Following these enquiries, France took a number of national regulatory actions to minimise the risk of adverse events associated with buflomedil.
Po teh poročilih je Francija sprejela več nacionalnih regulativnih ukrepov za zmanjšanje tveganja resnih neželenih učinkov, povezanih z uporabo buflomedila.
France previously conducted two pharmacovigilance and toxicovigilance investigations following reports of nervous system and cardiac serious adverse events (SAEs) associated with the use of buflomedil.
Francija je doslej izvedla dve preiskavi farmakovigilance in toksikovigilance po prejemu poročil o resnih neželenih dogodkih (SAE) živčnega sistema in srca, povezanih z uporabo buflomedila.
The CHMP also noted the results of the Thalès observational drug utilisation study, including 300 000 patients and conducted to assess the impact of the RMMs implemented in France on prescription patterns.
CHMP je upošteval tudi rezultate Thalsove opazovalne študije o uporabi zdravila, v katero je bilo vključenih 300 000 bolnikov, in ocenil vpliv ukrepov za obvladovanje tveganj v Franciji z vzorci predpisovanja zdravila.
The CHMP concluded that the impact of the implemented measures was very weak and that the expected impact of the proposed measures was insufficient to adequately address the identified risks observed with buflomedil.
CHMP je zaključil, da je bil učinek uvedenih ukrepov zelo šibak in da pričakovani učinek predlaganih ukrepov ne zadošča, da bi lahko opredeljena tveganja, ki so jih opazili pri uporabi buflomedila, ustrezno odpravili.
• The Committee considered, based on the assessment of the impact of risk minimisation measures already implemented in some Member States and on the published literature, that the risk minimisation measures proposed by the Marketing Authorisation Holder would not be able to adequately reduce the risks of serious adverse events to a clinically acceptable level.
• odbor je menil, da na podlagi ocene vpliva ukrepov za zmanjševanje tveganj, ki so bili v nekaterih državah članicah že uvedeni, in na podlagi objavljene literature, ukrepi za zmanjšanje tveganja, ki jih je predlagal imetnik dovoljenja za promet z zdravilom, ne bi zadoščali za ustrezno zmanjšanje tveganja resnih neželenih učinkov na klinično sprejemljivo raven;
The concerns regarding the rapid deterioration of renal function in these patients, requiring regular and frequent monitoring were also reiterated.
Poudarjena je bila tudi zaskrbljenost zaradi naglega slabšanja delovanja ledvic pri teh bolnikih, zaradi česar jih je treba redno in pogosto spremljati.
• The Committee considered that buflomedil-containing medicinal products showed only limited clinical efficacy in the symptomatic treatment of chronic peripheral vascular disease.
• odbor je menil, da so pokazala zdravila z buflomedilom samo omejeno klinično učinkovitost pri simptomatskem zdravljenju kronične periferne žilne bolezni;
The EudraVigilance review identified 74 cases of adverse events associated with buflomedil, with a total of 35 cases recording cardiac adverse and 39 cases recording neurological adverse events.
S pregledom sistema EudraVigilance je bilo ugotovljenih 74 primerov neželenih učinkov, povezanih z uporabo buflomedila, s skupaj 35 primeri zabeleženih neželenih dogodkov srca in 39 primeri zabeleženih nevroloških neželenih dogodkov.
The CHMP also carried out a separate assessment of the safety of the parenteral formulations of buflomedil, which are used in the hospital setting for the treatment of severe chronic ischaemia of the lower limbs.
CHMP je ločeno ocenil varnost parenteralnih formulacij buflomedila, ki se uporabljajo v bolnišnicah za zdravljenje hude kronične ishemije spodnjih udov.
Regarding the LIMB study, the results indicated a trend of a decrease in symptoms (symptomatic deterioration of PAOD, amputations) although there was an increase in cardiovascular events (MI, stroke, CV deaths).
Rezultati v zvezi s študijo LIMB kažejo na trend zmanjšanja simptomov (zmanjšanje simptomov BOPA, manj amputacij), vendar se je število kardiovaskularnih dogodkov povečalo (miokardni infarkt, kap, smrt zaradi kardiovaskularnih bolezni).
Overall benefit-risk assessment
Splošna ocena razmerja med koristmi in tveganji
• The Committee raised concerns regarding the rapid deterioration of renal function in patients with peripheral vascular disease, requiring regular and frequent monitoring.
• odbor je izrazil skrb glede hitrega slabšanja delovanja ledvic pri bolnikih s periferno žilno boleznijo, zaradi česar jih je treba redno in pogosto nadzirati;
The CHMP noted a review of French Eudravigilance data analysing spontaneous reports associated with treatment with buflomedil, to identify cases where cardiac and neurological reactions occurred under normal therapeutic doses (i.e. maximum of 600 mg daily for the oral tablet formulation).
CHMP je upošteval pregled francoskih podatkov v sistemu Eudravigilance, ki analizirajo spontana poročila, povezana z zdravljenjem z buflomedilom, da opredeli primere, v katerih so se kardiološke in nevrološke reakcije pojavile z običajnimi terapevtskimi odmerki (tj. največ 600 mg na dan za formulacijo peroralnih tablet).
The CHMP noted the efficacy data submitted by the MAH, including the relatively recent large placebocontrolled LIMB (Limbs International Medicinal Buflomedil) study.
CHMP je upošteval podatke o učinkovitosti, ki jih je predložil imetnik dovoljenja za promet z zdravilom, tudi relativno novo in obširno s placebom kontrolirano študijo LIMB (Limbs International Medicinal Buflomedil).
• The Committee therefore considered that the risk-benefit balance of buflomedil-containing medicinal products is not positive under normal conditions of use.
• zato je odbor menil, da razmerje med tveganji in koristmi uporabe zdravil, ki vsebujejo buflomedil, v običajnih pogojih uporabe ni pozitivno.
These risks are compounded by the fact that buflomedil is a substance with a narrow therapeutic index and that buflomedil treatment requires dose-adaptation to adjust for renal function.
Ta tveganja še zaostruje dejstvo, da je buflomedil snov z ozkim terapevtskim indeksom, in da je treba pri zdravljenju z buflomedilom odmerek ustrezno prilagoditi glede na delovanje ledvic.
The CHMP noted the proposed additional revisions to the SmPC, restricting the population by further narrowing the PAOD indication and revising the wording of the contraindication in severe renal impairment in order to improve compliance to prescribing in the event of renal insufficiency.
CHMP je zaznal predlagane dodatne popravke povzetka glavnih značilnosti zdravila, ki omejujejo populacijo z dodatnim zoženjem indikacije BOPA in popravljenim besedilom za kontraindikcije pri hudi okvari ledvic z namenom izboljšati skladnost pri predpisovanju v primeru ledvične insuficience.
• The Committee considered that in this context, the narrow therapeutic index of buflomedil is of major concern, as patients with peripheral vascular disease treated with buflomedil are inherently likely to experience decreased renal function, due to the nature of their condition.
• odbor je upošteval, da je v zvezi s tem ozek terapevtski indeks buflomedila glavna skrb, saj je pri bolnikih s periferno žilno boleznijo, zdravljenih z buflomedilom, verjetnost za zmanjšano delovanje ledvic inherentna zaradi narave njihove bolezni;
According to the approved indication, the injection formulation of buflomedil is used to initiate PAOD therapy, to be followed by a switch to oral therapy.
V skladu z odobreno indikacijo se injekcijska formulacija buflomedila uporablja za začetek zdravljenja BOPA, nato pa bolnik preide na peroralno zdravljenje.
While acknowledging the iatrogenic nature of the reported cases, the CHMP considered that these cases provide supportive evidence of the cardiovascular and neurological risks of buflomedil, as adverse events were noted in patients administered twice the daily dosage, which suggests that the risks are associated with overdoses of relatively small magnitudes.
Ob priznavanju iatrogene narave sporočenih primerov je CHMP menil, da ti primeri ustrezno podpirajo dokaze o kardiovaskularnih in nevroloških tveganjih buflomedila, saj so neželene učinke opazili pri bolnikih, ki so prejemali odmerke dvakrat na dan, kar kaže, da je obseg tveganj, povezan s prevelikim odmerjanjem, relativno majhen.
Although the 12 cases were complicated by underlying clinical conditions and other concomitant medications, the CHMP considered them to confirm the risk of serious adverse events associated with the use of buflomedil under normal conditions of use.
Čeprav se je 12 primerov zapletlo zaradi osnovnih kliničnih boleznih in sočasne uporabe drugih zdravil, jih je CHMP upošteval pri potrditvi tveganja resnih neželenih učinkov, povezanih z uporabo buflomedila v običajnih pogojih uporabe.
As a result, when addressing the risk-benefit of buflomedil under normal conditions for use, the CHMP assumed a switch to oral formulations and therefore considered that the risk/benefit of buflomedil injectable needs to be considered within the overall discussion of the risk-benefit of buflomedil.
Posledično CHMP ob obravnavanju razmerja med tveganji in koristmi uporabe buflomedila v običajnih pogojih uporabe predvideva prehod na peroralno formulacijo, zato meni, da je treba razmerje med tveganji in koristmi injekcije buflomedila upoštevati v okviru splošne razprave o razmerju med tveganji in koristmi buflomedila.
The CHMP concluded that due to the similarities between the proposed RMMs and the ones implemented in France, it is possible to conclude on the effectiveness of the proposed RMMs, despite the lack of implementation in all member states and that these measures are inadequate to prevent the occurrence of serious adverse events with buflomedil.
CHMP je zaključil, da je zaradi podobnosti med predlaganimi ukrepi za obvladovanje tveganj in tistimi, ki so v Franciji že uvedeni, mogoče sklepati o učinkovitosti predlaganih ukrepov za obvladovanje tveganja, čeprav še niso bili vpeljani v vseh državah članicah, in da ti ukrepi ne zadoščajo za preprečevanje hudih neželenih učinkov z buflomedilom.
Following a European PSUR assessment and a full benefit-risk assessment completed by the MAH in January 2010, the MAH proposed a number of measures to address the identified concerns.
Po evropskem redno posodobljenem poročilu o varnosti zdravila (PSUR) in celoviti oceni razmerja med tveganji in koristmi, ki ga je imetnik dovoljenja za promet z zdravilom izvedel januarja 2010, je imetnik dovoljenja za promet z zdravilom predlagal številne ukrepe za rešitev opredeljenih težav.
The reported ADRs were mainly related to serious neurological and cardiovascular ADRs.
Neželeni učinki, o katerih so poročali, so bili večinoma povezani z resnimi nevrološkimi in kardiovaskularnimi neželenimi učinki.
The CHMP noted that according to the French experience (including the results of the Thalès study and the publication by Bruhat et al.), cases of non-compliance with the recommended dose, nonadjustment of dose in patients with renal impairment and lack of monitoring of renal function persist, resulting in cases of serious adverse events, which is unacceptable for a product for which the only benefit is a limited level of efficacy in the lower limb peripheral vascular disease indication.
CHMP je na podlagi francoskih izkušenj (vključno z rezultati Thalesove študije in publikacije Bruhat in dr.) uvidel, da še naprej prihaja do neusklajenosti s priporočenim odmerkom, neprilagojevanja odmerka pri bolnikih z okvaro ledvic, velikokrat izostane tudi spremljanje delovanja ledvic, vse skupaj pa povzroči primere hudih neželenih učinkov, kar je za zdravilo, katerega edina korist je omejena raven učinkovitosti za indikacijo periferna žilna bolezen spodnjih okončin, nesprejemljivo.
The CHMP was of the opinion that this data showed the risks associated with buflomedil in view of its narrow therapeutic margin.
Po mnenju CHMP ta podatek kaže na tveganje, povezano z uporabo buflomedila glede na njegovo ozko terapevtsko mejo.
The CHMP also considered a review of the individual case safety reports (ICSR) database conducted by the MAH, to identify cases of cardiological or neurological adverse events under normal conditions of use, i.e. cases where the dose did not exceed the maximum daily dose of 600mg, cases with accidental overdoses or cases including patients with known renal impairment requiring dose adjustment.
CHMP je upošteval tudi pregled podatkovne baze posamičnih poročil o škodljivih neželenih učinkih (individual case safety reports, ICSR), ki ga je opravil imetnik dovoljenja za promet z zdravilom za opredelitev primerov kardioloških ali nevroloških neželenih učinkov v običajnih pogojih uporabe, tj. v primerih, kjer odmerek ni presegel največjega dnevnega odmerka 600 mg, primere nenamernega prevelikega odmerjanja ali primere, ki vključujejo bolnike z znano okvaro ledvic, pri katerih je treba odmerek prilagoditi.
The CHMP also noted the MAH proposal to reduce the pack size, to minimise the consequences of an intentional overdose.
CHMP je opazil tudi predlog imetnika dovoljenja za promet z zdravilom za zmanjšanje velikosti pakiranja in s tem posledic nenamernega prevelikega odmerjanja.
• The Committee therefore concluded, in view of the available data, that the risks of serious cardiac and neurological adverse events associated with the use of buflomedil-containing medicinal products in the symptomatic treatment of chronic peripheral vascular disease, under normal conditions of use, outweigh the limited benefits.
• odbor je zato v okviru razpoložljivih podatkov sklenil, da je tveganje resnih neželenih učinkov na srce in nevroloških neželenih učinkov ob uporabi zdravil, ki vsebujejo buflomedil, pri simptomatskem zdravljenju kronične periferne vaskularne bolezni v običajnih pogojih uporabe, večje od omejenih koristi;
• The Committee considered that a number of serious cardiac and neurological adverse events have been reported with the use of buflomedil under normal conditions of use, particularly in elderly patients.
• odbor je upošteval, da so bila predložena številna poročila o resnih neželenih učinkih na srce in nevroloških neželenih učinkih pri uporabo buflomedila v običajnih pogojih uporabe, zlasti pri starejših bolnikih;
These reported 188 and 26 patients respectively who experienced AEs.
Prva poroča o 188, druga pa o 26 bolnikih, ki so imeli neželene učinke.
In addition, the CHMP noted the evidence of limited clinical efficacy of buflomedil, as demonstrated in recent clinical trials.
CHMP je upošteval tudi dokaze glede omejene klinične učinkovitosti buflomedila, ki so jih dala novejša klinična preskušanja.
In conclusion, taking into account the serious cardiac and neurological adverse events associated with the use of buflomedil-containing medicinal products under normal conditions of use, the evidence of limited clinical efficacy which is insufficient to compensate for the risks associated with the use of buflomedil and the established concerns regarding the effectiveness of the risk minimisation measures, the CHMP considered that the risk-benefit balance of buflomedil-containing medicinal products is not positive under normal conditions of use.
CHMP je zato ob upoštevanju resnih neželenih učinkov na srce in nevroloških neželenih učinkov, povezanih z zdravili, ki vsebujejo buflomedil, ob običajnih pogojih uporabe, in dokazov omejene klinične učinkovitosti, ki ne nadomestijo tveganj, povezanih z uporabo buflomedila, in zaradi ugotovljenih skrbi glede učinkovitosti ukrepov za zmanjšanje tveganj, sklenil, da razmerje med tveganji in koristmi zdravil, ki vsebujejo buflomedil, v običajnih pogojih uporabe ni pozitivno.
However, the CHMP considered that the risk minimisation measures proposed by the MAH are unlikely to reduce the serious cardiac and neurological adverse events associated with the use of buflomedil to a clinically acceptable level.
CHMP je kljub temu menil, da ni verjetno, da bi ukrepi za zmanjševanje tveganj, ki jih je predlagal imetnik dovoljenja za promet z zdravilom, zmanjšali resne neželene učinke na srce in nevrološke neželene učinke, povezane z uporabo buflomedila, na klinično sprejemljivo raven.
Consequently, while the efficacy remains largely unchanged since the granting of the initial MA, the CHMP was of the opinion that the available evidence is not supportive of a significant clinical efficacy of buflomedil on cardiovascular events and on walking distance.
Posledično je CHMP menil, da ostaja učinkovitost od podelitve prvega dovoljenja za promet z zdravilom v veliki meri enaka in da z razpoložljivimi dokazi značilna klinična učinkovitosti buflomedila pri kardiovaskularnih dogodkih in prehojeni razdalji ni prepričljivo dokazana.
The CHMP considered the proposal for a website dedicated to buflomedil to be unlikely to significantly improve the awareness of prescribers, as previous communication tools already implemented in France were insufficient to improve compliance with indications and renal monitoring.
CHMP je opazil, da imetnik dovoljenja za promet z zdravilom ni predlagal umika formulacije tablet s 300 mg. CHMP je menil, da ni verjetno, da bi predlagana spletna stran, posvečena buflomedilu, znatno izboljšala zavedanje zdravnikov, ki zdravilo predpisujejo, saj prejšnje komunikacijsko orodje, uvedeno v Franciji, ni zadoščalo za izboljšanje skladnosti z indikacijami in ni povečalo nadzora delovanja ledvic.
This is of particular concern as patients with peripheral vascular disease are inherently likely to experience decreased renal function due to the nature of their condition.
To je še zlasti zaskrbljujoče zaradi bolnikov s periferno žilno boleznijo, pri katerih je verjetnost za zmanjšano delovanje ledvic inherentna zaradi narave njihove bolezni.
In these enquires, the reported nervous system SAEs consisted mainly of convulsions, myoclonia and status epilepticus while the cardiac SAEs consisted mainly of tachycardia, hypotension, ventricular rhythm disorders and cardiac arrest.
V teh preiskavah so sporočeni resni neželeni dogodki živčnega sistema obsegali predvsem krče, mioklonijo in epileptični status, resni neželeni dogodki srca pa so obsegali predvsem tahikardijo, hipotenzijo, ventrikularno motnjo ritma in srčni zastoj.
Regarding risk minimisation measures, the CHMP noted the MAH proposals but considered that these are unlikely to be sufficient to prevent the occurrence of serious cardiac and neurological adverse events under normal conditions of use nor reduce the well identified risks of accidental overdoses and non-compliance with renal function monitoring associated with the use of buflomedil to an acceptable level.
Glede ukrepov za zmanjšanje tveganj je CHMP upošteval predloge imetnika dovoljenja za promet z zdravilom, vendar je menil, da verjetno ne bodo zadoščali za preprečevanje pojava resnih neželenih učinkov za srce in nevroloških neželenih učinkov pri običajnih pogojih uporabe ali za zmanjšanje dobro znanih tveganj nenamernega prevelikega odmerjanja in tudi ne bodo privedli do rutinskega nadziranja delovanja ledvic, povezanega z uporabo buflomedila.
With regards to safety, the CHMP concluded that the use of buflomedil is associated with a number of serious cardiological (mainly tachycardia, hypotension, ventricular rhythm disorders and cardiac arrest) and neurological (mainly convulsions, myoclonia and status epilepticus) adverse events, which occur under normal conditions of use, particularly in elderly patients, who are predominantly the patient population relevant to the approved indication.
Glede varnosti je CHMP zaključil, da je uporaba buflomedila povezana s številnimi resnimi kardiološkimi (predvsem tahikardijo, hipotenzijo, ventrikularno motnjo ritma in srčnim zastojem) in nevrološkimi (predvsem krči, mioklonijo in epileptičnim statusom) neželenimi učinki, ki so se pojavili v običajnih pogojih uporabe, zlasti pri starejših bolnikih, ki predstavljajo pretežno populacijo bolnikov za odobreno indikacijo.
In summary, the CHMP concluded that the use of buflomedil is associated with a number of serious cardiological (mainly tachycardia, hypotension, ventricular rhythm disorders and cardiac arrest) and neurological (mainly convulsions, myoclonia and status epilepticus) adverse events, which occur under normal conditions of use, particularly in elderly patients, who are predominantly the patient population relevant to the approved indication.
Povzetek sklepa CHMP je, da je uporaba buflomedila povezana s številnimi resnimi kardiološkimi (predvsem tahikardijo, hipotenzijo, ventrikularno motnjo ritma in srčnim zastojem) in nevrološkimi (predvsem krči, mioklonijo in epileptičnim statusom) neželenimi učinki, ki so se pojavili v običajnih pogojih uporabe, zlasti pri starejših bolnikih, ki predstavljajo pretežno populacijo bolnikov za odobreno indikacijo.
The MAH review of the ICSR database identified 33 cases involving the use of a maximum daily dose of 600 mg. From these, a total of 21 cases of neurological adverse events were retrieved.
V pregledu podatkovne baze ICSR je imetnik dovoljenja za promet z zdravilom opredelil 33 primerov z uporabo največjega dnevnega odmerka 600 mg.
Having assessed the risk minimisation measures proposed by the MAH, the CHMP concluded that given the high risk with buflomedil, notably in patients with advanced vascular disease and/or diabetes and metabolic syndrome, in patients with impaired renal function and in elderly patients, no adequate or sufficient measures could be identified to reduce the risks associated with buflomedil to an acceptable level.
Po ocenitvi ukrepov za zmanjšanje tveganj, ki jih je predlagal imetnik dovoljenja za promet z zdravilom, je CHMP zaključil, da ustreznih ali zadostnih ukrepov za zmanjšanje tveganj, povezanih z buflomedilom, na sprejemljivo raven, zlasti pri bolnikih z napredovalo žilno boleznijo in/ali sladkorno boleznijo in presnovnim sindromom pri bolnikih z okvarjenim delovanjem ledvic in pri starejših bolnikih, ni bilo mogoče opredeliti.
Having assessed the totality of the risk minimisation measures proposed by the MAH, the CHMP concluded that given the high risk with buflomedil, notably in patients with impaired renal function and in elderly patients, no measures could be identified to reduce the risks associated with buflomedil to an acceptable level.
Po ocenitvi vseh ukrepov za zmanjšanje tveganj, ki jih je predlagal imetnik dovoljenja za promet z zdravilom, je CHMP zaključil, da noben od ukrepov za zmanjšanje tveganj, povezanih z buflomedilom, na sprejemljivo raven, zlasti pri bolnikih z okvarjenim delovanjem ledvic in pri starejših bolnikih, ni zadosten.
(Invente d) name
(Izmiљlje no) ime
MA (EU) Number
Љtevilka (EU) dovoljenja za promet
Strength Pharmaceuti cal form
Farmacevtska oblika
Route of administratio n
Pot uporabe Stična ovojnina
This procedure ended on 28 November 2006.
Ta postopek se je zaključil 28. novembra 2006.
This conclusion is accepted.
Tak zaključek je bil sprejet.