natgillin/translations-raw huggingface dataset:
For the suspension to be lifted, the Marketing Authorisation Holders should provide convincing data to identify a patient population in which the benefits of meprobamate clearly outweigh its identified risks (see Annex III of the Opinion).
Za odpravo začasnega umika dovoljenja za promet morajo imetniki dovoljenja za promet z zdravilom predložiti prepričljive podatke z opredelitvijo populacije bolnikov, v kateri koristi zdravljenja z meprobamatom jasno odtehtajo opredeljena tveganja (glejte Dodatek III tega mnenja).
Overall benefit-risk assessment
Splošna ocena razmerja med tveganji in koristmi
Afssaps therefore considered the benefit-risk of meprobamate-containing products to be unfavourable and notified the European Medicines Agency (EMA) and the Committee for Medicinal Products for Human Use (CHMP) on 25 July 2011 of its intention to suspend the French marketing authorisations of oral medicines containing meprobamate, effective as of January 2012.
Afssaps je zato menil, da je razmerje med tveganji in koristmi zdravil, ki vsebujejo meprobamat, neugodno, ter dne 25. julija 2011 Evropsko agencijo za zdravila (EMA) in Odbor za zdravila za uporabo v humani medicini (CHMP) obvestil o svoji nameri za začasni umik francoskih dovoljenj za promet z zdravili, ki vsebujejo meprobamat, za peroralno uporabo, ki začne veljati januarja 2012.
The CHMP also noted that the available medical practice guidelines for anxiety disorder, alcohol withdrawal and migraine do not recommend meprobamate.
CHMP je prav tako opozoril, da razpoložljive smernice medicinske prakse za anksiozno motnjo, odtegnitev alkohola in migreno ne priporočajo meprobamata.
Some MAHs nonetheless proposed minor amendments to the product information, in particular with regard to treatment duration.
Nekateri imetniki dovoljenja za promet z zdravilom pa so predlagali manjše spremembe podatkov o zdravilu, predvsem v zvezi s trajanjem zdravljenja.
While the CHMP noted the minor decrease in the number of elderly patients, it raised concerns over the high proportion of elderly patients using the product.
Čeprav je CHMP opazil manjši upad števila starejših bolnikov, je izrazil zadržke zaradi velikega deleža starejših bolnikov, ki uporabljajo zdravilo.
The most frequently encountered serious adverse events were comas (11 cases), consciousness disorders (16 cases), confusion states (15 cases) and intoxications (33 cases, including deliberate, accidental or nonspecified).
Najpogostejši resni neželeni učinki so bili kome (11 primerov), motnje zavesti (16 primerov), stanja zmedenosti (15 primerov) in zastrupitve (33 primerov, vključno z namernimi, naključnimi in nedoločenimi).
Meprobamate is a carbamate derivative, acting as a central nervous system depressant with anxietyrelieving, sedative and muscle relaxant activity.
Meprobamat je derivat karbamata, ki deluje kot zaviralec osrednjega živčnega sistema ter blaži anksioznost, deluje kot pomirjevalo in mišični relaksant.
Oral formulations of meprobamate have been authorised in the EU as prescription-only products.
Peroralne farmacevtske oblike meprobamata so bile v EU odobrene kot zdravila, ki se izdajajo le na recept.
Based on the same Eudravigilance dataset, the CHMP also noted 11 cases of withdrawal symptoms, of which one was fatal.
Na podlagi istega nabora podatkov iz baze Eudravigilance je CHMP ugotovil tudi 11 primerov odtegnitvenih simptomov, od katerih je bil en primer s smrtnim izidom.
Giving due consideration to the serious risk of withdrawal symptoms, the CHMP recommended that the withdrawal of meprobamate from the market should be implemented over a 15 month period, in order to ensure the safe termination of treatment or switching of patients already being treated with meprobamate.
Ob ustreznem upoštevanju resnega tveganja za odtegnitvene simptome je CHMP priporočil umik meprobamata s trga v obdobju 15 mesecev, da se zagotovitvi varna prekinitev zdravljenja oziroma sprememba zdravljenja za bolnike, ki so že zdravljeni z meprobamatom.
In summary, the CHMP assessed the totality of the available data, including responses submitted by the MAHs in writing and during an oral explanation, as well as the nationally-conducted French pharmacovigilance assessments.
CHMP je ocenil vse razpoložljive podatke, vključno z odzivi, ki so jih posredovali imetniki dovoljenja za promet z zdravilom v pisni obliki in ustni obrazložitvi, kakor tudi nacionalno izvedene francoske farmakovigilančne ocene.
The CHMP was concerned by the identified risk of pharmacodependence, including in cases under normal conditions of use, as suggested by the 17 reported cases of pharmacodependence and withdrawal symptoms (13 serious and 4 non-serious).
CHMP je izrazil zaskrbljenost zaradi ugotovljenega tveganja za farmakološko odvisnost, vključno s primeri pri običajnih pogojih uporabe, kot je pokazalo 17 primerov farmakološke odvisnosti in odtegnitvenih simptomov (13 resnih in 4 neresni).
The risks of serious withdrawal symptoms were also acknowledged by the MAH during the oral explanation.
Tveganja za resne odtegnitvene simptome je v ustni obrazložitvi potrdil tudi imetnik dovoljenja za promet z zdravilom.
Finally, the CHMP also noted a clinical epidemiological study by Kovacs et al, 2002, which reported 25 cases of accidental overdoses with meprobamate.
CHMP je opozoril tudi na klinično epidemiološko študijo avtorjev Kovacs et al, 2002, v kateri je bilo zabeleženih 25 primerov naključnega prevelikega odmerjanja meprobamata.
Regarding meprobamate-only products, the first Lille CPRV analysis identified 119 medically confirmed cases following the implementation of the risk minimisation measures, which was similar to the data for the period prior to the implementation, despite an assumed reduction in patient exposure, based on sales data.
V zvezi z zdravili, ki vsebujejo le meprobamat, je bilo v prvi analizi agencije Lille CPRV po uvedbi ukrepov za zmanjšanje tveganja ugotovljenih 119 medicinsko potrjenih primerov, kar je bilo podobno podatkom za obdobje pred uvedbo, kljub predvidenemu zmanjšanju izpostavljenosti bolnikov, ki je temeljilo na podatkih o prodaji.
The first analysis reviewed meprobamate-only products, indicated as withdrawal aid for alcoholdependent subjects, with a treatment duration of 1 to 3 weeks, with a maximum of 12 weeks.
V prvo analizo so bila vključena zdravila, ki so vsebovala le meprobamat, indiciran za pomoč pri odtegnitvi za odvisnike od alkohola, s trajanjem zdravljenja od 1 do 3 tednov, največ pa 12 tednov.
The CHMP also reviewed spontaneous case reports submitted to the Eudravigilance database and identified 18 cases of accidental overdoses, of which 17 were fatal.
CHMP je pregledal tudi spontana poročila o primerih, ki so bila posredovana v podatkovno bazo Eudravigilance, ter ugotovil 18 primerov naključnega prevelikega odmerjanja, od katerih je bilo 17 primerov s smrtnim izidom.
Annex II Scientific conclusions and grounds for the suspension of the marketing authorisations presented by the EMA
Dodatek II Znanstveni zaključki in podlaga za začasni umik dovoljenj za promet z zdravilom, ki jih je predstavila Evropska agencija za zdravila
Elderly patients constitute a considerable proportion of patients and use in this population is of concern, especially considering the increased risk of adverse events due to interactions with concomitant medication.
Starejši bolniki predstavljajo znaten delež bolnikov, uporaba v tej populaciji pa je zaskrbljujoča, še posebej ob upoštevanju povečanega tveganja za neželene učinke zaradi medsebojnega delovanja s sočasno uporabljanimi zdravili.
An association with the use of meprobamate/aceprometazine was considered as possible in all cases.
Povezava z uporabo kombiniranih zdravil meprobamata in aceprometazina je bila v vseh primerih upoštevana kot možna.
Two recent pharmacovigilance analyses of data from spontaneous reports, conducted by the Lille CRPV (Centre régional de pharmacovigilance) and finalised in 2011, did not identify any significant impact of the implemented risk minimisation measures and noted the lack of clinical data on the benefit of these products.
Dve nedavni farmakovigilančni analizi podatkov iz spontanih poročil, ki ju je izvedla regionalna agencija za farmakovigilanco Lille CRPV (Centre régional de pharmacovigilance) in sta bili zaključeni leta 2011, nista pokazali nikakršnega bistvenega vpliva na izvedene ukrepe za zmanjšanje tveganja, sta pa opozorili na pomanjkanje kliničnih podatkov v korist teh zdravil.
Following a number of French national safety and efficacy reviews and pharmacovigilance analyses of meprobamate, the French National Competent Authority (Afssaps) implemented risk minimisation measures to reduce the identified risks of meprobamate and initiated national pharmacovigilance analyses to assess the impact of these measures.
Po številnih francoskih nacionalnih pregledih varnosti in učinkovitosti ter farmakovigilančnih analizah meprobamata je francoski pristojni nacionalni organ (Afssaps) uvedel ukrepe za zmanjšanje tveganja, da bi zmanjšali ugotovljena tveganja pri uporabi meprobamata, ter začel z nacionalnimi farmakovigilančnimi analizami, da bi ocenil učinek teh ukrepov.
The CHMP noted that the majority of MAHs responded that they considered the benefit-risk of their products to be positive and that routine pharmacovigilance activities were sufficient to address the identified safety concerns.
CHMP je zabeležil, da je večina imetnikov dovoljenja za promet z zdravilom odgovorila, da so bili mnenja, da je razmerje med tveganji in koristmi njihovih zdravil pozitivno in da rutinske farmakovigilančne aktivnosti zadoščajo za reševanje ugotovljenih zadržkov v zvezi z varnostjo.
The CHMP was of the opinion that the identified risks persist, despite the implemented risk minimisation measures, particularly in patients over the age of 65, who are at high risk of falls and confusion.
CHMP je bil mnenja, da ugotovljena tveganja kljub uvedenim ukrepom za zmanjšanje tveganja, ostajajo, še posebej pri bolnikih nad 65 letom starosti, pri katerih obstaja velika nevarnost za padce in zmedenost.
Consequently, the CHMP recommended to the European Commission the suspension of the Marketing Authorisations of meprobamate-containing medicinal products listed in Annex I of the Opinion in all concerned EU Member States, to be effective within 15 months of the adoption of the European Commission Decision, in order to ensure the safe termination of treatment or switching of patients already being treated with meprobamate.
Odbor CHMP je Evropski komisiji zato priporočil začasni umik dovoljenj za promet z zdravili, ki vsebujejo meprobamat in so našteta v Dodatku I tega mnenja, v vseh zadevnih državah članicah EU, ki začne veljati v roku 15 mesecev po sprejetju sklepa Evropske komisije, da se zagotovi varna prekinitev zdravljenja oziroma sprememba zdravljenja za bolnike, ki so že zdravljeni z meprobamatom.
Meprobamate can cause physical and psychological dependence and a potentially life-threatening abstinence syndrome with delirium on abrupt withdrawal, in particular after prolonged use, with pharmacological effects similar to those of alcohol and barbiturates, including within the normal dosage and treatment duration, due to the nature of the product.
Meprobamat lahko povzroči fizično in psihološko odvisnost in potencialno življenjsko nevaren abstinenčni sindrom z delirijem ob nenadni prekinitvi, še posebej po daljši uporabi, s farmakološkimi učinki, ki so podobni učinkom alkohola in barbituratov, tudi v okviru običajnega odmerka in trajanja zdravljenja zaradi narave zdravila.
One MAH suggested that further to the treatment duration restriction already implemented in France, the only way to reduce the number of voluntary overdose cases would be to restrict the use of the product to hospital-use only.
Eden izmed imetnikov dovoljenja za promet z zdravilom je predlagal, da je poleg omejitve trajanja zdravljenja, ki je v Franciji že v veljavi, edini način za zmanjšanje števila primerov namernega prevelikega odmerjanja omejitev uporabe zdravila na izključno bolnišnično uporabo.
• The Committee raised concerns regarding the considerable proportion of elderly patients and regarding use in this population, especially considering the increased risk of adverse events due to interactions with concomitant medication.
• Odbor je izrazil zadržke v zvezi z znatnim deležem starejših bolnikov in uporabo zdravila v tej populaciji, še posebej ob upoštevanju povečanega tveganja za neželene učinke zaradi medsebojnega delovanja s sočasno uporabljenimi zdravili.
The CHMP noted that the available data on the efficacy of meprobamate is limited in some indications and non-existent in others.
CHMP je zabeležil, da so razpoložljivi podatki o učinkovitosti meprobamata za nekatere indikacije omejeni, za druge indikacije pa ne obstajajo.
• The CHMP considered that the available data showed only very limited clinical efficacy of meprobamate in its approved indications.
• CHMP je menil, da razpoložljivi podatki prikazujejo le zelo omejeno klinično učinkovitost meprobamata za njegove odobrene indikacije.
• The CHMP therefore concluded that the risk-benefit balance of meprobamate-containing medicinal products for oral use is not positive under normal conditions of use.
• Zato je odbor CHMP sklenil, da razmerje med tveganji in koristmi zdravil, ki vsebujejo meprobamat, za peroralno uporabo, pri običajnih pogojih uporabe ni pozitivno.
The second analysis reviewed a combination product containing meprobamate together with aceprometazine, indicated in the treatment of occasional insomnia, with a treatment duration of 2 to 5 days.
V drugo analizo so bila vključena kombinirana zdravila, ki vsebujejo meprobamat skupaj z aceprometazinom, in so indicirana za zdravljenje občasne nespečnosti s trajanjem zdravljenja od 2 do 5 dni.
Other frequent SOCs were psychiatric disorders, skin and subcutaneous tissue disorders, and haematologic and lymphatic disorders (6-9% each).
Drugi pogosti neželeni učinki po organskih sistemih so bili psihiatrične motnje, bolezni kože in podkožja ter bolezni krvi in limfatičnega sistema (6-9 % vsaka).
The CHMP also acknowledged the potential confounding effect of co-medication as patients were co-medicated in almost all cases, particularly with psychotropic drugs.
CHMP je tudi potrdil možni dodatni učinek zaradi sočasnega zdravljenja z drugimi zdravili, saj so bolniki skoraj v vseh primerih prejemali tudi druga, predvsem psihotropna zdravila.
However, the CHMP was of the opinion that this may have increased the risks of adverse events with meprobamate due to interactions and therefore it cannot be excluded that meprobamate may have had a contributory role.
Vendar pa je bil CHMP mnenja, da je to zaradi medsebojnega delovanja lahko povečalo tveganje za neželene učinke meprobamata in zato ni mogoče izključiti, da je bil meprobamat dodatni dejavnik.
Meprobamate is considered to have a relatively narrow therapeutic index, with a steep dose-response curve, resulting in an increased risk of unintentional overdoses with serious and potentially fatal adverse events, including coma, profound hypotension, hypothermia, respiratory arrest and cardiogenic shock.
Za meprobamat velja, da ima relativno ozek terapevtski indeks s strmo krivuljo odmerek/odziv, kar povzroča povečano tveganje za nenamerne prevelike odmerke z resnimi in potencialno usodnimi neželenimi učinki, vključno s komo, hudo hipotenzijo, hipotermijo, zastojem dihanja in kardiogenim šokom.
Meprobamate may induce generalized tonic-clonic attacks in the predisposed which may be a drawback during alcohol withdrawal, a condition characterized by an increased susceptibility to convulsions.
Meprobamat lahko povzroči generalizirane tonično-klonične napade pri osebah, ki so nagnjene k temu, kar lahko predstavlja pomanjkljivost v času odtegnitve alkohola, torej stanja, ki ga zaznamuje povečana dovzetnost za krče.
This analysis assessed the impact of the implementation of the 2009 risk minimisation measures (restriction of the indications, reduction of pack size and circulation of a DHPC) on their risk profile.
Pri tej analizi je bil ocenjen vpliv uvedbe ukrepov za zmanjšanje tveganja iz leta 2009 (omejitev indikacij, zmanjšanje velikosti pakiranja in kroženje protokola DHPC) v njihovem profilu tveganja.
One MAH considered the benefit-risk of meprobamate to be negative in the alcohol withdrawal indication and proposed to remove the indication where authorised.
Za enega izmed imetnikov dovoljenja za promet z zdravilom je bilo razmerje med tveganji in koristmi meprobamata negativno pri indikaciji odtegnitve alkohola in je predlagal umik te indikacije, kjer je to dovoljeno.
During the study period, the main adverse events occurred generally in the SOCs nervous system disorders (34%), procedure-related lesions/intoxications and complications (8%) and general disorders (8%).
V času trajanja študije so se po organskih sistemih glavni neželeni učinki pojavljali kot bolezni živčevja (34 %) in lezije/zastrupitve in zapleti, povezani s postopkom (8 %) ter kot splošne težave (8 %).
In summary, the CHMP noted the 52 fatal cases identified (including 30 cases of overdoses) in the two French pharmacovigilance analyses, for which an association with meprobamate was considered possible.
Skupno je CHMP v dveh francoskih farmakovigilančnih analizah zabeležil 52 primerov s smrtnim izidom (vključno s 30 primeri prevelikih odmerkov), za katere je bila kot možna upoštevana povezava z meprobamatom.
Therefore, in order to assess the safety profile of meprobamate, mainly neurological and psychiatric adverse events, including pharmacodependence and serious withdrawal symptoms under normal conditions of use, particularly in the elderly, the CHMP reviewed the data from the two pharmacovigilance analyses of safety data on meprobamate conducted by the Lille CRPV, which were the basis of the Afssaps decision to suspend the marketing authorisations for the products concerned.
Zato je z namenom ocenitve varnostnega profila meprobamata, predvsem nevroloških in psihiatričnih neželenih učinkov, vključno s farmakološko odvisnostjo in z resnimi odtegnitvenimi simptomi pri običajnih pogojih uporabe, še posebej pri starejših osebah, pregledal podatke dveh farmakovigilančnih analiz o varnosti meprobamata, ki ju je izvedla agencija Lille CRPV in ki sta predstavljali podlago za odločitev organa Afssaps za začasen umik dovoljenj za promet z zadevnimi zdravili.
In conclusion, taking into account the serious neurological and psychiatric adverse events associated with the use of meprobamate, including under normal conditions of use, the risk of accidental overdoses and of pharmacodependence associated with withdrawal symptoms, the very limited clinical evidence of meprobamate and the lack of effectiveness of the implemented and proposed risk minimisation measures, the CHMP was of the opinion that the risk-benefit balance of meprobamatecontaining medicinal products for oral use is not positive under normal conditions of use.
Ob upoštevanju resnih nevroloških in psihiatričnih neželenih učinkov, povezanih z uporabo meprobamata, tudi pri običajnih pogojih uporabe, tveganj za naključna prevelika odmerjanja in farmakološko odvisnost, povezanih z odtegnitvenimi simptomi, zelo omejenih kliničnih dokazov o meprobamatu in pomanjkanju učinkovitosti uvedenih in predlaganih ukrepov za zmanjševanje tveganja, je bil CHMP mnenja, da razmerje med tveganji in koristmi zdravil, ki vsebujejo meprobamat, za peroralno uporabo, pri običajnih pogojih uporabe ni pozitivno.
This analysis assessed the impact of the implementation of risk minimisation measures (restriction of the indication and the posology as well as a reduction of the pack size) on its risk profile.
Pri tej analizi je bil ocenjen vpliv uvedbe ukrepov za zmanjšanje tveganja (omejitev indikacije in odmerjanja kot tudi omejitev velikosti pakiranja) v profilu tveganja.
The CHMP also noted the pharmacovigilance analyses of the impact of the risk minimisation measures for meprobamate and meprobamate/aceprometazine implemented in France, which did not result in a significant nor sufficient reduction of the incidence of adverse reactions associated with meprobamate, including in cases of normal conditions of use.
CHMP je opozoril tudi na farmakovigilančne analize vpliva ukrepov za zmanjšanje tveganja za zdravila z meprobamatom in zdravila s kombinacijo meprobamata in aceprometazina, uvedenih v Franciji, ki niso prikazali bistvenega ali zadostnega zmanjšanja pojavnosti neželenih učinkov, povezanih z meprobamatom, vključno s primeri običajnih pogojev uporabe.
The CHMP reviewed the available data submitted by the MAHs but considered that this limited data was insufficient to conclude on the safety of meprobamate and the predictability of any associated risks.
CHMP je pregledal razpoložljive podatke, ki so jih predložili imetniki dovoljenja za promet z zdravilom, a je te omejene podatke imel za nezadostne, da bi na njihovi podlagi lahko sklepal o varnosti meprobamata ter o predvidljivosti morebitnih povezanih tveganj.
The CHMP therefore concluded that accidental overdoses are a serious risk with meprobamate.
CHMP je zato sklenil, da naključna prevelika odmerjanja predstavljajo resno tveganje pri uporabi meprobamata.
• The Committee noted that meprobamate has a relatively narrow therapeutic index and therefore considered that accidental overdoses, which are often serious and can be fatal, are a serious risk with meprobamate.
• Odbor je opozoril, da ima meprobamat relativno ozek terapevtski indeks in je zato menil, da naključna prevelika odmerjanja, ki so pogosto resna in lahko imajo smrtni izid, predstavljajo resno tveganje pri uporabi meprobamata.
The CHMP concluded that no risk minimisations measures could be identified that would adequately reduce the identified risks associated with the use of meprobamate to a clinically acceptable level, especially with regard to elderly patients and the risk of pharmacodependence.
CHMP je sklenil, da ni mogoče določiti nobenih ukrepov za zmanjšanje tveganja, ki bi v zadostni meri zmanjšali ugotovljena tveganja, povezana z uporabo meprobamata, na klinično sprejemljivo raven, še posebej za starejše bolnike, ter tveganje za farmakološko odvisnost.
The CHMP noted that meprobamate has a relatively narrow therapeutic index, with a steep dose-response curve, as supported by the available data which identified a number of accidental overdoses which were often serious, including fatalities.
CHMP je opozoril, da ima meprobamat relativno ozek terapevtski indeks s strmo krivuljo odmerek/odziv, kot dokazujejo razpoložljivi podatki, ki so pokazali številna naključna prevelika odmerjanja, ki so bila pogosto resna, vključno s smrtnimi izidi.
With regards to safety, the CHMP considered that a number of serious neurological (coma, loss of consciousness) and psychiatric (pharmacodependence and withdrawal symptoms) adverse events, which can be serious and potentially fatal, have been reported with the use of meprobamate, including under normal conditions of use.
V zvezi z varnostjo je CHMP menil, da so pri uporabi meprobamata poročali o številnih resnih nevroloških (koma, izguba zavesti) in psihiatričnih (farmakološka odvisnost in odtegnitveni simptomi) neželenih učinkih, ki so lahko resni in s potencialnim smrtnim izidom tudi pri običajnih pogojih uporabe.
With regard to risk minimisation measures, the CHMP reviewed the pharmacovigilance analyses of the impact of the risk minimisation measures for meprobamate and meprobamate/aceprometazine implemented in France and the limited additional risk minimisation measures proposed by the MAHs.
V zvezi z ukrepi za zmanjšanje tveganja je CHMP pregledal farmakovigilančne analize vpliva ukrepov za zmanjšanje tveganja za meprobamat in kombinacijo meprobamata in aceprometazina, ki so bili uvedeni v Franciji, ter omejene dodatne ukrepe za zmanjšanje tveganja, ki so jih predlagali imetniki dovoljenja za promet z zdravilom.
7 fatalities associated with meprobamate were reported during the study period (including 2 due to overdoses).
V času trajanja študije so poročali o 7 smrtnih izidih, povezanih z meprobamatom (vključno z 2 zaradi prevelikega odmerka).