natgillin/translations-raw huggingface dataset:
Only usability testing required by the Medical Device Directive 93/42 has been performed, which is considered to be acceptable since a medical device that is intended to administer a medicinal product is governed by the Directive 93/42, without prejudice to the provisions of Directive 2001/83 with regard to the medicinal product.
Opravljeno je bilo samo testiranje uporabnosti, ki ga zahteva Direktiva o medicinskih pripomočkih 93/42; to velja za sprejemljivo, ker medicinske pripomočke, namenjene aplikaciji zdravila, ureja Direktiva 93/42, brez poseganja v določbe Direktive 2001/83 v zvezi z zdravilom.
US study A48294
Ameriška študija A48294
Overall conclusion
Skupni zaključek
Clinical studies The 2 phase III studies were conducted from 2005 to 2009 (study A40196 in Europe and Canada and study A48294 in the US).
Klinične študije Med letoma 2005 in 2009 sta bili opravljeni dve študiji III. faze (študija A40196 v Evropi in Kanadi ter študija A48294 v ZDA).
This application was submitted according to Article 8(3) of Directive 2001/83/EC - full application, and assessed according to the decentralised procedure, with the NL acting as RMS (NL/H/2041/001/DC).
Ta vloga je bila predložena v skladu s členom 8(3) Direktive 2001/83/ES (samostojna vloga) in ocenjena v okviru decentraliziranega postopka, pri čemer je Nizozemska bila referenčna država članica (NL/H/2041/001/DC).
EU/Canada study A40196
EU/kanadska študija A40196
But women had also the option to follow the bleeding rules of the YAZ FlexMB.
Vendar so ženske imele tudi možnost upoštevanja pravil za upravljanje krvavitev iz režima YAZ FlexMB.
The current application concerns Yvidually and associated names for the indication of oral contraception.
Trenutna vloga zadeva zdravilo Yvidually in povezana imena, indicirano za peroralno kontracepcijo.
However, the noted slight increase in days of intracyclic bleeding or other bleeding problems were not shown to result in a high number of discontinuations: 8/888 (0.8%) in the EU/CAN study and 12/1406 (0.9%) in the US study.
Kljub temu opisano rahlo povečanje števila dni krvavitev med cikli in druge težave s krvavitvami niso povzročili velikega števila prenehanj zdravljenja: 8/888 (0,8 %) v EU/kanadski študiji in 12/1406 (0,9 %) v ameriški študiji.
The summary of product characteristics, labelling and package leaflet remain as per the final versions achieved during the Coordination group procedure as mentioned in Annex III for Yvidually and associated names (see Annex I).
Povzetek glavnih značilnosti zdravila, označevanje in navodilo za uporabo ostajajo enaki kot v zadnjih različicah, pripravljenih med postopkom usklajevalne skupine, kot je navedeno v Prilogi III za zdravilo Yvidually in povezana imena (glejte Prilogo I).
Contraceptive efficacy of the dosing regimen
Kontracepcijska učinkovitost režima odmerjanja
Most women rate the dispenser as easy to use and have no difficulties in understanding the Quick reference card, User manual, and Symbol Guide.
Večina žensk je razdelilnik ocenila kot preprostega za uporabo in ni imela težav pri razumevanju kartice s kratkimi navodili, navodila za uporabo in razlage simbolov.
• YAZ Stop & Go regimen
• Režim YAZ Stop & Go
The dispenser which has been designed to be an integral part of Yvidually in order to deliver tablets in line with the proposed dose regimen, has not been used in the pivotal studies.
Razdelilnik, zasnovan kot sestavni del zdravila Yvidually, ki bi zagotavljal uporabo tablet skladno s predlaganim režimom odmerjanja, v ključnih študijah ni bil uporabljen.
In this study, Pearl Indices obtained were in line with those obtained in the original file of YAZ 24+4.
V tej študiji so bili Pearlovi indeksi v skladu z vrednostmi, dobljenimi v originalni dokumentaciji režima YAZ 24+4.
Tablet dispenser
Razdelilnik tablet
• YAZ Flex MB regimen
• Režim Yaz Flex MB
General dosing rules:
Splošna pravila odmerjanja:
The contraceptive efficacy was investigated in the YAZ Flex MB regimen arm in both pivotal studies.
Kontracepcijska učinkovitost je bila raziskana v kraku z režimom YAZ Flex MB v obeh ključnih študijah.
Within this period, the woman may decide herself to take a 4-day tablet-free interval or not.
V tem obdobju se lahko ženska odloči za 4-dnevno obdobje brez jemanja tablet ali ne.
Therefore the data available do not indicate that the noted bleeding patterns had a negative impact on tolerability of the women choosing a flexible dose regimen in order to postpone withdrawal bleeding.
Razpoložljivi podatki torej ne kažejo, da bi opaženi vzorci krvavitev negativno vplivali na prenašanje zdravila pri ženskah, ki so izbrale režim s prilagodljivim odmerjanjem, da bi odložile odtegnitveno krvavitev.
Both were presented as pivotal studies with regard to the efficacy and safety assessment of Yvidually.
Obe sta bili z vidika presoje učinkovitosti in varnosti zdravila Yvidually predloženi kot ključni študiji.
The longer the postponement the higher this risk, which is clearly shown in the fixed extended arm in which no break - no withdrawal bleed was allowed (33 days of intracyclic bleeding/year).
Daljše je odlašanje, večje je tveganje, kar je jasno razvidno v fiksnem podaljšanem kraku, v katerem nista bila dovoljena premor oziroma odtegnitvena krvavitev (33 dni krvavitev med cikli/leto).
Yvidually is intended to be marketed with an innovative tablet dispenser with a reminder function.
Zdravilo Yvidually se bo tržilo z inovativnim razdelilnikom za tablete, ki ima funkcijo opomnika.
There are no signals that the compliance is less than that reported in the initial clinical studies, in which a paper + pencil was used to adhere to the dose regimen.
Ni znakov, da bi bilo upoštevanje navodil slabše od poročanega v začetnih kliničnih študijah, kjer so si ženske pri upoštevanju režima odmerjanja pomagale s svinčnikom in papirjem.
Interim analysis of the additional study 14701 with Yvidually and the tablet dispenser indicates that women rate the dispenser as easy to use, and that there are no signals that it adversely affects compliance.
Vmesna analiza dodatne študije 14701 z zdravilom Yvidually in razdelilnikom tablet kaže, da večina žensk razdelilnik ocenjuje kot preprostega za uporabo in da ni znakov negativnega učinka na skladnost z navodili.
When starting intake of Yvidually, tablets must be taken continuously for a minimum of 24 days
Ko se začne jemanje zdravila Yvidually, je treba tablete jemati neprekinjeno najmanj 24 dni.
Based on the above, the CHMP agreed that the results of the YAZ Flex MB regimen could be extrapolated to a regimen where women are allowed to schedule their withdrawal bleeding irrespective of bleeding and/or spotting.
Na podlagi navedenega se je CHMP strinjal, da je mogoče rezultate režima YAZ Flex MB prenesti na režim, ki ženskam dovoljuje načrtovanje odtegnitvene krvavitve ne glede na krvavitev oziroma madeže.
In the additional European study 14701, the bleeding pattern of the regimen applied for including use of the tablet dispenser was investigated.
V dodatni evropski študiji 14701 so raziskali vzorec krvavitev v predlaganem režimu in uporabo razdelilnika tablet.
Bleeding pattern of the dosing regimen
Vzorec krvavitev v režimu odmerjanja
She schedules no withdrawal bleeding, thus no tablet-free interval.
Pri tem ne načrtuje odtegnitvene krvavitve oziroma obdobja brez jemanja tablet.
This high PI outcome is unreliable and not in line with CHMP Guideline on Clinical Investigation of Steroid Contraceptives in Women (EMEA/CPMP/EWP/519/98 Rev 1), which requires that a sufficient number of cycles should be studied to obtain the desired precision of the estimate of contraceptive efficacy.
Ta visoki rezultat za Pearlov indeks ni zanesljiv in ne ustreza Smernici odbora CHMP za klinične raziskave steroidnih kontracepcijskih sredstev pri ženskah (EMEA/CPMP/EWP/519/98 Rev 1), ki zahteva preučitev zadostnega števila ciklov, da se doseže želena točnost ocene kontracepcijske učinkovitosti.
The applicant has also provided interim results of the additional study 14701 with Yvidually and the tablet dispenser.
Predlagatelj je predložil tudi vmesne rezultate dodatne študije 14701 zdravila Yvidually in razdelilnika tablet.
The composition of Yvidually is identical to the authorised combined oral contraceptive (COC) Yaz 24+4.
Sestava zdravila Yvidually je identična sestavi odobrenega kombiniranega peroralnega kontracepcijskega sredstva Yaz 24+4.
The CHMP requested the applicant to submit the final results of the study 14701 when available, to show that the use of the dispenser positively influences the compliance of Yvidually.
Odbor CHMP je pozval predlagatelja, naj predloži končne rezultate študije 14701, ko bodo razpoložljivi, da bi potrdili, da razdelilnik tablet pozitivno vpliva na upoštevanje navodil za jemanje zdravila Yvidually.
Based on the above, the CHMP agreed that the results of the YAZ Flex MB regimen could be extrapolated to the proposed dosing regimen of Yvidually.
Na podlagi navedenega se je CHMP strinjal, da je mogoče rezultate režima YAZ Flex MB prenesti na predlagani režim zdravila Yvidually.
During days 25-120, the tablets can be taken continuously up to a maximum of 120 days.
Med 25. in 120. dnem se lahko tablete jemljejo neprekinjeno največ 120 dni.
Dose recommendations
Priporočila za odmerjanje
As the difference between the point estimate and the upper limit of the 95% CI is smaller than 1, it can be concluded that this EU-Canada study on its own is sufficiently large with regard to requirements on precision of the point estimate as recommended in the CHMP Guideline on Clinical Investigation of Steroid Contraceptives in Women (EMEA/CPMP/EWP/519/98 (Rev 1), and therefore considered reliable.
Ker je razlika med točkovno oceno in zgornjo mejo 95-odstotnega intervala zaupanja manjša od 1, je mogoče zaključiti, da je EU/kanadska študija sama po sebi dovolj velika z vidika zahtev po točnosti točkovne ocene, ki so priporočene v Smernici odbora CHMP za klinične raziskave steroidnih kontracepcijskih sredstev pri ženskah (EMEA/CPMP/EWP/519/98 Rev 1), in se zato šteje za zanesljivo.
These studies evaluated contraceptive efficacy, i.e. the number of unintended pregnancies, PI (calculated as the pregnancy rate in population divided by 100 years of user exposure) and cumulative pregnancy rate in the YAZ Flex MB arms, as well as bleeding pattern and cycle control parameters in all treatment arms of both studies.
V teh študijah so ocenjevali učinkovitost kontracepcije, tj. število nenačrtovanih zanositev, Pearlov indeks (izračunan kot stopnja zanositev v populaciji, deljena s 100 leti izpostavitve uporabnic) in kumulativno stopnjo zanositev v krakih YAZ Flex MB ter vzorce krvavitev in parametre nadzora cikla v vseh krakih zdravljenja obeh študij.
Thus, the CHMP only considered the EU-Canada study, which is the study that included women in Europe (n=880) as pivotal for the assessment of the contraceptive efficacy of Yvidually.
Zato je CHMP kot ključno študijo za oceno kontracepcijske učinkovitosti zdravila Yvidually upošteval samo EU-kanadsko študijo, v katero so bile vključene ženske iz Evrope (n = 880).
In addition, the number of patients in this YAZ Stop & Go arm is much lower compared to the Flex MB regimen (200 vs. 1400 patients) hampering any comparison.
Poleg tega je bilo število žensk v tem kraku YAZ Stop & Go (200 žensk) veliko manjše v primerjavi z režimom Flex MB (1400 žensk), kar otežuje kakršno koli primerjavo.
Moreover, with considerably less 4-day tablet-free intervals and longer periods of active treatment in both variants, it is highly likely that the efficacy will be at least as good as established for YAZ 24+4.
Poleg tega je pri bistveno manjšem številu 4-dnevnih premorov brez jemanja tablet in pri daljših obdobjih aktivnega zdravljenja v obeh režimih zelo verjetno, da bo učinkovitost vsaj enako dobra kot pri uveljavljenem režimu YAZ 24+4.
Further evidence for the efficacy of the YAZ Stop & Go regimen was obtained when the results of an interim analysis of an additional ongoing European multi-center randomised open study 14701, using the dispenser with the proposed dosing regimen of Yvidually became available.
Dodaten dokaz učinkovitosti režima YAZ Stop & Go zagotavljajo rezultati vmesne analize dodatne, še nezaključene, evropske multicentrične, randomizirane, nezaslepljene študije 14701 z uporabo razdelilnika s predlaganim režimom odmerjanja zdravila Yvidually.
The key studies should be at least large enough to give the overall PI (number of pregnancies per 100 woman years) with a two-sided 95% confidence interval such that the difference between the upper limit of the 95% confidence interval and the point estimate does not exceed 1.
Ključne študije morajo biti vsaj tako velike, da pri izračunu skupnega Pearlovega indeksa (števila zanositev na 100 žensk-let) in dvorepega 95-odstotnega intervala zaupanja razlika med zgornjo mejo 95-odstotnega intervala zaupanja in točkovno oceno ne presega 1.
During the CMDh referral, since no agreement was reached, the procedure was referred to the CHMP according to Article 29(4).
Ker med zasedanjem usklajevalne skupine za postopek z medsebojnim priznavanjem in decentralizirani postopek (zdravila za uporabo v humani medicini) ni bilo doseženo soglasje, je bil postopek v skladu s členom 29(4) napoten odboru CHMP v presojo.
Postponing a withdrawal bleed will introduce higher risk of intracyclic bleeding in most women, as is already known from current COCs, but the data available do not indicate that the noted bleeding patterns of Yvidually had a negative impact on tolerability of the women.
Odlašanje odtegnitvene krvavitve poveča tveganje krvavitve med cikli pri večini žensk, kar je že znano pri drugih kombiniranih peroralnih kontraceptivih, vendar razpoložljivi podatki ne kažejo, da bi opaženi vzorci krvavitev negativno vplivali na prenašanje zdravila Yvidually pri ženskah.
• Any 4-day tablet free interval can only be started if tablet taking has been continuous for 24 days i.e. after the completion of the mandatory phase.
• Vsako 4-dnevno obdobje brez jemanja tablet se sme začeti samo, če je bilo jemanje neprekinjeno 24 dni, tj. po končani obvezni fazi.
Table 1 Overview of the different regimens studied in the pivotal trials US study A48294 (3 arms)
Preglednica 1: Povzetek različnih režimov, raziskanih v ključnih preskušanjih Ameriška študija A48294 (3 kraki)
When looking at the results of the YAZ Stop and Go regimen, it was noted that the PI was higher (3.52; 95% CI; 1.29 - 7.67) compared to the YAZ Flex MB regimen in the same study (1.67 95% CI; upper limit 2.67).
Pri pregledu rezultatov režima YAZ Stop & Go je bil ugotovljen višji Pearlov indeks (3,52; 95-odstotni IZ 1,29-7,67) kot pri režimu YAZ Flex MB iz iste študije (1,67; zgornja meja 95-odstotnega IZ 2,67).
However it was discussed and noted that the high PI in YAZ Stop & Go arm of USstudy A48294 was based on only 170 Woman Years (WY) of use, resulting in a wide 95% CI; 3.52 (95% CIs: 1.29 - 7.67).
Vendar pa je bilo obravnavano in ugotovljeno, da je visoki Pearlov indeks v kraku YAZ Stop & Go ameriške študije A48294 temeljil na samo 170 ženskah-letih uporabe, s posledično širokim 95-odstotnim IZ; 3,52 (95-odstotni IZ: 1,29-7,67).
With the regimen applied for, a tablet-free interval is allowed at any time during day 25 to 120 of the treatment cycle - i.e. any 4-day break can only be started if tablet taking has been continuous for 24 days.
V predlaganem režimu je dovoljeno obdobje brez jemanja tablet kadar koli med 25. in 120. dnem cikla zdravljenja, kar pomeni, da se vsak 4-dnevni premor lahko začne samo, če so se pred tem tablete neprekinjeno jemale 24 dni.
• The Committee considered that the overall efficacy has been sufficiently proven by the data presented, in particular the EU/Canada study.
• Odbor je presodil, da predložene študije zadovoljivo dokazujejo splošno učinkovitost.
As expected with an extended dosage regimen, different bleeding patterns have been observed, but the data available do not indicate that the noted bleeding patterns of Yvidually had a negative impact on tolerability of the women.
Po pričakovanjih so v podaljšanem režimu odmerjanja opazili drugačne vzorce krvavitev, vendar razpoložljivi podatki ne kažejo, da bi opaženi vzorci krvavitev negativno vplivali na prenašanje zdravila Yvidually pri ženskah.
Moreover, with considerably less tablet-free intervals and longer periods of active treatment in both variants, efficacy will be at least as good as established for the currently authorised YAZ 24+4.
Poleg tega bo pri bistveno manjšem številu premorov brez jemanja tablet in daljših obdobjih aktivnega zdravljenja v obeh režimih učinkovitost vsaj enako dobra kot pri uveljavljenem režimu YAZ 24+4.
Based on the above, it was concluded that contraceptive efficacy had been sufficiently demonstrated with the YAZ Flex MB variant of the regimen (Pearl Index of 0.63, upper limit of 95% CI 1.24), which is considered representative of the proposed dosing regimen of Yvidually with regard to contraceptive efficacy.
Glede na navedeno se zaključi, da je bila kontracepcijska učinkovitost zadostno dokazana za različico režima YAZ Flex MB (Pearlov indeks 0,63, zgornja meja 95-odstotnega intervala zaupanja 1,24), ki se šteje za reprezentativnega predlaganemu režimu odmerjanja zdravila Yvidually z vidika kontracepcijske učinkovitosti.
The Pearl Index (PI) calculated as the pregnancy rate in the study population divided by 100 years of user exposure, was used to assess contraceptive efficacy.
Za ocenjevanje kontracepcijske učinkovitosti je bil uporabljen Pearlov indeks (PI), ki se izračuna kot stopnja zanositev v preučevani populaciji, deljena s 100 leti izpostavitve uporabnic.
The contraceptive efficacy was demonstrated for the YAZ Flex MB regimen in the pivotal EU/Canada study A40196, by a PI of 0.63 with a corresponding upper limit of the 95% confidence interval of 1.24 in women between 18 and 35 years of age, and a PI for method failure (PIA adjusted) of 0.59 (upper limit 95% confidence interval 1.22).
Kontracepcijska učinkovitost je bila dokazana za režim Yaz Flex MB v ključni EU/kanadski študiji A40196 s Pearlovim indeksom 0,63 in ustrezno zgornjo mejo 95-odstotnega intervala zaupanja 1,24 pri ženskah, starih od 18 do 35 let, ter Pearlovim indeksom neuspešne metode (popravljeni PIA) 0,59 (zgornja meja 95-odstotnega intervala zaupanja 1,22), kot je prikazano v spodnji preglednici.
• After any 4-day tablet-free interval , a new mandatory phase starts, i.e. tablets must be taken for a minimum of 24 days before any new break can be scheduled.
• Po vsakem 4-dnevnem premoru brez jemanja tablet se začne novo obdobje obveznega jemanja, kar pomeni, da se morajo tablete jemati najmanj 24 dni pred načrtovanjem naslednjega premora.
Further supportive evidence of adequate contraceptive efficacy of Yvidually was obtained from the interim analysis of an ongoing trial with Yvidually where the calculated PI was 0 with an upper limit of the 95% confidence interval of 1.0, which is considered conclusive in terms of precision of the Pearl Index.
Dodatne podporne dokaze zadostne kontracepcijske učinkovitosti zdravila Yvidually je zagotovila vmesna analiza preskušanja zdravila Yvidually, ki še poteka, v kateri je izračunani Pearlov indeks 0 z zgornjo mejo 95-odstotnega intervala zaupanja 1,0, kar se z vidika točnosti Pearlovega indeksa šteje za prepričljivo.
Notwithstanding, during the initial DCP procedure a calculation of the PI was requested for the Stop & Go arm, YAZ fixed extended arm, and YAZ 24+4 arm, see table below:
Kljub temu je bil med začetnim decentraliziranim postopkom zahtevan izračun Pearlovih indeksov za krake Stop & Go, fiksni podaljšani YAZ in YAZ 24+4; glejte spodnjo preglednico:
Table 2 Pearl index in the treatment arms YAZ Stop & Go, YAZ fixed extended and YAZ
Preglednica 2: Pearlovi indeksi za krake zdravljenja YAZ Stop & Go, fiksni podaljšani YAZ in YAZ 24+4
In general, the reason for the break (bleeding occurrence or woman's own choice) will not influence the contraceptive efficacy, as long as the general rules of intake will be adhered to, that is regular uninterrupted daily tablet intake for at least 24 days and tablet-free intervals of a maximum of 4 days between intake cycles.
Na splošno, razlog za premor (pojav krvavitve ali ženskina lastna izbira) ne bo vplival na kontracepcijsko učinkovitost, dokler bo ženska upoštevala splošna pravila jemanja tablet, torej redno neprekinjeno dnevno jemanje najmanj 24 dni in največ 4-dnevni premori brez jemanja tablet med posameznimi cikli jemanja.
After each 4-day tablet-free interval, a new mandatory intake cycle of a minimum of 24 days starts.
Po vsakem 4-dnevnem premoru brez jemanja tablet se začne novo obdobje obveznega jemanja, ki traja najmanj 24 dni.
If 3 consecutive days of bleeding and/or spotting occurred during a treatment cycle, a 4-day tablet-free period was advised (i.e. ‘managed bleeding' = MB).
Če se med ciklom zdravljenja pojavijo krvavitev oziroma madeži, ki trajajo tri zaporedne dni, se priporoča 4-dnevno obdobje brez jemanja tablet (t. i. „upravljanje krvavitve“ = UK).
During days 25- 120, the woman may decide to take a 4-day tablet-free interval (she schedules a withdrawal bleeding) at any time that suits her best, and irrespective of bleeding.
Med 25. in 120. dnem se lahko ženska odloči za 4-dnevno obdobje brez jemanja tablet (kar pomeni, da načrtuje odtegnitveno krvavitev), ko ji najbolj ustreza ne glede na krvavitve.
The mean duration of withdrawal bleeding was longer in the extended cycle regimens and the mean duration of the intracyclic bleeding episodes was higher when compared to YAZ 24+4 (7-8 days vs 5 days).
V režimih s podaljšanim ciklom je bilo povprečno trajanje odtegnitvene krvavitve daljše in povprečno trajanje epizod krvavitev med cikli daljše kot v režimu YAZ 24+4 (7-8 dni v primerjavi s 5 dnevi).
The reason for the break (bleeding occurrence or woman's own choice) will not influence the contraceptive efficacy, as long as the general rules of intake will be adhered to, that is regular uninterrupted daily tablet intake for at least 24 days and tablet-free intervals of a maximum of 4 days between intake cycles.
Razlog za premor (pojav krvavitve ali ženskina lastna izbira) ne bo vplival na kontracepcijsko učinkovitost, dokler bo ženska upoštevala splošna pravila jemanja tablet, torej redno neprekinjeno dnevno jemanje najmanj 24 dni in največ 4-dnevni premori brez jemanja tablet med posameznimi cikli jemanja.
The exposure was limited to 357 women-years (wy), but the calculated PI was 0, with an upper limit of the 95% confidence interval of 1.0 fulfilling the requirements of precision of the CHMP Guideline on Clinical Investigation of Steroid Contraceptives in Women (EMEA/CPMP/EWP/519/98 Rev 1).
Izpostavljenost je bila omejena na 357 žensk-let, ampak izračunani Pearlov indeks je 0 z zgornjo mejo 95-odstotnega intervala zaupanja 1,0, kar izpolnjuje zahteve glede točnosti iz Smernice odbora CHMP za klinične raziskave steroidnih kontracepcijskih sredstev pri ženskah (EMEA/CPMP/EWP/519/98 Rev 1).
In the conventional YAZ 24+4 arm, the number of 4-day tablet-free intervals within one year is 10.1, as the tablet-free intervals are mandatory (i.e. 24 days of tablet intake followed by a 4 day break (YAZ 24+4)), versus 4.2 and 4.6 breaks for YAZ Flex MB and YAZ Stop & Go respectively.
V enem letu je število 4-dnevnih premorov brez jemanja tablet 10,1 v običajnem kraku YAZ 24+4, saj so premori brez jemanja tablet obvezni (tj. 24 dni jemanja tablet, ki jim sledi 4-dnevni premor (YAZ 24+4)), 4,2 v režimu YAZ Flex MB in 4,6 v režimu YAZ Stop & Go, glejte preglednico 1.
Evidence is primarily based on the adequate pearl indices obtained on EU/Canada study including an European population that allowed a 4-day tablet-free interval in case of 3 consecutive days of bleeding and/or spotting (Flex MB regimen).
Dokazi temeljijo predvsem na zadovoljivih Pearlovih indeksih iz EU/kanadske študije, v katero je bila vključena evropska populacija in ki je omogočala 4-dnevni premor brez jemanja tablet, če se med ciklom zdravljenja pojavijo krvavitev oziroma madeži, ki trajajo tri zaporedne dni (režim Flex MB).