natgillin/translations-raw huggingface dataset:
It was noted by the CHMP that the increase in walking distance on flat ground is likely to be greater than the increase measured on the treadmill - which is set on an incline. 
CHMP je upošteval, da bi bilo povečanje prehojene razdalje na ravnih tleh verjetno večje kot tisto, ki so ga izmerili na tekočem traku (ki je nameščen pod naklonom).
Cilostazol is mainly metabolised by CYP3A4, and CYP2C19 and has two main active metabolites, OPC13015 (dehydrocilostazol, 3-7 times more potent than cilostazol), and OPC-13213 (trans-hydroxycilostazol, 2 - 5 times less potent than cilostazol). 
Cilostazol se pretežno presnavlja s CYP3A4 in CYP2C19 ter ima dva glavna aktivna presnovka, OPC-13015 (dehidrocilostazol, 3- do 7-krat močnejši od cilostazola) in OPC-13213 (trans-hidroksicilostazol, 2- do 5-krat šibkejši od cilostazola).
• The Committee has reviewed all adverse drug reaction data and clinical trial data associated with Cilostazol; in particular the cardiovascular events and bleeding reactions. 
• Odbor je preučil vse podatke o neželenih učinkih zdravila in podatke iz kliničnih študij, povezane s cilostazolom; še zlasti podatke o kardiovaskularnih dogodkih in krvavitvah.
The experts were first asked to discuss the current standard approach to the clinical management of peripheral arterial occlusive disease (PAOD), the characteristics of the patients treated with cilostazol and the clinical relevance of the benefits of cilostazol. 
Strokovnjaki so najprej razpravljali o trenutnem standardnem pristopu h kliničnemu zdravljenju periferne arterijske okluzivne bolezni (PAOB), značilnostih bolnikov, zdravljenih s cilostazolom, in kliničnem pomenu koristi cilostazola.
It also inhibits the vascular smooth muscle cell proliferation as well as decreases triglycerides and increases HDL-cholesterol. 
Prav tako zavira proliferacijo celic žilnih gladkih mišic in znižuje ravni trigliceridov ter zvišuje ravni holesterola HDL.
In view of this, the CHMP considered that patients treated concomitantly with two or more additional antiplatelet or anticoagulant agents (e.g. aspirin acetylsalicylic acid, clopidogrel, heparin, warfarin, acenocoumarol, dabigatran, rivaroxaban or apixaban) should not be treated with cilostazol-containing products. 
Zato je CHMP menil, da bolniki, ki sočasno uporabljajo dva ali več antiagregacijskih ali antikoagulacijskih zdravil (npr. acetilsalicilno kislino (aspirin), klopidogrel, heparin, varfarin, acenokumarol, dabigatran, rivaroksaban ali apiksaban), ne bi smeli uporabljati zdravil, ki vsebujejo cilostazol.
The experts agreed that the CASTLE study had some limitations (including early termination and high rate of dropout, study restrictive in certain patient groups, exclusion of high risk patients, and review of the patients by their doctors in a 6-month period) but that some of those were expected with such a long term Phase IV study. 
Strokovnjaki so se strinjali, da je študija CASTLE imela nekaj pomanjkljivosti (vključno s predčasnim zaključkom in visoko stopnjo prekinitve zdravljenja, omejitvami v nekaterih skupinah bolnikov, izločanjem bolnikov z visokim tveganjem in zdravniškim pregledom v šestmesečnem obdobju), vendar pa so bile nekatere pričakovane glede na tako dolgo trajanje študije IV. faze.
The range of improvement was between +28% to +100% for cilostazol, and -10% to +42% for placebo in the individual trials. 
Obseg izboljšanja je bil v posameznih preskušanjih od +28 % do +100 % pri cilostazolu in od -10 % do +42 % pri placebu.
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 zdravili
A closer monitoring of treatment success after 3 months instead of 6 months, with a view to discontinuing cilostazol where the treatment effect is considered to be inadequate is now recommended. 
Priporočil je tudi natančnejše spremljanje uspešnosti zdravljenja po treh namesto šestih mesecih in prekinitev zdravljenja s cilostazolom, kadar je učinek zdravljenja nezadosten.
Excesses in bleeding time during cilostazol treatment outside a prespecified range as to be defined in the protocol will be assessed and appropriate risk minimisation measures will be proposed when the final study report is available. 
V njej bodo ocenjevali čas krvavitev med zdravljenjem s cilostazolom, daljšim od dopustnega, ki bo določen v protokolu, nato pa bodo po predložitvi končnega poročila o študiji sprejeti primerni ukrepi za zmanjšanje tveganja.
It was recognised by the experts that the benefit of cilostazol products was small but was clinically significant, and enough to restore independence for some patients and to get them started with their rehabilitation program. 
Strokovnjaki so potrdili, da so koristi zdravil, ki vsebujejo cilostazol, majhne, vendar klinično pomembne in zadostne, da lahko nekateri bolniki znova postanejo samostojni in začnejo program rehabilitacije.
The Committee is of the opinion, considering the metabolism of cilostazol, that there is a potential for interactions that could increase the risks associated with cilostazol. 
Odbor meni, da zaradi načina presnove cilostazola obstaja možnost medsebojnega delovanja, ki bi lahko povečalo tveganja, povezana s cilostazolom;
The study was terminated prematurely as a result of a lower than expected event rate and higher than expected drop-out rate. 
Študijo so predčasno zaključili zaradi dejstva, da je bila pogostnost dogodkov manjša, stopnja prekinitve zdravljenja pa višja od pričakovane.
A drug utilisation study conducted in one region of Spain found that patients receiving cilostazol were older and used more concomitant medications than those in the clinical trials. 
Študija uporabe zdravila, ki so jo izvedli v eni od španskih pokrajin, je pokazala, da so bili bolniki, ki so jim predpisali cilostazol, starejši in so sočasno uporabljali več zdravil kot tisti v kliničnih preskušanjih.
The primary endpoint in the nine efficacy trials (called mid-term trials) was maximum walking distance (absolute claudication distance - ACD), measured by exercise treadmill testing. 
Primarni opazovani dogodek v devetih študijah učinkovitosti (imenovanih srednjeročne študije) je bila najdaljša prehojena razdalja (absolutna klavdikacijska razdalja - ACD), izmerjena med preskusom s hojo po tekočem traku.
However, they recognised that there is a risk of bleeding with triple therapy and that triple therapy should be avoided (cilostazol and two antiplatelet drugs). 
So pa strokovnjaki potrdili, da obstaja tveganje za krvavitve pri tritirnem zdravljenju, ki se mu je zato treba izogniti (cilostazol in dve antiagregacijski zdravili).
• In view of the above safety concerns, the Committee agreed on a number of risk minimisation measures, including changes to the product information to strengthen the wording of the PI to reduce the risk of haemorrhagic events, cardiac events and potential drug-drug interactions (contra-indication in at-risk patients, recommendation of adjustment of the dose, strengthening of the warning to ensure suitability of the treatment with cilostazol). 
• ob upoštevanju zgoraj navedenih zadržkov glede varnosti je Odbor določil več ukrepov za zmanjšanje tveganja, ki vključujejo spremembe informacij o zdravilu, s katerimi bi spremenili besedilo tako, da bi zmanjšali tveganje za krvavitve, srčne dogodke in morebitno medsebojno delovanje zdravil (kontraindikacija pri bolnikih s povečanim tveganjem, priporočena prilagoditev odmerka, okrepitev opozoril za zagotovitev ustreznosti zdravljenja s cilostazolom).
Considering all available data on the safety and efficacy of cilostazol as well as the conclusions of the ad-hoc expert group meeting, the CHMP has agreed on a number of measures including the restriction of the indication to “second-line use, in patients in whom lifestyle modifications (including stopping smoking and [supervised] exercise programs) and other appropriate interventions have failed to sufficiently improve their intermittent claudication symptoms”, and the introduction of three new contraindications, in patients with history of severe tachyarrhythmia, patients treated concomitantly with two or more additional anti-platelet/anticoagulant agents and patients with unstable angina pectoris, myocardial infarction within the last 6 months, or a coronary intervention in the last 6 months. 
Na podlagi pregleda vseh razpoložljivih podatkov o varnosti in učinkovitosti cilostazola ter zaključkov s sestanka ad hoc strokovne skupine je CHMP predlagal več ukrepov, ki vključujejo omejitev indikacije na „zdravljenje druge izbire pri bolnikih, pri katerih spremembe življenjskega sloga (vključno s prenehanjem kajenja in [nadzorovanimi] programi telesne dejavnosti) in drugi primerni ukrepi niso zadovoljivo izboljšali simptomov intermitentne klavdikacije ter tri nove kontraindikacije - pri bolnikih, ki imajo v anamnezi hudo tahiaritmijo, pri bolnikih, ki sočasno uporabljajo dva ali več drugih antiagregacijskih/antikoagulacijskih zdravil, in pri bolnikih z nestabilno angino pektoris, srčnim infarktom v zadnjih šestih mesecih ali koronarno intervencijo v zadnjih šestih mesecih.
However, the pharmacological effects of cilostazol suggest that it may cause more serious cardiac arrhythmias in some patients. 
Vendar pa obstaja možnost, da bi lahko farmakološki učinki cilostazola pri nekaterih bolnikih povzročili resnejše srčne aritmije.
Data relating to quality of life assessments and responder analyses was considered in the assessment as these data give some insight into the issue of the clinical relevance of the treatment effect, which is complicated by the fact that patients are likely to have different levels of benefit depending on the severity of their intermittent claudication (IC) symptoms. 
Med vrednotenjem zdravil so upoštevali podatke v zvezi z ocenami kakovosti življenja in analizami odziva, ki bi lahko pomagali razjasniti klinični pomen učinka zdravljenja, ki ga je težko opredeliti zaradi dejstva, da bo zdravilo pri bolnikih verjetno izkazalo različne stopnje koristi, odvisno od resnosti simptomov intermitentne klavdikacije (IK).
The experts acknowledged that minor adverse events were commonly seen in some patients but no major side effects were recorded by any of the experts. 
Strokovnjaki so potrdili, da so pri nekaterih bolnikih pogosto opazili blažje neželene dogodke, noben strokovnjak pa ni opazil resnejših neželenih učinkov.
The primary analysis, pre-specified in the protocols, demonstrated a statistically significant longer walking distance in patients receiving cilostazol 100mg bid over placebo. 
Primarna analiza, vnaprej določena v protokolih, je pokazala statistično pomembno podaljšanje prehojene razdalje pri bolnikih, ki so prejemali 100 mg cilostazola dvakrat na dan, v primerjavi s placebom.
A pooled meta-analysis of these trials using the ratio of geometric means for LOG (ACD at last visit/ACD at baseline) for cilostazol vs. placebo demonstrated a treatment effect of 1.15 (95% CI: 1.11 - 1.19) for ACD. 
Metaanaliza združenih podatkov iz teh preskušanj, pri kateri so za beleženje razlik med cilostazolom in placebom uporabili geometrične srednje vrednosti (ACD ob zadnjem obisku/ACD ob izhodišču), je pokazala učinek zdravljenja, ki je znašal 1,15 (95-odstotni IZ: 1,11-1,19) za ACD.
Direct Healthcare Professional Communication (DHPC), to rapidly communicate the outcome of the present review. 
CHMP je odobril neposredno obvestilo zdravstvenim delavcem (DHPC - Dear Healthcare Professional Communication), da se jim v najkrajšem možnem času sporoči izid tega pregleda.
In addition, a phase IV double-blind placebo-controlled efficacy study (PACE study), was performed also with pentoxifylline as active comparator. 
Izvedli so tudi dvojno slepo, s placebom nadzorovano študijo učinkovitosti IV. faze (študija PACE), v kateri so prav tako uporabili pentoksifilin kot primerjalno zdravilno učinkovino.
However, it was noted that the activity of cilostazol as a phosphodiesterase enzyme (PDE-3) inhibitor raises a potential safety concern over cardiac arrhythmias that may result from the increase in resting heart rate (cilostazol has been demonstrated to increase heart rate by ~5.1 and ~7.4 beats per minute at the authorised doses). 
Po drugi strani je menil, da zaviralno delovanje cilostazola na encim fosfodiesterazo (PDE-3) predstavlja morebitno varnostno tveganje zaradi srčnih aritmij, ki so lahko posledica povišanja srčne frekvence med mirovanjem (cilostazol dokazano poviša srčno frekvenco za ~5,1 in ~7,4 utripa na minuto pri odobrenih odmerkih).
These included eight double-blind controlled phase III trials, two of which compared the efficacy of cilostazol with an active comparator (pentoxifylline) and placebo over 24 weeks. 
Preskušanja so vključevala osem dvojno slepih nadzorovanih preskušanj III. faze; v dveh od njih so primerjali učinkovitost cilostazola in primerjalne zdravilne učinkovine (pentoksifilina) ter placeba v 24-tedenskem obdobju.
However, concomitant aspirin and clopidogrel treatment together increased the risk of bleeding in the cilostazol group compared with the placebo patients. 
Po drugi strani pa je sočasna uporaba aspirina in klopidogrela povečala tveganje za krvavitve v skupini s cilostazolom v primerjavi s skupino s placebom.
However, causality and magnitude of this risk is difficult to quantify given the lack of a clear signal in clinical trials and given the level of confounding due to the background concomitant medication used by these patients. 
Vendar pa je vzročnost in stopnjo omenjenega tveganja težko opredeliti zaradi pomanjkanja trdnih dokazov iz kliničnih preskušanj in zelo različnih zdravil, ki jih ti bolniki sočasno uporabljajo.
The study will also aim to quantify off-label use, describe dosage patterns and identify the medical specialties of physicians prescribing cilostazol. 
Cilj študije bo tudi količinsko opredeliti uporabo, ki ni skladna z odobrenimi indikacijami, opisati vzorce odmerjanja in opredeliti specializacije zdravnikov, ki predpisujejo cilostazol.
The CHMP therefore considered that cilostazol should be contraindicated in patients with unstable angina pectoris, myocardial infarction within the last 6 months, or a coronary intervention in the last 6 months, and that additional warning should be included in the PI. 
Zato je CHMP menil, da bi morala biti uporaba cilostazola kontraindicirana pri bolnikih z nestabilno angino pektoris, srčnim infarktom v zadnjih šestih mesecih ali koronarno intervencijo v zadnjih šestih mesecih, in da bi morali v informacije o zdravilu vključiti dodatna opozorila.
• The Committee, as a consequence, concluded that the benefit-risk balance of cilostazol-containing medicinal products is positive under normal conditions of use only for second-line use, in patients in whom lifestyle modifications and other appropriate interventions have failed to sufficiently improve their intermittent claudication symptoms, and subject to the agreed risk minimisation measures, including changes to the product information. 
• na podlagi naštetega je Odbor zaključil, da je razmerje med tveganji in koristmi za zdravila, ki vsebujejo cilostazol, v normalnih pogojih uporabe pozitivno samo za zdravljenje druge izbire pri bolnikih, pri katerih spremembe življenjskega sloga in drugi primerni ukrepi niso zadovoljivo izboljšali simptomov intermitentne klavdikacije, in samo če so upoštevani odobreni ukrepi za zmanjšanje tveganja, ki vključujejo spremembe informacij o zdravilu.
Although clinical trial data did not substantiate safety concerns raised from spontaneous ADR reporting, the CHMP concluded that the risk of bleeding and some cardiovascular events including tachyarrhythmias cannot be excluded in at-risk patients. 
Čeprav podatki iz kliničnih preskušanj niso potrdili upravičenosti zadržkov glede varnosti, ki so jih sprožila spontana sporočila o neželenih učinkih, je CHMP zaključil, da tveganja za krvavitve in nekatere kardiovaskularne dogodke, ki vključujejo tahiaritmije, pri bolnikih s povečanim tveganjem ni mogoče izključiti.
Secondary efficacy endpoints included painfree walking distance (initial claudication distance - ICD) measured by treadmill exercise; and Quality of Life assessments. 
Sekundarni opazovani dogodki učinkovitosti so vključevali razdaljo, prehojeno brez bolečin (začetna klavdikacijska razdalja - ICD), izmerjeno med preskusom s hojo po tekočem traku, in ocene kakovosti življenja.
Grounds for the variation to the terms of the marketing authorisation 
Podlaga za spremembo pogojev dovoljenja za promet z zdravilom
The results from clinical trials did not generate any signal of serious cardiac arrhythmic events, but a small number of serious events (ventricular tachycardia, electrocardiogram QT prolongation (including Torsade de Pointes)) were received from spontaneous sources/non-interventional studies and some of these were considered compatible with the chronotropic effects of cilostazol. 
Rezultati iz kliničnih preskušanj niso razkrili nobenih resnih neželenih učinkov, povezanih s srčnimi aritmijami, obstaja pa majhno število poročil o resnih dogodkih (ventrikularni tahikardiji, podaljšanju intervala QT na elektrokardiogramu, vključno s Torsade de Pointes)) iz spontanih virov/neintervencijskih študij; nekateri dogodki so bili skladni s kronotropnimi učinki cilostazola.
The expert group noted the spontaneous reports of haemorrhage when used with one or two antiplatelet drugs, but were reassured by the absence of evidence from the published placebo-controlled studies. 
Strokovna skupina je upoštevala spontana poročila o krvavitvah pri sočasni uporabi z enim ali več antiagregacijskimi zdravili, vendar je zaradi odsotnosti dokazov iz objavljenih s placebom nadzorovanih študij menila, da ni razloga za skrb.
It was noted that there was a small excess of cases of heart failure (cilostazol: 2.9%, vs. placebo: 2.4%) and hypotension (cilostazol: 0.7%, vs. placebo: 0.1%) in the CASTLE study. 
V študiji CASTLE so opazili nekoliko večje število primerov srčnega popuščanja (cilostazol: 2,9 %, placebo: 2,4 %) in hipotenzije (cilostazol: 0,7 %, placebo: 0,1 %).
Safety data for cilostazol available from the efficacy trials (mid-term trials), the long-term safety trial CASTLE and stroke prevention studies, as well as case reports from spontaneous sources and noninterventional studies were considered in this review. 
Med pregledom so upoštevali podatke o varnosti cilostazola, pridobljene med preskušanji učinkovitosti (srednjeročnimi preskušanji), dolgoročno študijo varnosti CASTLE in študijami za preprečevanje možganskih kapi, ter tudi poročila o primerih iz spontanih virov in neintervencijskih študij.
The most common adverse events included headache, diarrhoea, abnormal stools, dizziness, palpitations and tachycardia, already listed in the Product Information. 
Med najpogostejšimi neželenimi dogodki so bili glavobol, driska, nenormalno blato, omotica, palpitacije in tahikardija, ki so že vključeni v informacije o zdravilu.
The hazard ratio for mortality (cilostazol vs. placebo) was 0.94, 95% CI [0.63-1.39]. 
Razmerje tveganja za smrt (cilostazol v primerjavi s placebom) je bilo 0,94, s 95odstotnim IZ [0,63-1,39].
The CHMP considered that causality was difficult to assess in these reports, especially given the level of confounding due to the background conditions in these patients. 
CHMP je menil, da je iz teh poročil težko oceniti vzročnost, predvsem zaradi zelo različnih predhodnih zdravstvenih stanj bolnikov.
Palpitations and tachycardia were well-documented in clinical trials. 
V kliničnih študijah so bile izčrpno dokumentirane palpitacije in tahikardija.
In view of the modest benefits of cilostazol and of the existing safety concerns, the Committee is of the view that the use of cilostazol should be restricted to those who would benefit the most from treatment, i.e. patients for whom life-style modifications (stopping smoking and exercise programs) 
Ob upoštevanju majhnih koristi cilostazola in obstoječih zadržkov glede varnosti Odbor meni, da je treba uporabo cilostazola omejiti na tiste bolnike, ki bi imeli od zdravljenja največ koristi, tj. na bolnike, pri katerih spremembe življenjskega sloga (prenehanje kajenja in programi telesne dejavnosti) ter drugi primerni ukrepi niso imeli zadovoljivega učinka.
The WMD estimates a mean improvement from baseline for walking distance of 87.4m for cilostazol 100mg bid and 43.7m for placebo (p<0.0001) with a mean baseline walking distance of about 133m (66% improvement with cilostazol). 
Glede na WMD naj bi bilo povprečno izboljšanje prehojene razdalje glede na izhodišče 87,4 m pri uporabi 100 mg cilostazola dvakrat na dan in 43,7 m pri uporabi placeba (p < 0,0001) pri povprečni izhodiščni prehojeni razdalji 133 m (66-odstotno izboljšanje s cilostazolom).
In the CASTLE trial, a lower bleeding event rate was observed in the cilostazol arm than in the placebo arm and the use of concomitant aspirin did not increase the frequency of bleeding in the sub-group treated with cilostazol. 
V študiji CASTLE so v skupini s cilostazolom opazili manjšo pogostnost krvavitev kot v skupini s placebom in tudi sočasna uporaba aspirina v podskupini, zdravljeni s cilostazolom, ni povečala pogostnosti krvavitev.
Finally The Committee agreed to drug utilisation studies to describe the characteristics of new users of cilostazol and the duration of the use of cilostazol and discontinuation patterns, and thereby to evaluate the effectiveness of the implemented risk minimisation measures; 
Poleg tega je Odbor odobril tudi študijo uporabe zdravila za opredelitev značilnosti novih uporabnikov cilostazola in trajanja uporabe ter vzorcev prekinitve zdravljenja ter nadaljnjo študijo za oceno učinkovitosti sprejetih ukrepov za zmanjšanje tveganja;
Cilostazol is a dihydroquinolinone derivative that inhibits cyclic adenosine monophosphate (cAMP) phosphodiesterase, suppressing cAMP degradation and thereby increasing cAMP levels in platelets and blood vessels. 
Cilostazol je derivat dihidrokinolinona, ki zavira fosfodiesterazo, specifično za ciklični adenozin monofosfat (cAMP), s čimer zavira razgradnjo cAMP in posledično zvišuje njegove ravni v trombocitih in krvnih žilah.
The therapeutic indication that has been approved for cilostazol products in Europe is the improvement of the maximal and pain-free walking distances in patients with intermittent claudication (IC), who do not have rest pain and who do not have evidence of peripheral tissue necrosis (peripheral arterial disease (PAD) Fontaine stage II). 
Terapevtska indikacija, ki je bila v Evropi odobrena za zdravila, ki vsebujejo cilostazol, je izboljšanje najdaljše prehojene razdalje in razdalje, prehojene brez bolečin, pri bolnikih z intermitentno klavdikacijo (IK), ki nimajo bolečin med mirovanjem in ne kažejo znakov odmiranja perifernih tkiv (periferne arterijske bolezni (PAB) v II.
Although a post-hoc analysis, the demonstration that the current accepted CV MACE in studies of new drugs (CV death, non-fatal MI and stroke) was statistically significantly lower in the treatment group was felt to give strong reassurance on CV safety. 
Kljub post hoc analizi je dejstvo, da je bila stopnja resnih neželenih srčnih dogodkov, ki so trenutno odobreni v študijah novih zdravil (kardiovaskularna smrt, srčni infarkt brez smrtnega izida in možganska kap), statistično znatno nižja v skupini, ki je prejemala zdravilo, močan dokaz o kardiovaskularni varnosti.
In all efficacy trials cilostazol showed a higher percentage improvement in ACD when compared with placebo and this was statistically significant in 6 of the 9 trials. 
V vseh študijah učinkovitosti cilostazola so opazili višji odstotek izboljšanja absolutne klavdikacijske razdalje v primerjavi s placebom, ki je bil statistično pomemben v šestih od devetih preskušanj.