natgillin/translations-raw huggingface dataset:
On 14 June 2012 the CVMP adopted a final opinion confirming the recommendation, included in its opinion of 8 March 2012, that variations are necessary in the marketing authorisations for the veterinary medicinal products containing clorsulon, closantel, nitroxinil, rafoxanide or triclabendazole as a single active substance and for the veterinary medicinal products administered as pour-on to cattle containing triclabendazole and moxidectin in order to amend the summaries of product characteristics and package leaflets in line with recommended by the CVMP changes in the product information. 
14. junija 2012 je odbor CVMP sprejel končno mnenje, v katerem je potrdil priporočilo iz mnenja z dne 8. marca 2012, da so potrebne spremembe dovoljenj za promet z zdravili za uporabo v veterinarski medicini, ki vsebujejo klorsulon, klozantel, nitroksinil, rafoksanid ali triklabendazol kot edino zdravilno učinkovino, in z zdravili za uporabo v veterinarski medicini, ki se dajejo govedu kot kožni poliv in vsebujejo triklabendazol ter moksidektin, da bi uskladili povzetke glavnih značilnosti zdravila in navodila za uporabo s spremembami informacij o zdravilu, ki jih je priporočil odbor CVMP.
Based on the evaluation of the available data, the CVMP adopted, on 8 March 2012, an opinion recommending variations of the marketing authorisations for the veterinary medicinal products containing clorsulon, closantel, nitroxinil, rafoxanide or triclabendazole as a single active substance and for the veterinary medicinal products administered as pour-on to cattle containing triclabendazole and moxidectin. 
Na podlagi vrednotenja razpoložljivih podatkov je odbor CVMP 8. marca 2012 sprejel mnenje, v katerem je priporočil spremembo dovoljenj za promet z zdravili za uporabo v veterinarski medicini, ki vsebujejo klorsulon, klozantel, nitroksinil, rafoksanid ali triklabendazol kot edino zdravilno učinkovino, in z zdravili za uporabo v veterinarski medicini, ki se dajejo govedu kot kožni poliv in vsebujejo triklabendazol ter moksidektin.
Opinion following an Article 351 referral for all veterinary medicinal products containing active substances belonging to the class of flukicides for which no maximum residue limit has been established in milk and which are intended for use in ruminants producing milk for human consumption 
Mnenje v zvezi z napotitvijo v skladu s členom 351 za vsa zdravila za uporabo v veterinarski medicini, ki vsebujejo zdravilne učinkovine proti metljajem, za katere ni bila določena mejna vrednost ostankov v mleku, in ki se uporabljajo pri vseh prežvekovalcih, katerih mleko je namenjeno prehrani ljudi
Opinion following an Article 35 referral for all veterinary medicinal products containing active substances belonging to the class of flukicides for which no maximum residue limit has been established in milk and which are intended for use in ruminants EMA/759491/2012 
Mnenje v zvezi z napotitvijo v skladu s členom 35 za vsa zdravila za uporabo v veterinarski medicini, ki vsebujejo zdravilne učinkovine proti metljajem, za katere ni bila določena mejna vrednost ostankov v mleku, in ki se uporabljajo pri prežvekovalcih stran 2/2
The referral procedure was initiated on 13 December 2012. 
Napotitveni postopek se je začel dne 13. decembra 2012.
• The Committee considered the referral under article 13(2) of Regulation No 1234/2008 
• Odbor je obravnaval napotitev po členu 13(2) Uredbe št. 1234/2008;
Available from: http://www.ginasthma.org/. 
Dostopno prek: http://www.ginasthma.org/
Study CT07 
Študija CT07
Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2011. 
Global Strategy for Asthma Management and Prevention (Svetovna strategija za vodenje in preprečevanje astme), Global Initiative for Asthma (Svetovna pobuda za astmo - GINA), 2011.
As the reference and concerned Member States were not able to reach an agreement in respect of the variation, on 23 November 2012, Germany triggered a referral under Article 13 of Commission Regulation EC No 1234/2008. 
Ker referenčna in zadevne države članice niso mogle doseči soglasja v zvezi s spremembo, je Nemčija dne 23. novembra 2012 sprožila napotitveni postopek po členu 13 Uredbe Komisije (ES) št.
Overall summary of the scientific evaluation of Kantos Master and associated names (see Annex I) 
Splošni povzetek znanstvenega vrednotenja zdravila Kantos Master in povezanih imen (glejte Prilogo I)
On the basis of the questions raised by Sweden the points to be considered by the CHMP were: 
Na podlagi vprašanj, ki jih je zastavila Švedska, je moral CHMP preučiti ugotovitvi, da:
Post hoc analysis of data from study CT07 
Post hoc analiza podatkov iz študije CT07
The concept of this “early intervention” is clearly advocated in the 2011 GINA guidelines1 where it is stated that “The benefit in preventing exacerbations appears to be the consequence of early intervention at a very early stage of a threatened exacerbation”. 
Koncept „zgodnjega ukrepanja“ jasno zagovarjajo tudi smernice GINA1 iz leta 2011, v katerih je navedeno, da „se zdi, da so koristi pri preprečevanju eksacerbacij posledica zgodnjega ukrepanja v zelo zgodnjem obdobju možne eksacerbacije“.
The disease severity was based on lung function (FEV1) and use of rescue medication at entry to the study. 
Resnost bolezni je temeljila na delovanju pljuč (FEV1) in uporabi rešilnih zdravil ob vstopu v študijo.
Additional supportive data 
Dodatni spremljajoči podatki
However, it has never been demonstrated that a small increase in total ICS dose would have an impact on the lung function or on the clinical outcomes. 
Vendar pa ni bilo nikoli dokazano, da je rahlo povečanje skupnega odmerka ICS vplivalo na delovanje pljuč ali na klinične izide.
• The Committee noted that there was no comparison with the standard of care, according to the GINA guideline. 
• Odbor je upošteval, da ni bila izvedena primerjava s standardno oskrbo v skladu s smernicami GINA.
This comparability has also been confirmed in a comparative clinical study between Kantos Master and associated names (Foster 10/6) and Symbicort 200/6 (budesonide/formoterol)3. 
Ta primerljivost je bila potrjena tudi v primerjalni klinični študiji zdravila Kantos Master in povezanih imen (Foster 10/6) in zdravila Symbicort 200/6 (budezonid/formoterol)3.
In addition, both components have been developed as an extrafine formulation, which means they reach the most peripheral airways where most of the inflammatory process takes place during asthma exacerbation. 
Poleg tega sta bili obe sestavini razviti v izjemno drobni sestavi, kar pomeni, da dosežeta najbolj periferne dihalne poti, kjer se med eksacerbacijo astme odvija največ vnetnih procesov.
Therefore, the CHMP recommended the granting of the variation to the terms of the marketing authorisations for the medicinal products referred to in Annex I for which the valid 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. 
zato je CHMP priporočil odobritev spremembe pogojev dovoljenj za promet z zdravili, navedenimi v Prilogi I, katerih povzetek glavnih značilnosti zdravila, označevanje in navodila za uporabo ostanejo enaki kot končne različice, dogovorjene med postopkom usklajevalne skupine, kakor je omenjeno v Prilogi III.
Significant improvements were also observed in the secondary efficacy variables (Forced Expiratory Volume in the 1st second (FEV1), asthma symptoms, medication free days etc.) in both treatment arms. 
Pomembno izboljšanje so opazili tudi pri sekundarnih spremenljivkah učinkovitosti (forsiranem ekspiracijskem volumnu v prvi sekundi (FEV1), simptomih astme, številu dni brez zdravil itd.) v obeh skupinah, ki sta prejemali zdravljenje.
Both components (BDP and FF) have been shown to be effective in the case of asthma exacerbation due to their anti-inflammatory and bronchodilating effects, and their effects are enhanced if they are administered in combination. 
Obe sestavini (BDP in FF) sta zaradi svojih protivnetnih in bronhodilatacijskih učinkov dokazano učinkoviti pri eksacerbaciji astme, njun učinek pa se še poveča, če se uporabita v kombinaciji.
Kantos Master has received marketing authorisation in the European Union through the Mutual Recognition Procedure (MRP). 
Zdravilo Kantos Master je pridobilo dovoljenje za promet v Evropski uniji po postopku medsebojnega priznavanja.
The extrapolation of data from Symbicort SMART was questionable as the similarity of these two products in the MART regimen has not been established. 
2. je bila ekstrapolacija podatkov o zdravilu Symbicort SMART vprašljiva, saj ni bila dokazana podobnost med omenjenima dvema zdraviloma pri zdravljenju po shemi MART.
The CHMP also took into account the suitability of Kantos Master (in terms of its components and its formulation) for the MART approach. 
CHMP je upošteval tudi primernost zdravila Kantos Master (glede na njegove sestavine in sestavo) za shemo MART.
These results were irrespective of the type of fixed ICS/LABA comparator (budesonide/formoterol or salmeterol/fluticasone), and irrespective of whether the maintenance dose of the comparator was similar or up to two fold higher. 
Ti rezultati so bili neodvisni od vrste primerjalne fiksne kombinacije ICS/LABA (budezonid/formoterol ali salmeterol/flutikazon) in od tega, ali je bil vzdrževalni odmerek primerjalnega zdravila podoben ali do dvakrat večji.
It was concluded that the key factor of the MART approach is not the overall amount of ICS given, but when the dose is given. 
Zaključeno je bilo, da ključni dejavnik pri zdravljenju po shemi MART ni velikost skupnega odmerka ICS, ampak pravočasno dajanje odmerka.
Annex II Scientific conclusions and grounds for the variation to the terms of the marketing authorisations 
Znanstveni zaključki in podlaga za spremembo pogojev dovoljenj za promet z zdravilom
Kantos Master in MART was also significantly efficacious regarding the mean number of rescue medication at entry to the study (>0 and ≤1, >1 and ≤2, and >2) in the three groups (similar hazard ratio of 0.51, 0.64 and 0.52, respectively). 
Zdravljenje z zdravilom Kantos Master po shemi MART je bilo pomembno učinkovito tudi glede povprečnega števila rešilnih zdravil ob vstopu v študijo (> 0 in ≤ 1, > 1 in ≤ 2 ter > 2) v vseh treh skupinah (podobno razmerje tveganja 0,51, 0,64 oziroma 0,52).
A post hoc analysis was conducted with two subgroups of patients in order to demonstrate that both groups of patients in the study CT07 were not overtreated or undertreated. 
Post hoc analiza je bila izvedena z dvema podskupinama bolnikov, namen analize pa je bil dokazati, da skupini bolnikov v študiji CT07 nista prejemali prevelikih ali premajhnih odmerkov.
It was also observed that the group of patients using Kantos Master as reliever took on average approximately 80µg more of BDP per day which is equivalent to less than one extra inhaler actuation per day. 
Opaženo je bilo tudi, da je skupina bolnikov, ki je prejemala zdravilo Kantos Master kot olajševalno zdravljenje, v povprečju jemala 80 µg več BDP na dan, kar je enako enemu dodatnemu vdihu iz inhalatorja na dan.
Literature data 
Podatki iz literature
Moreover, the onset of action of formoterol as a bronchodilator is faster compared to other LABAs such as salmeterol, and is therefore well suited for the acute relief of bronchospasm. 
Poleg tega začne formoterol učinkovati kot bronhodilator hitreje kot drugi dolgo delujoči beta-2-agonisti, kot je salmeterol, in je zato primernejši za akutno lajšanje bronhospazmov.
Kantos Master is a fixed-dose combination (FDC) of the inhaled corticosteroid (ICS) beclometasone diproprionate (BDP) and the long-acting beta2-agonist (LABA) formoterol fumarate (FF) which is indicated as regular maintenance treatment of asthma administrated twice daily. 
Zdravilo Kantos Master je ustaljena kombinacija odmerkov (FDC) inhalacijskega kortikosteroida (ICS) beklometazon dipropionata (BDP) in dolgo delujočega beta-2-agonista (LABA) formoterol fumarata (FF), ki je indicirana za redno vzdrževalno zdravljenje astme z dajanjem dvakrat na dan.
The results demonstrated that MART with Kantos Master was significantly superior to salbutamol in prolonging the time to first severe exacerbations and in reducing the mean yearly rate of severe exacerbations in both subgroups of patients. 
Rezultati so pokazali, da je bilo zdravljenje z zdravilom Kantos Master po shemi MART pomembno učinkovitejše od zdravljenja s salbutamolom pri podaljšanju časa do prve hude eksacerbacije in znižanju povprečne letne stopnje hudih eksacerbacij pri obeh podskupinah bolnikov.
In the Symbicort MART development program, marked improvements in asthma control have been obtained when part of the dose was given on an as-needed basis. 
Med programom razvoja zdravila Symbicort SMART so dosegli opazno izboljšanje v obvladovanju astme, ko so del odmerka dajali po potrebi.
The patients enrolled in this study were being treated with a higher mean ICS dose at entry to the study (between 700µg and 1100µg, expressed as labelled or BDP equivalent dose respectively) than during the clinical study (ICS dose in the group taking Kantos Master as reliever and in the group taking salbutamol was respectively about 701.2 µg/day and 488.8 µg/day, always given as part of an ICS-LABA combination). 
Bolniki, vključeni v študijo, so bili ob vstopu v študijo zdravljeni z večjim povprečnim odmerkom ICS (med 700 µg in 1100 µg, izraženimi kot označen odmerek oziroma ekvivalenten odmerek BDP) kot med klinično študijo (odmerka ICS v skupini, ki je prejemala zdravilo Kantos Master kot olajševalno zdravljenje, in v skupini, ki je jemala salbutamol, sta bila približno 701,2 µg/dan oziroma 488,8 µg/dan, vedno dana kot del kombinacije ICS in LABA).
On 20 January 2012, the MAH submitted a type II variation via the MRP for Kantos Master and associated names (DE/H/0873/001/II/024), to request the inclusion of “Maintenance and reliever therapy taken as regular maintenance treatment and as needed in response to asthma symptoms”. 
Imetnik dovoljenja za promet z zdravilom je dne 20. januarja 2012 po postopku medsebojnega priznavanja predložil vlogo za spremembo tipa II za zdravilo Kantos Master in povezana imena (DE/H/0873/001/II/024), s katero je zaprosil za vključitev indikacije „vzdrževalno in olajševalno zdravljenje, ki se uporablja kot redno vzdrževalno zdravljenje in po potrebi glede na simptome astme“.
Therefore, the CHMP was of the opinion that the positive effect of Kantos Master on exacerbations was not achieved through a simple increase in daily ICS dose but with the timely delivery of a small dose of BDP together with the bronchodilator, when patient's symptoms worsened. 
Zato je CHMP menil, da pozitivni učinek zdravila Kantos Master na eksacerbacije ni bil dosežen z majhnim povečanjem dnevnega odmerka ICS, ampak s pravočasnim dajanjem majhnih odmerkov BDP z bronhodilatatorjem ob poslabšanju simptomov bolnika.
In both more severe (defined by FEV1 < 70%) and less severe groups (FEV1 ≥ 70%), Kantos Master in MART was significantly efficacious (similar hazard ratio of 0.65 and 0.61, respectively). 
Tako v skupini s hujšo astmo (določeno kot FEV1 < 70 %) kot v skupini z manj hudo astmo (FEV1 ≥ 70 %) je bilo zdravljenje z zdravilom Kantos Master po shemi MART pomembno učinkovito (podobno razmerje tveganja 0,65 oziroma 0,61).
Therefore, the CHMP considered that the positive therapeutic effect of MART with Kantos Master has been demonstrated in patients who had a reduction in the daily ICS dose and in patients who did not have any step down treatment (i.e. the subgroup of patients taking up to 500 µg daily at entry and during treatment). 
Zato je CHMP menil, da so bili pozitivni terapevtski učinki zdravljenja z zdravilom Kantos Master po shemi MART dokazani pri bolnikih, ki so prejemali zmanjšani dnevni odmerek inhalacijskih kortikosteroidov, in pri bolnikih, pri katerih niso zmanjšali odmerka (tj. pri podskupini bolnikov, ki je jemala do 500 µg na dan ob vstopu v študijo in med zdravljenjem).
The data from the main pivotal study that were submitted with the application to support safety and efficacy of Kantos Master for the maintenance and reliever therapy taken as regular maintenance treatment and as needed in response to asthma symptoms have not demonstrated that the MART treatment regimen was non-inferior to standard of care treatment, as the control group did not actually receive treatment according to standard of care. 
1. podatki glavne ključne študije, ki so bili predloženi skupaj z vlogo v podporo varnosti in učinkovitosti zdravila Kantos Master za vzdrževalno in olajševalno zdravljenje, ki se uporablja kot redno vzdrževalno zdravljenje in po potrebi glede na simptome astme, niso pokazali, da zdravljenje po shemi MART ni slabše od standardnega zdravljenja, saj kontrolna skupina ni dejansko prejemala zdravljenja v skladu s standardno oskrbo;
One arm of patients were treated with an entry ICS dose of 500 µg or less and another arm had an entry ICS dose of more than 500 µg. 
Bolniki v enem kraku so bili ob vstopu zdravljeni z odmerkom 500 µg ICS ali manj, bolniki v drugem kraku pa z odmerkom, večjim od 500 µg.
A further additional analysis of the study CT07 has been conducted in patients with severe asthma as it was considered that if under-treatment with Kantos Master in MART occurred, it should be most evident in this population who requires higher ICS doses to control their asthma. 
Nadaljnjo dodatno analizo študije CT07 so izvedli pri bolnikih s hudo astmo, saj so menili, da bi bile posledice morebitnega zdravljenja s premajhnimi odmerki zdravila Kantos Master po shemi MART pri tej populaciji bolnikov najbolj očitne, saj za obvladovanje astme potrebujejo večje odmerke ICS.
Although a reduction to the mean ICS dose was observed in patients at entry to the study, the results showed that the mean FEV1 improved in both groups of patients during the run-in period and further improvement were observed during the 48-week treatment period, with a change from baseline to the end of the study of about 100mL in both groups. 
Čeprav je bilo pri bolnikih ob vstopu v študijo opaženo zmanjšanje povprečnega odmerka ICS, so rezultati v obeh skupinah pokazali izboljšanje povprečnega FEV1 med uvodnim zdravljenjem in nadaljnje izboljšanje v 48 tednih zdravljenja; sprememba od začetka do konca študije je bila v obeh skupinah približno 100 ml. CHMP je upošteval, da ni bila izvedena primerjava s standardno oskrbo v skladu s smernicami GINA.
The similar particle size of the two components also leads to co-deposition in the same regions of the lung, favouring a synergistic interaction. 
Ker so delci obeh sestavin podobno veliki, se skupaj nalagajo v istih delih pljuč, kar omogoča sinergijsko delovanje.
The CHMP was therefore of the opinion that the effectiveness of Kantos Master in MART was not due to a potential under-treatment of the comparator arm in the study CT07, and that the maintenance administration of Kantos Master at one inhalation twice daily had a clinically significant benefit in these patients. 
Zato je CHMP menil, da učinkovitost zdravljenja z zdravilom Kantos Master po shemi MART ni bila povezana z morebitnimi premajhnimi odmerki v primerjalni skupini v študiji CT07 in da je zdravilo Kantos Master kot vzdrževalno zdravljenje z enim vdihom iz inhalatorja dvakrat na dan pri teh bolnikih pokazalo klinično pomembne koristi.
This additional analysis further demonstrated that Kantos Master in MART is not associated with under-treatment of patients in case of uncontrolled asthma. 
Ta dodatna analiza je nadalje pokazala, da učinkovitost zdravila Kantos Master po shemi MART ni povezana z dajanjem premajhnih odmerkov bolnikom z neurejeno astmo.
The daily maintenance dose, in both arms of the study was 200µg of extrafine beclometasone, which is clinically equivalent to 500µg of non extrafine beclometasone. 
Dnevni vzdrževalni odmerek v obeh skupinah je bil 200 µg beklometazona v izredno drobnih delcih, kar je klinično ekvivalentno 500 µg beklometazona, ki ni v izredno drobnih delcih.
This treatment approach of using a maintenance dose of a fixed combination of ICS and LABA and additional doses of the same combination in case of symptom worsening instead of a separate short acting beta2-agonist (SABA) is called “Maintenance And Reliever Therapy” (MART). 
Način zdravljenja, pri katerem se namesto ločenega kratko delujočega beta-2-agonista (SABA) uporabijo vzdrževalni odmerek fiksne kombinacije ICS in LABA ter dodatni odmerki iste kombinacije v primeru poslabšanja simptomov, se imenuje „vzdrževalno in olajševalno zdravljenje“ (MART).
As Kantos Master contain formoterol and beclometasone and in view of the results of the study, the Committee considered the published data to be relevant in the applied regimen. 
Na podlagi dejstva, da zdravilo Kantos Master vsebuje formoterol in beklometazon, in ob upoštevanju rezultatov študije je Odbor presodil, da so objavljeni podatki pomembni za uporabljeno shemo;
However, the Committee agreed that there was no evidence that patients in the comparator group were under-treated as patients in both group had shown clinical benefit from their maintenance treatment. 
Vendar pa se je Odbor strinjal, da ni bilo dokazov, da bi bili bolniki v primerjalni skupini zdravljeni s premajhnimi odmerki, saj je vzdrževalno zdravljenje pokazalo klinično korist za bolnike v obeh skupinah.
As Kantos Master contain formoterol and beclometasone, and in view of the results of the submitted study, the Committee considered the published data to be relevant in the applied regimen. 
Na podlagi dejstva, da zdravilo Kantos Master vsebuje formoterol in beklometazon, in rezultatov predložene študije je Odbor presodil, da so objavljeni podatki pomembni za uporabljeno shemo.
Inhaled beclometasone dipropionate /formoterol extra fine fixed combination in the treatment of asthma: evidence and future perspectives. 
Fabbri, L. M., „Inhaled beclometasone dipropionate /formoterol extra fine fixed combination in the treatment of asthma: evidence and future perspectives (Fiksna kombinacija odmerkov inhalacijskega beklometazon dipropionata in formoterola v izredno majhnih delcih za zdravljenje astme: dokazi in perspektive za prihodnost), Expert Opinion Pharmacother.
• The Committee is of the opinion that the data of the pivotal study CT07 indicated a significant reduction in the risk of severe exacerbations of asthma and significant longer time to exacerbation can be obtained when Kantos Master dose is given as needed. 
• Odbor je menil, da so podatki iz ključne študije CT07 pokazali, da lahko jemanje odmerkov zdravila Kantos Master po potrebi pomembno zmanjša tveganja za pojav hudih eksacerbacij astme in pomembno podaljša čas do eksacerbacij;
In order to demonstrate the efficacy of Kantos Master and associated names as maintenance treatment and as needed in response to symptoms of asthma, the MAH submitted data from a phase III pivotal clinical study, randomised, double blind, double dummy, two arms parallel group (Study CT07). 
Imetnik dovoljenja za promet z zdravilom je za dokaz učinkovitosti zdravila Kantos Master in povezanih imen kot vzdrževalnega zdravljenja in zdravljenja po potrebi glede na simptome astme predložil podatke iz ključne klinične študije III. faze, ki je bila randomizirana, dvojno slepa, uporabljen je bil dvojni placebo in je imela vzporedno skupino z dvema krakoma (študija CT07).
• The Committee reviewed all available data, to support the safety and efficacy of Kantos Master and associated names for “maintenance and reliever therapy taken as regular maintenance treatment and as needed in response to asthma symptoms”. 
• Odbor je pregledal vse razpoložljive podatke, predložene v podporo varnosti in učinkovitosti zdravila Kantos Master in povezanih imen za „vzdrževalno in olajševalno zdravljenje, ki se uporablja kot redno vzdrževalno zdravljenje in po potrebi glede na simptome astme“;