natgillin/translations-raw huggingface dataset:
In 2005, rather than conducting a new study in line with the “Note for guidance on statistical principles for clinical trials” (CPMP/ICH/363/96) then in force, the MAH decided to perform a post-hoc reevaluation of Study S2, i.e. establishing the definition of the primary hypothesis, the corresponding evaluation plan and the statistical analysis methods in full knowledge of the results. 
Leta 2005 se je imetnik dovoljenja za promet zdravilom raje kot za novo študijo v skladu s tedaj veljavnimi „Navodili o statističnih načelih za klinična preskušanja“ (CPMP/ICH/363/96) odločil, da bo izvedel post-hoc ovrednotenje Študije S2, tj. z vzpostavitvijo opredelitve primarne hipoteze, ustreznega načrta vrednotenja in metod za statistično analizo ob popolnem poznavanju rezultatov.
In addition, the CHMP noted that data generated in study S2 have not established the long term efficacy of Symbioflor 2 beyond 8 weeks of treatment. 
Poleg tega je odbor CHMP opozoril, da podatki, pridobljeni v Študiji S2, ne dokazujejo dolgoročne učinkovitosti zdravila Symbioflor 2, ki bi trajala več kot 8 tednov zdravljenja.
Proof of the efficacy of Symbioflor 2 in this patient population would have required a prospective, double-blinded, randomized and placebo-controlled trial as per the guideline CPMP/EWP/785/97 in force at the time of the conduct of the study. 
Za dokaz učinkovitosti zdravila Symbioflor 2 pri tej populaciji bolnikov bi bilo treba izvesti prospektivno, dvojno slepo, randomizirano in s placebom nadzorovano preskušanje v skladu s smernico CPMP/EWP/785/97, ki je veljala v času izvedbe študije.
In the absence of a run-in phase and specific inclusion criteria, there was also insufficient assurance that the patient population suffered from IBS. 
V odsotnosti uvajalne faze in konkretnih vključitvenih meril ni bilo zadostnega zagotovila, da je populacija bolnikov res imela sindrom razdražljivega črevesa.
The evaluation of the results was descriptive and thus did not allow establishing whether the differences in efficacy between Symbioflor 2 and placebo were statistically different and clinically meaningful. 
Ovrednotenje rezultatov je bilo opisno in zato ni bilo mogoče ugotoviti, ali so bile razlike v učinkovitosti med zdravilom Symbioflor 2 in placebom statistično značilne in klinično pomembne.
In the re-evaluation report of Study S2 (2005), the endpoints were redefined, combining parameters of a patient-centred assessment of spontaneous symptoms with endpoints based on physical examination by the physician. 
V poročilu, v katerem so ponovno ovrednotili Študijo S2 (2005), so ponovno opredelili opazovane dogodke in združili parametre k bolnikom usmerjene ocene spontanih simptomov z opazovanimi dogodki fizičnega pregleda, ki ga je opravil zdravnik.
Based on the review of all available data in the framework of this Article 31 procedure, the CHMP concludes that there are no new elements since the granting of the marketing authorisation for Symbioflor 2 (Escherichia coli bacteria (cells and autolysate)) and associated names, and therefore the previous conclusion of the national competent authorities on a positive benefit-risk balance remains unchanged. 
Na podlagi pregleda vseh razpoložljivih podatkov v okviru tega postopka v skladu s členom 31 odbor CHMP zaključuje, da od izdaje dovoljenja za promet z zdravilom za zdravilo Symbioflor 2 (bakterije Escherichia coli (celice in avtolizat)) in povezana imena ni bilo nobenih novih elementov, zato prejšnji sklep pristojnega nacionalnega organa o pozitivnem razmerju med tveganji in koristmi ostaja nespremenjen.
In general, the CHMP was of the opinion that, although the reporting might have been suboptimal and uncertainties remain with regards to the nature and frequency of the adverse events occurring with Symbioflor 2 in order to fully characterize its safety profile and notably its long term safety profile, the analysis of the safety data did not raise particular concerns. 
Na splošno je bil odbor CHMP mnenja, da čeprav poročanje morda ni bilo optimalno in ostajajo negotovosti glede narave in pogostosti neželenih učinkov zdravila Symbioflor 2 pri celoviti opredelitvi njegovega varnostnega profila, predvsem dolgoročnega varnostnega profila, z analizo podatkov o varnosti niso odkrili pomembnih pomislekov.
Given the heterogeneity of the disease and the absence of data, the CHMP asked the MAH to submit evidence to support this indication. 
Glede na heterogenost bolezni in odsotnost podatkov je odbor CHMP zaprosil imetnika dovoljenja za promet z zdravilom, naj predloži dokaze v podporo tej indikaciji.
Finally, the CHMP noted that the total number of reports was low, and as per the Weber effect, a decline in reporting of adverse events is likely over time. 
Končno je odbor CHMP opozoril, da je skupno število poročil majhno, v skladu z Webrovim učinkom pa se sčasoma lahko pričakuje zmanjšanje poročanja o neželenih učinkih.
Symbioflor 2 (Escherichia coli bacteria (cells and autolysate)) and associated names (Symbioflor 2) is a probiotic containing living Escherichia coli bacteria, which exist in normal gut flora in humans. 
Zdravilo Symbioflor 2 (bakterije Escherichia coli (celice in avtolizat) in povezana imena (Symbioflor 2) je probiotik, ki vsebuje žive bakterije Escherichia coli, ki so del normalne črevesne flore pri ljudeh.
Apart from data on IBS, no controlled or uncontrolled clinical study or literature data are available to assess the efficacy and safety of Symbioflor 2 in the treatment of these diseases. 
Razen podatkov o sindromu razdražljivega črevesa ni na voljo podatkov iz nadzorovanih ali nenadzorovanih kliničnih študij ali literature, s katerimi bi lahko ocenili učinkovitost in varnost zdravila Symbioflor 2 pri zdravljenju teh bolezni.
No study was submitted to support the indication in the treatment of functional gastrointestinal disorders. 
V podporo indikaciji za zdravljenje funkcionalnih motenj prebavil ni bila predložena nobena študija.
The evaluations presented in the Study Report of Study S2 (1989), based on a primary endpoint of “global evaluation” of efficacy by the investigator at the end of the trial, showed that Symbioflor 2 administered over an 8-week period had better outcomes than placebo on most of the evaluated endpoints. 
Ocene, predstavljene v študijskem poročilu o Študiji S2 (1989) na podlagi primarnega opazovanega dogodka „splošna ocena“ učinkovitosti s strani raziskovalca na koncu preskušanja, so pokazale, da so bili izidi večine ocenjevanih opazovanih dogodkov pri jemanju zdravila Symbioflor 2, ki so ga dajali v osemtedenskem obdobju, boljši kot pri jemanju placeba.
Indication in the treatment of irritable bowel syndrome 
Indikacija za zdravljenje sindroma razdražljivega črevesa
• The CHMP considered that “functional gastrointestinal disorders” is a heterogeneous group of individual diseases with a wide range of different underlying pathophysiologies and symptoms that require different treatment modalities. 
• odbor CHMP je presodil, da so „funkcionalne motnje prebavil“ heterogena skupina posameznih bolezni s širokim razponom različnih osnovnih patofiziologij in simptomov, ki zahtevajo različne načine zdravljenja.
• Considering available safety data from the clinical trial and post-marketing experience with Symbioflor 2, the CHMP came to the conclusion that the demonstrated risks were overall low. 
• z upoštevanjem razpoložljivih podatkov o varnosti iz kliničnega preskušanja in izkušenj iz obdobja trženja z zdravilom Symbioflor 2 je odbor CHMP sklenil, da so dokazana tveganja na splošno nizka.
The value of an observational study for substantiating the efficacy of the product in this patient population is limited and therefore the CHMP concluded that this study could not be regarded as adequately supporting the efficacy of Symbioflor 2 in this age group. 
Vrednost opazovalne študije pri dokazovanju učinkovitosti zdravila v tej populaciji bolnikov je omejena, zato je odbor CHMP zaključil, da ta študija ne more veljati kot ustrezna podpora za učinkovitost zdravila Symbioflor 2 v tej starostni skupini.
Although Study S2 was conducted before requirements of the current IBS guideline “Guideline on the evaluation of medicinal products for the treatment of irritable bowel syndrome” (CPMP/EWP/785/97) or the previous CHMP point to consider on IBS came into force, the original protocol of Study S2 neither defined a primary endpoint nor planned for a statistical analysis. 
Čeprav je bila Študija S2 opravljena, preden so začele veljati zahteve sedanje smernice za sindrom razdražljivega črevesa z naslovom „Smernice za vrednotenje zdravil za zdravljenje sindroma razdražljivega črevesa“ (CPMP/EWP/785/97) ali argument odbora CHMP, ki ga je treba upoštevati pri sindromu razdražljivega črevesa, prvotni protokol Študije S2 ni niti opredelil primarnega opazovanega dogodka niti ni načrtoval statistične analize.
• The CHMP reviewed all available data from clinical studies, published literature, post-marketing experience, including responses and communications submitted by the MAH in writing, on the efficacy and safety of Symbioflor 2 in their proposed indications and sought as well views of the ad hoc expert group on Symbioflor 2; 
• odbor CHMP je pregledal vse razpoložljive podatke iz kliničnih študij, objavljene literature, izkušenj iz obdobja trženja, vključno z odgovori in sporočili, ki jih je pisno predložil imetnik dovoljenja za promet z zdravilom, o učinkovitosti in varnosti zdravila Symbioflor 2 pri predlaganih indikacijah, poleg tega pa je zaprosil tudi za stališča ad hoc strokovne skupine o zdravilu Symbioflor 2;
Additional bias might have been introduced by various other deficiencies encountered in the conduct of Study S2, including the fact that the endpoint was solely based on the rating by the investigator on a weekly basis rather than selfassessed by the patient closer to the administration of Symbioflor 2. 
Do dodatne pristranskosti je morda prišlo zaradi različnih drugih pomanjkljivosti, ki so jih opazili pri izvedbi Študije S2, vključno z dejstvom, da je bil opazovani dogodek utemeljen samo z oceno, ki jo je raziskovalec podajal enkrat tedensko, ne pa z bolnikovo samooceno, ki bi bila časovno bližje dajanju zdravila Symbioflor 2.
This study therefore cannot be considered to contribute to further establishing the safety profile of Symbioflor 2. 
Te študije torej ni mogoče upoštevati kot prispevek k dodatnemu ugotavljanju varnostnega profila zdravila Symbioflor 2.
The CHMP acknowledged the deletion of the indication “functional gastrointestinal disorders” during this procedure. 
Odbor CHMP je med postopkom upošteval izbris indikacije „funkcionalne motnje prebavil“.
The CHMP concluded that this study cannot be regarded as adequately supporting an indication for Symbioflor 2 in this age group. 
Odbor CHMP je zaključil, da ta študija ne more veljati kot ustrezna podpora za indikacijo zdravila Symbioflor 2 v tej starostni skupini.
It is therefore unlikely that post-marketing data will provide significant further information on the safety profile of Symbioflor 2 in the treatment of IBS. 
Zato je malo verjetno, da bodo podatki iz obdobja trženja zagotovili pomembne dodatne informacije o varnostnem profilu zdravila Symbioflor 2 pri zdravljenju sindroma razdražljivega črevesa.
• A 2005 re-analysis of a 1988 study “Efficacy and tolerability of Symbioflor2: A randomised, multicentre, double-blind, placebo-controlled trial in 298 patients with irritable bowel syndrome treated continuously for 8 weeks with Symbioflor 2 (clinical phase IV). 
• leta 2005 opravljena ponovna analiza študije iz leta 1988 „Učinkovitost in prenašanje zdravila Symbioflor 2: randomizirano, multicentrično, dvojno slepo, s placebom nadzorovano preskušanje pri 298 bolnikih s sindromom razdražljivega črevesa, ki so se osem tednov zdravili z zdravilom Symbioflor 2 (klinična faza IV).
Whereas it cannot generally be stated that probiotics are efficacious or not efficacious in the treatment of IBS, it appears that specific probiotic species or strains could potentially be efficacious for specific symptoms of the disease. 
Ni mogoče na splošno reči, da so probiotiki pri zdravljenju sindroma razdražljivega črevesa učinkoviti ali da niso učinkoviti, kaže pa, da so določene probiotične vrste ali sevi potencialno učinkoviti pri določenih simptomih bolezni.
In addition, the CHMP was of the opinion that the adequacy of a global evaluation criterion defined by the MAH for the assessment of the efficacy of Symbioflor 2 in the treatment of IBS was questionable in comparison to the specific, better measurable and less subjective evaluation of changes in stool related abnormalities and pain. 
Poleg tega je odbor CHMP menil, da je primernost merila skupne ocene, ki ga je opredelil imetnik dovoljenja za promet z zdravilom za ocenjevanje učinkovitosti zdravila Symbioflor 2 pri zdravljenju sindroma razdražljivega črevesa, vprašljiva v primerjavi s konkretnim, bolje merljivim in manj subjektivnim ocenjevanjem sprememb nenormalnosti, povezanih z blatom, in bolečine.
From post-marketing experience, only 18 adverse reactions have been reported to Eudravigilance for Symbioflor 2, covering both the treatment of IBS and other functional gastrointestinal disorders despite significant exposure over several decades of marketing and the pharmacovigilance system put in place by the MAH since the early 2000. 
Iz obdobja trženja so v zbirko Eudravigilance poročali samo o 18 neželenih učinkih zdravila Symbioflor 2, ki zajemajo zdravljenje sindroma razdražljivega črevesa in drugih funkcionalnih motenj prebavil, kljub precejšnji, večdesetletni izpostavljenosti in sistemu farmakovigilance, ki ga je vzpostavil imetnik dovoljenja za promet z zdravilom kmalu po letu 2000.
Although the results of Study S2 point at a possible efficacy of Symbioflor 2 in the treatment of IBS, a large unexplained heterogeneity was observed among centres in terms of treatment effect and response rate. 
Čeprav rezultati Študije S2 nakazujejo na morebitno učinkovitost zdravila Symbioflor 2 pri zdravljenju sindroma razdražljivega črevesa, so med centri opazili veliko nepojasnjeno heterogenost glede učinka zdravljenja in stopnje odzivnosti.
“Functional gastrointestinal disorders” defines a heterogeneous group of individual diseases, ranging from functional oesophageal, gastric, intestinal, biliary, pancreatic to functional anorectal disorders, with a wide range of different underlying pathophysiologies and symptomatic entities that require different treatment modalities. 
„Funkcionalne motnje prebavil“ so opredeljene kot heterogena skupina posameznih bolezni, od funkcionalnih ezofagealnih, želodčnih, črevesnih, žolčnih, pankreatičnih do funkcionalnih anorektalnih motenj, s širokim obsegom različnih osnovnih patofiziologij in simptomatskih stanj, ki zahtevajo različne načine zdravljenja.
In 2005, based on the evaluation of the available evidence at that time in the claimed indications ("functional gastrointestinal disorders'', "irritable bowel syndrome"), the application was refused by the German National Competent Authority on the ground that a positive benefit-risk had not been adequately established. 
Leta 2005 je nemški pristojni nacionalni organ na podlagi ovrednotenja razpoložljivih dokazov v tistem času za zahtevane indikacije („funkcionalne motnje prebavil“, „sindrom razdražljivega črevesa“) zavrnil vlogo z utemeljitvijo, da pozitivno razmerje med tveganji in koristmi ni bilo dokazano v zadostni meri.
No adverse events were reported in the observational study conducted in children and adolescents. 
Iz opazovalne študije pri otrocih in mladostnikih niso poročali o nobenih neželenih učinkih.
The CHMP agreed with the MAH's proposal to amend the product information to include the information of this review and concluded that, considering its long presence on the market with limited adverse drug reactions reporting, the safety profile of Symbioflor 2 is generally expected to be benign. 
Odbor CHMP se je strinjal s predlogom imetnika dovoljenja za promet z zdravilom, da spremeni informacije o zdravilu in vanje vključi informacije tega pregleda, in zaključil, da se glede na dolgoletno prisotnost na trgu z omejenim poročanjem o neželenih učinkih na splošno pričakuje sorazmerno benigen varnostni profil zdravila Symbioflor 2.
The CHMP recommends amendments to the product information and in view of the limitations of the currently available efficacy data for Symbioflor2 in the treatment of irritable bowel syndrome (IBS), the CHMP is of the view that a post-authorisation efficacy study should be conducted. 
Odbor CHMP priporoča spremembe informacij o zdravilu in v luči omejitev trenutno razpoložljivih podatkov o učinkovitosti zdravila Symbioflor 2 pri zdravljenju sindroma razdražljivega črevesa meni, da je treba opraviti študijo učinkovitosti po pridobitvi dovoljenja.
The CHMP therefore concluded that the possibility that significant bias had compromised the validity of the results of this study could not be ruled out. 
Odbor CHMP je zato zaključil, da ni mogoče izključiti možnosti, da je veljavnost rezultatov te študije ogrožena zaradi pomembne pristranskosti.
• Regulation of the immune system, gastrointestinal disorders, irritable bowel syndrome (DE). 
• uravnavanje imunskega sistema, prebavne motnje, sindrom razdražljivega črevesa (DE);
In the absence of relevant data submitted by the MAH and in view of the uncertainties about proof of efficacy in Study S2, the CHMP concluded that these results cannot be extrapolated from adults to children or to adolescents. 
V odsotnosti ustreznih podatkov, ki bi jih predložil imetnik dovoljenja za promet z zdravilom, in v luči negotovosti o dokazu učinkovitosti v Študiji S2 je odbor CHMP zaključil, da teh rezultatov ni mogoče ekstrapolirati z odraslih na otroke in mladostnike.
• The CHMP was of the opinion that, although the results of Study S2 seemed to suggest possible efficacy of Symbioflor 2 in IBS in adult patients, the possibility that significant bias had been introduced compromising the validity of the results could not be ruled out. 
• odbor CHMP je menil, da čeprav kaže, da rezultati Študije S2 nakazujejo na morebitno učinkovitost zdravila Symbioflor 2 pri sindromu razdražljivega črevesa pri odraslih, ni mogoče izključiti možnosti pomembne pristranskosti, ki ogroža veljavnost rezultatov.
The CHMP acknowledged the MAH's proposal to delete this indication as, in the absence of any data to support the treatment of functional gastrointestinal disorders, a positive benefit-risk balance of Symbioflor 2 could not be established; 
Odbor CHMP je sprejel predlog imetnika dovoljenja za promet z zdravilom, da izbriše to indikacijo, saj v odsotnosti podatkov v podporo zdravljenju funkcionalnih motenj prebavil pozitivnega razmerja med tveganji in koristmi zdravila Symbioflor 2 ni mogoče ugotoviti;
Overall, the evaluations presented by the MAH indicated that the decrease in symptom score was more important in the Symbioflor 2 than in the placebo arm. 
Skupaj so ocene, ki jih je predstavil imetnik dovoljenja za promet z zdravilom, pokazale, da je bilo zmanjšanje simptomov pomembnejše v skupini, ki je jemala zdravilo Symbioflor 2, kot v skupini, ki je jemala placebo.
In the absence of relevant data submitted by the MAH to support the paediatric use and in view of the uncertainties about the benefit-risk in Study S2 conducted in adult patients only, the CHMP concluded that extrapolation of the results from adults to children or adolescents was not justified. 
V odsotnosti ustreznih predloženih podatkov, ki bi jih predložil imetnik dovoljenja za promet z zdravilom, v podporo pediatrični uporabi in zaradi negotovosti glede razmerja med tveganji in koristmi v Študiji S2, izvedeni samo pri odraslih bolnikih, je odbor CHMP zaključil, da ekstrapolacija rezultatov z odraslih na otroke ali mladostnike ni utemeljena.
In this regards, the SmPC is amended to reflect that efficacy in children has not been established; 
V tem smislu se popravi povzetek glavnih značilnosti zdravila tako, da navaja, da učinkovitost pri otrocih ni bila ugotovljena;
• Functional disturbances of the gastrointestinal tract and irritable bowel syndrome (Colon irritable) (AT). 
• funkcionalne motnje prebavil in sindrom razdražljivega črevesa (iritabilni kolon) (AT);
In summary, in the absence of valid statistical evaluation and given the risk of bias and the paucity of elements contributing to support the robustness and the strength of the results (the evidence being based on a single pivotal trial), the CHMP was not able to confidently draw a conclusion with regards to the efficacy of Symbioflor 2 in IBS or a sub-type of IBS. 
Če povzamemo, v odsotnosti veljavnega statističnega ovrednotenja in glede na tveganje za pristranskost in pomanjkanje elementov, ki bi prispevali k podpori robustnosti in moči rezultatov (ker dokazi temeljijo na enem samem ključnem preskušanju), odbor CHMP ni mogel oblikovati zanesljivega sklepa o učinkovitosti zdravila Symbioflor 2 pri sindromu razdražljivega črevesa ali podtipu sindroma razdražljivega črevesa.
In the clinical development program, there were respectively 50 adverse drug reactions reported in the Symbioflor 2 group, and 44 in the placebo group for Study S2 in 79 patients. 
V programu kliničnega razvoja so iz Študije S2 pri 79 bolnikih poročali o 50 neželenih učinkih v skupini, ki je prejemala zdravilo Symbioflor 2, in o 44 neželenih učinkih v skupini, ki je prejemala placebo.
• Acknowledging the limitations of the established efficacy profile of Symbioflor 2, the CHMP requested the MAH to conduct a well-designed and adequately powered multi-centre, double blind, randomised, placebo controlled post approval efficacy study allowing for relevant subpopulation analyses to confirm the efficacy of Symbioflor 2 in the treatment of IBS in general versus subtypes of the disease such as IBS C and IBS D, gender, disease severity and address the sustainability of efficacy to confirm the efficacy of Symbioflor 2 in IBS; 
• S priznavanjem omejitev ugotovljenega varnostnega profila zdravila Symbioflor 2 je odbor CHMP zahteval, da imetnik dovoljenja za promet z zdravilom opravi dobro zasnovano multicentrično, dvojno slepo, randomizirano, s placebom nadzorovano študijo učinkovitosti po odobritvi z zadostno statistično močjo, ki bo omogočila primerne analize podpopulacij za potrditev učinkovitosti zdravila Symbioflor 2 pri zdravljenju sindroma razdražljivega črevesa na splošno v primerjavi s podtipi bolezni, kot so sindrom razdražljivega črevesa C in D, spol, resnost bolezni, ter preučila trajnost učinkovitosti za potrditev učinkovitosti zdravila Symbioflor 2 pri sindromu razdražljivega črevesa;
Furthermore, the CHMP requested that the MAH conduct a well-designed and adequately powered multi-centre, double blind, randomised, placebo controlled post approval efficacy study allowing for relevant subpopulation analyses to assess the efficacy of Symbioflor 2 in the treatment of IBS in general versus subtypes of the disease such as IBS C and IBS D, gender, disease severity and address the sustainability of efficacy to confirm the efficacy of Symbioflor 2 in IBS. 
Nadalje je odbor CHMP zahteval, da imetnik dovoljenja za promet z zdravilom opravi dobro zasnovano multicentrično, dvojno slepo, randomizirano, s placebom nadzorovano študijo učinkovitosti po odobritvi z zadostno statistično močjo, ki bo omogočila primerne analize podpopulacij za oceno učinkovitosti zdravila Symbioflor 2 pri zdravljenju sindroma razdražljivega črevesa na splošno v primerjavi s podtipi bolezni, kot so sindrom razdražljivega črevesa C in D, spol, resnost bolezni, ter preučila trajnost učinkovitosti za potrditev učinkovitosti zdravila Symbioflor 2 pri sindromu razdražljivega črevesa.