natgillin/translations-raw huggingface dataset:
Adverse effects might be delayed and might be subtle, including effect on fine motor skills or cognitive impairment, particularly in those with ongoing neurological disease.
Neželeni učinki so lahko zapozneli in komaj zaznavni, vključno z učinkom na finomotorične sposobnosti ali kognitivno poslabšanje, zlasti pri bolnikih z nevrološko boleznijo.
Another study showed that administration of the linear GdCAs gadodiamide and gadobenic acid directly into the cerebrospinal fluid (CSF) resulted in increased signal intensity in the DCN in rats up to 5 weeks after administration.
Druga študija je dokazala, da so imele podgane, ki so prejele linearni sredstvi GdCA, in sicer gadodiamid in gadobensko kislino neposredno v cerebrospinalno tekočino, do pet tednov po uporabi povečano intenzivnost signala v globokih možganskih jedrih.
Spontaneous release of Gd from its chelator, competition of Gd with other metals (e.g. in metal rich areas of the brain), and competition of the chelator with other chelators (e.g. macromolecules) can occur in the body.
V telesu se lahko pojavi spontano sproščanje gadolinija iz njegovega kelatorja, tekmovanje gadolinija z drugimi kovinami (npr. v predelih možganov, bogatih s kovinami) in tekmovanje kelatorja z drugimi kelatorji (npr. makromolekulami).
In order to minimise the risk of Gd accumulation in the brain and the potential associated harm in relation to linear GdCAs, PRAC considered options for risk minimisation measures such as warnings in the SmPC, contraindications and other additional risk minimisation measures.
Odbor PRAC je za zmanjšanje tveganja kopičenja gadolinija v možganih in morebitno povezanih škodljivih učinkov v zvezi z linearnimi sredstvi GdCA proučil mogoče ukrepe za zmanjšanje tveganja, kot so opozorila v povzetku glavnih značilnosti zdravila, kontraindikacije in drugi dodatni ukrepi za zmanjšanje tveganja.
Therefore, in view of the evidence regarding accumulation of Gd in brain and the plausible harmful effects, and accumulation of Gd in other tissues and the identified related risk, and considering that less restrictive risk minimisation measures are not feasible or not sufficient to bring the risk of accumulation of gadolinium in the brain and other tissues to an acceptable level, PRAC considered the suspension of the marketing authorisation of intravenous linear GdCAs is the most appropriate measure to mitigate the risks related to these products.
Odbor PRAC je glede na dokaze o kopičenju gadolinija v možganih in verjetne škodljive učinke ter kopičenje gadolinija v drugih tkivih in opredeljena povezana tveganja ter ob upoštevanju dejstva, da manj omejevalni ukrepi za zmanjšanje tveganja niso izvedljivi ali ne zadostujejo za zagotovitev sprejemljive ravni tveganja kopičenja gadolinija v možganih in drugih tkivih, menil, da je začasni umik dovoljenja za promet z linearnimi sredstvi GdCA za intravensko uporabo najprimernejši ukrep za zmanjšanje tveganj, povezanih s temi izdelki.
Although no adverse neurological effects have yet been demonstrated to be caused by gadolinium accumulation in the brain, long-term safety data are limited.
Čeprav še niso bili dokazani neželeni nevrološki učinki, ki naj bi jih povzročilo kopičenje gadolinija v možganih, so podatki o dolgoročni varnosti omejeni.
Gadolinium-associated plaques
Plaki, povezani z gadolinijem
• In relation to the Magnevist (gadopentetic acid) for intra-articular injection, in view of the low dose, the limited potential for repeated exposure for patients and the absence of evidence of brain accumulation, CHMP considered that the benefits of this product outweigh its risks.
• odbor CHMP je v zvezi s sredstvom Magnevist (gadopentetska kislina) za intraartikularno injiciranje glede na majhen odmerek, omejeno možnost večkratne izpostavljenosti bolnikov in neobstoj dokazov o kopičenju v možganih, menil, da koristi tega izdelka prevladajo nad njegovimi tveganji.
• In relation to the Magnevist (gadopentetic acid) for intra-articular injection, in view of the low dose, the limited potential for repeated exposure for patients and the absence of evidence of brain accumulation, PRAC considered that the benefits of this product outweigh its risks.
• odbor PRAC je v zvezi s sredstvom Magnevist (gadopentetska kislina) za intraartikularno injiciranje glede na majhen odmerek, omejeno možnost večkratne izpostavljenosti bolnikov in neobstoj dokazov za kopičenje v možganih, menil, da koristi tega izdelka prevladajo nad njegovimi tveganji.
Regarding the validity of an ex-vivo distribution study by Frenzel et al (2017), PRAC acknowledged the study does not contribute to the understanding in which form exactly Gd-based contrast agents are stored in the body, however PRAC considered that the study confirms, in line with other studies, that linear chelators lead to a higher amount of stored Gd and that there is a difference between linear and macrocyclic chelators in respect to binding to insoluble macromolecules.
(2017), priznal, da študija ne prispeva k razumevanju, v točno kakšni obliki se kontrastna sredstva, ki temeljijo na gadoliniju, shranjujejo v telesu, kljub temu pa je menil, da študija v skladu z drugimi študijami potrjuje, da linearni kelatorji povzročijo večjo količino shranjenega gadolinija ter da pri vezavi na netopne makromolekule obstaja razlika med linearnimi in makrocikličnimi kelatorji.
Macrocyclic agents show only a transient increase in Gd in the brain and undergo early washout.
Makrociklična sredstva kažejo samo začasno povečanje gadolinija v možganih in se kmalu izperejo;
These products undergo hepatic uptake, and have therefore a clinical utility for imaging poorly vascularised hepatic lesions, especially in the delayed phase imaging, that cannot be adequately studied with agents without hepatic uptake and thus allowing early diagnosis of potentially life threatening diseases.
Ta izdelka prehajata v hepatocite in sta zato klinično koristna za slikanje slabo vaskulariziranih jetrnih lezij, zlasti pri slikanju v zapozneli fazi, ki jih s sredstvi, ki ne prehajajo v hepatocite, ni mogoče ustrezno proučiti, ter tako omogočata zgodnje diagnosticiranje morebitnih življenjsko nevarnih bolezni.
In addition, low concentrations of linear gadolinium agents as well as macrocyclic agents were detected in non-clinical and clinical studies via mass spectrometry.
Poleg tega so bile z masno spektrometrijo v nekliničnih in kliničnih študijah ugotovljene nizke koncentracije linearnih in makrocikličnih sredstev, ki vsebujejo gadolinij.
Gadoxetic acid has a substantial liver uptake, is administered at a low dose (0.025 mmol/kg of body weight) and has a short time to delayed phase scanning (20 mins).
Gadoksetna kislina, ki jo jetra večinoma absorbirajo, se uporablja v majhnem odmerku (0,025 mmol/kg telesne mase), čas do zapoznele faze slikanja pa je kratek (20 minut).
Taking into account the evidence of accumulation of GdCAs in the brain, the fact that linear compounds have been detected in the brain to a much higher amount than the macrocyclic compounds and that they persist in the brain for a longer period, and considering the toxicity of Gd shown in non-clinical studies, the serious concerns about potential neurological harm, deposition in other tissues and its potential risks, and the identified risks associated with the use of linear GdCAs (including the risk of NSF and the gadolinium-associated plaques) and in view of the whole safety profile of these agents, PRAC maintained its conclusion that that the benefit in enhancement of MR images of intravenous linear agents does not outweigh the known and potential risks of these products.
Odbor PRAC je ob upoštevanju dokazov o kopičenju sredstev GdCA v možganih, dejstva, da so bile linearne spojine v možganih ugotovljene v veliko večji količini kot makrociklične spojine in da so se v možganih ohranile dlje časa ter ob upoštevanju toksičnosti gadolinija, dokazane v nekliničnih študijah, resnih pomislekov v zvezi z morebitnimi škodljivimi nevrološkimi učinki, odlaganjem v drugih tkivih ter njegovimi morebitnimi in opredeljenimi tveganji, povezanimi z uporabo linearnih sredstev GdCA (vključno s tveganjem NSF in z gadolinijem povezanih plakov), ter glede na celoten varnostni profil teh sredstev vztrajal pri zaključku, da korist linearnih sredstev za intravensko uporabo pri izboljšanju kontrasta magnetnoresonančnih slik ne prevlada nad znanimi in morebitnimi tveganji teh izdelkov.
PRAC also considered the two linear GdCAs, gadoxetic acid and gadobenic acid in the liver imaging indication.
Odbor PRAC je tudi proučil dve linearni sredstvi GdCA, in sicer gadoksetno kislino in gadobensko kislino, za indikacijo slikanja jeter.
For liver imaging, some GdCAs allow the possibility of a delayed phase imaging.
Nekatera sredstva GdCA omogočajo slikanje jeter v zapozneli fazi.
Renal impairment is also known to increase the long term retention of Gd in rats in line with the propensity of GdCAs to release Gd in vivo.
Znano je tudi, da se pri podganah zaradi ledvične okvare poveča dolgoročno zadrževanje gadolinija v skladu z nagnjenostjo sredstev GdCA k sproščanju gadolinija in vivo.
These products have an uptake by hepatocytes and can provide in addition to the dynamic phase imaging a delayed phase imaging for highly vascularised hepatic lesions and to detect lesions that are visible only in the delayed phase.
Ta izdelka, ki ju hepatociti absorbirajo, omogočata slikanje v dinamični in zapozneli fazi pri zelo vaskulariziranih jetrnih lezijah ter pri odkrivanju lezij, ki jih je mogoče videti samo v zapozneli fazi.
Linear GdCAs products
Linearni izdelki GdCA
In view of the affected brain areas (including DN and GP), potential neurological effects would include effects on fine motor skills or cognitive impairment, particularly in patients with ongoing neurological disease, which may mask these events.
Morebitni nevrološki učinki bi lahko glede na poškodovane predele možganov (ki vključujejo DN in GP) vključevali učinke na finomotorične sposobnosti ali kognitivno poslabšanje, zlasti pri bolnikih z nevrološko boleznijo, ki lahko prikrije te dogodke.
Intra-articular GdCA products
Izdelki GdCA za intraartikularno uporabo
• Furthermore, dense deposits in various tissues were detected after GdCA administration by Transmission electron microscopy (TEM), which were regarded as Gd deposits.
• poleg tega so bile po uporabi sredstva GdCA s transmisijsko elektronsko mikroskopijo (TEM) ugotovljeni gosti depoziti v različnih tkivih, ki so se šteli za depozite gadolinija.
With regards to non-clinical studies, unchelated gadolinium in the form of gadolinium chloride has been shown to be toxic with effects including cellular necrosis, fibrosis, and lesions related to mineral deposition (Spencer et al. 1997; Rees et al. 1997), and an in vitro study in rat neurons reported gadolinium-induced cytotoxicity via oxidative injury (Xia et al. 2011).
V nekliničnih študijah se je pokazalo, da je nekelatiran gadolinij v obliki gadolinijevega klorida toksičen ter med drugim povzroča celično nekrozo, fibrozo in lezije, povezane z odlaganjem mineralov (Spencer idr., 1997; Rees idr.
There is no strong evidence of a true difference in the rate of hypersensitivity reactions or other acute reactions associated with GdCAs or of a difference in the rate of ADRs with a fatal outcome across the class.
Trdni dokazi, da se sredstva GdCA iz tega razreda med seboj dejansko razlikujejo glede na stopnjo z njimi povezanih preobčutljivostnih reakcij ali drugih akutnih reakcij ter glede na stopnjo neželenih učinkov zdravila s smrtnim izidom, niso na voljo.
Deposition of gadolinium in the brain
Odlaganje gadolinija v možganih
The CHMP also concluded that there are practical difficulties for an effective restriction of the number of doses administered during the lifetime of a patient.
Odbor CHMP je tudi zaključil, da obstajajo praktične težave za učinkovito omejitev števila odmerkov, ki jih bolnik prejme v svojem življenju;
• The PRAC considered that the risk related to linear intravenous GdCAs gadobenic acid (in all indications besides liver imaging), gadodiamide, gadopentetic acid, and gadoversetamide, taking into account the whole safety profile, including the additional potential risk of harm from brain and other tissues accumulation outweighs the benefits.
• odbor PRAC je menil, da tveganje, povezano z linearnimi sredstvi GdCA za intravensko uporabo, tj. z gadobensko kislino (pri vseh indikacijah, razen slikanja jeter), gadodiamidom, gadopentetsko kislino in gadoversetamidom, ob upoštevanju celotnega varnostnega profila, vključno z dodatnim morebitnim tveganjem škodljivih učinkov zaradi kopičenja v možganih in drugih tkivih, prevlada nad koristmi;
The PRAC considered all the available data related to the safety and efficacy to the medicinal products containing gadodiamide, gadopentetic acid, gadobenic acid, gadoxetic acid, gadoteridol, gadobutrol, gadoteric acid and gadoversetamide within the procedure under Article 31 of Directive 2001/83/EC.
Odbor PRAC je v okviru postopka v skladu s členom 31 Direktive 2001/83/ES proučil vse razpoložljive podatke o varnosti in učinkovitosti zdravil, ki vsebujejo gadodiamid, gadopentetsko kislino, gadobensko kislino, gadoksetno kislino, gadoteridol, gadobutrol, gadotersko kislino in gadoversetamid.
• The CHMP considered that the risk related to linear intravenous GdCAs gadobenic acid (in all indications besides liver imaging), gadodiamide, gadopentetic acid, and gadoversetamide, taking into account the whole safety profile, including the additional potential risk of harm from brain and other tissues accumulation outweighs the benefits.
• odbor CHMP je menil, da tveganje, povezano z linearnimi sredstvi GdCA za intravensko uporabo, tj. z gadobensko kislino (pri vseh indikacijah, razen slikanja jeter), gadodiamidom, gadopentetsko kislino in gadoversetamidom, ob upoštevanju celotnega varnostnega profila, vključno z dodatnim morebitnim tveganjem škodljivih učinkov zaradi kopičenja v možganih in drugih tkivih, prevlada nad koristmi;
The clinical finding (e.g. Radbruch et al.) that macrocyclic agents do not cause brain T1 hyperintensity was replicated by other groups and can therefore be considered to be substantiated.
), da makrociklična sredstva ne povzročajo hiperintenzivnosti T1, so ponovile druge skupine, zato je zanjo mogoče šteti, da je utemeljena.
• The CHMP took into account that the linear intravenous agents, Multihance (gadobenic acid) and Primovist (gadoxetic acid), undergo hepatic uptake, and therefore have clinical utility for imaging poorly vascularised hepatic lesions, especially in the delayed phase imaging, that cannot be adequately studied with agents without hepatic uptake and thus allowing early diagnosis of potentially life threatening diseases.
• odbor CHMP je upošteval, da linearni sredstvi za intravensko uporabo, tj. Multihance (gadobenska kislina) in Primovist (gadoksetna kislina), prehajata v hepatocite, zato sta klinično koristni za slikanje slabo vaskulariziranih jetrnih lezij, zlasti pri slikanju v zapozneli fazi, ki jih s sredstvi, ki ne prehajajo v hepatocite, ni mogoče ustrezno proučiti, ter tako omogočata zgodnje diagnosticiranje morebitnih življenjsko nevarnih bolezni.
In non-clinical studies (Robert et al. 2016 Lohrke et al. 2015; Lohrke et al. 2016; Kartamihardja et al. 2016a; Kartamihardja et al. 2016b; Smith et al. 2017; Rasschaert et al. 2016; MAH unpublished studies) the levels were typically around 10-fold higher with linear agents.
V nekliničnih študijah (Robert idr., 2016, Lohrke idr.
• Gadolinium accumulation has also been reported in a range of other tissues including the liver, kidney, muscle, skin and bone in non-clinical and clinical studies.
• V nekliničnih in kliničnih študijah so poročali o kopičenju gadolinija tudi v različnih drugih tkivih, vključno z jetri, ledvicami, mišicami, kožo in kostmi.
PRAC noted that gadoxetic acid has only the liver imaging indication.
Poudaril je, da ima gadoksetna kislina samo eno indikacijo, in sicer slikanje jeter.
• The PRAC took into account that the linear intravenous agents, Multihance (gadobenic acid) and Primovist (gadoxetic acid), undergo hepatic uptake, and therefore have clinical utility for imaging poorly vascularised hepatic lesions, especially in the delayed phase imaging, that cannot be adequately studied with agents without hepatic uptake and thus allowing early diagnosis of potentially life threatening diseases.
• odbor PRAC je upošteval, da linearni sredstvi za intravensko uporabo Multihance (gadobenska kislina) in Primovist (gadoksetna kislina) prehajata v hepatocite, zato sta klinično koristni za slikanje slabo vaskulariziranih jetrnih lezij, zlasti pri slikanju v zapozneli fazi, ki jih s sredstvi, ki ne prehajajo v hepatocite, ni mogoče ustrezno proučiti, ter tako omogočata zgodnje diagnosticiranje morebitnih življenjsko nevarnih bolezni.
• Although no adverse neurological effects, such as cognitive or movement disorders, have been demonstrated to be caused by gadolinium accumulation in the brain, long-term safety data are limited.
• čeprav niso bili dokazani neželeni nevrološki učinki, kot so kognitivne motnje ali motnje gibanja, ki naj bi jih povzročilo kopičenje gadolinija v možganih, so podatki o dolgoročni varnosti omejeni.
Therefore the CHMP recommends the variation to the terms of the marketing authorisations for medicinal products containing intravenous gadobutrol, gadoteric acid, gadoteridol, gadoxetic acid, intravenous gadobenic acid in the indication of liver imaging, intra-articular gadoteric acid and intraarticular gadopentetic acid.
Odbor CHMO zato priporoča spremembo pogojev dovoljenj za promet z zdravili, ki vsebujejo gadobutrol, gadotersko kislino, gadoteridol, gadoksetno kislino za intravensko uporabo, gadobensko kislino za intravensko uporabo za indikacijo slikanja jeter ter gadotersko kislino za intraartikularno uporabo in gadopentetsko kislino za intraartikularno uporabo.
The PRAC also concluded that there are practical difficulties for an effective restriction of the number of doses administered during the lifetime of a patient.
Odbor PRAC je tudi zaključil, da obstajajo praktične težave za učinkovito omejitev števila odmerkov, ki jih bolnik prejme v svojem življenju;
Taking into account the extensive exposure and the absence of clinical or non-clinical adverse outcomes of gadolinium accumulation in the brain, CHMP considered that such harmful effects and potential interaction with disease processes are “possible” rather than “plausible”, as the latter would imply a stronger potential for harm; in this sense, “yet” was also removed.
Škodljivi učinki in morebitna interakcija z bolezenskimi procesi so verjetni glede na podatke, ki dokazujejo dekelacijo linearnih sredstev in vivo, in ugotovljeno toksičnost nekelatiranega gadolinija na podlagi nekliničnih podatkov.“ Odbor CHMP je ob upoštevanju velike izpostavljenosti in neobstoja kliničnih ali nekliničnih neželenih izidov kopičenja gadolinija v možganih menil, da so taki škodljivi učinki in morebitna interakcija z bolezenskimi procesi „mogoči“ in ne „verjetni“, saj bi to pomenilo večjo možnost za škodljive učinke; zato je bil tudi „še“ izbrisan;
PRAC maintained its view that conducting clinical studies to fully address the potential risk associated with Gd accumulation in the brain would not be feasible within a reasonable period of time.
Odbor PRAC je vztrajal pri stališču, da v razumnem času ne bi bilo mogoče izvesti kliničnih študij za popolno obravnavanje morebitnega tveganja, povezanega s kopičenjem gadolinija v možganih.
The benefit-risk balance of medicinal products containing intravenous gadobutrol, gadoteric acid, gadoteridol, gadoxetic acid, intravenous gadobenic acid in the indication of liver imaging, intra-articular gadoteric acid and intra-articular gadopentetic acid is favourable subject to agreed changes to the product information:
je razmerje med koristmi in tveganji zdravil, ki vsebujejo gadobutrol, gadotersko kislino, gadoteridol, gadoksetno kislino, gadobensko kislino za intravensko uporabo za indikacijo slikanja jeter ter gadotersko kislino za intraartikularno uporabo in gadopentetsko kislino za intraartikularno uporabo, ugodno, vendar je treba v informacijah o izdelku upoštevati dogovorjene spremembe:
Toxicity of accumulation of Gd in the brain
Toksičnost kopičenja gadolinija v možganih
The CHMP, as a consequence, considers that the benefit-risk balance of medicinal products containing intravenous gadobutrol, gadoteric acid, gadoteridol, gadoxetic acid, intravenous gadobenic acid in the indication of liver imaging, intra-articular gadoteric acid and intra-articular gadopentetic acid remains favourable subject to amendments to the product information.
Odbor CHMP zato meni, da je razmerje med koristmi in tveganji zdravil, ki vsebujejo gadobutrol, gadotersko kislino, gadoteridol, gadoksetno kislino za intravensko uporabo, gadobensko kislino za intravensko uporabo za indikacijo slikanja jeter ter gadotersko kislino za intraartikularno uporabo in gadopentetsko kislino za intraartikularno uporabo, ugodno, vendar je treba informacije o izdelku spremeniti.
• Although no adverse neurological effects, such as cognitive or movement disorders, have yet been demonstrated to be caused by gadolinium accumulation in the brain, long-term safety data are limited.
• čeprav še ni bilo dokazano, da neželene nevrološke učinke, kot so kognitivne motnje ali motnje gibanja, povzroči kopičenje gadolinija v možganih, so podatki o dolgoročni varnosti omejeni.
Duration of gadolinium retention in the brain
Kako dolgo gadolinij ostane v možganih
Harmful effects and potential interaction with disease processes are plausible in view of stability data suggesting dechelation of linear agents in vivo and the known toxicity of unchelated gadolinium.
Škodljivi učinki in morebitna interakcija z bolezenskimi procesi so verjetni, glede na to da podatki o stabilnosti kažejo dekelacijo linearnih sredstev in vivo in ugotovljeno toksičnost nekelatiranega gadolinija.
• High Gd levels with high inter-individual variability were detected in saline-treated controls.
• med kontrolami z raztopino natrijevega klorida so bile ugotovljene visoke ravni gadolinija z veliko spremenljivostjo med posamezniki.
Harmful effects and potential interaction with disease processes are possible in view of data supporting dechelation of linear agents in vivo and the known toxicity of unchelated gadolinium based on non-clinical data.
Škodljivi učinki in morebitna interakcija z bolezenskimi procesi so mogoči glede na podatke, ki dokazujejo dekelacijo linearnih sredstev in vivo, in toksičnost nekelatiranega gadolinija, ugotovljeno na podlagi nekliničnih podatkov;
Therefore, the PRAC considered that the benefits of gadobenic acid and gadoxetic acid outweigh the risks related to these products in the context of liver imaging.
Zato je menil, da pri slikanju jeter koristi gadobenske kisline in gadoksetne kisline prevladajo nad tveganji, povezanimi s tema izdelkoma;
The PRAC also noted that high GdCAs doses were tested (20x2.5 mmol) by McDonald et al., and the study duration is comparably short (e.g. the total doses tested in Frenzel et al 2017 was half that of McDonald et al (10x2.5mmol), while the time period to the last tissue sampling in Frenzel et al 2017 was 24 days instead of 7 days in McDonald 2017.)
preskusili visoke odmerke sredstev GdCA (20 x 2,5 mmol) in da je študija trajala sorazmerno kratek čas (npr. skupno število odmerkov, ki so jih preskusili Frenzel idr.
Gadolinium-associated plaques with sclerotic bodies on histology have been reported with some gadolinium-containing contrast agents in patients who do not otherwise have symptoms or signs of nephrogenic systemic fibrosis.
Poročalo se je, da so bili pri bolnikih brez simptomov ali znakov nefrogene sistemske fibroze na podlagi histologije pri nekaterih kontrastnih sredstvih, ki vsebujejo gadolinij, ugotovljeni plaki s sklerotičnimi spremembami, povezani z gadolinijem.
• Only a small signal was detected in a brain region which McDonald et al. assumed to be the dentate nucleus (DN), but this assignment is not convincing when regarding the figures shown.
predpostavili, da je dentatno jedro (DN), vendar pa ta določitev glede na navedene podatke ni prepričljiva;