TYLOPLUS 20 % BG 20 g/100 g България - български - БАБХ (Българска агенция по безопасност на храните)

tyloplus 20 % bg 20 g/100 g

s.c. crida pharm s.r.l. - Тилмикозин фосфат - прах за перорален разтвор - 20 g/100 g - птици, свине

Opdivo Европейски съюз - български - EMA (European Medicines Agency)

opdivo

bristol-myers squibb pharma eeig - nivolumab - melanoma; hodgkin disease; carcinoma, renal cell; carcinoma, non-small-cell lung; carcinoma, transitional cell; squamous cell carcinoma of head and neck; urologic neoplasms; mesothelioma; colorectal neoplasms - Антинеопластични средства - melanomaopdivo as monotherapy or in combination with ipilimumab is indicated for the treatment of advanced (unresectable or metastatic) melanoma in adults and adolescents 12 years of age and older. relative to nivolumab monotherapy, an increase in progression free survival (pfs) and overall survival (os) for the combination of nivolumab with ipilimumab is established only in patients with low tumour pd-l1 expression. adjuvant treatment of melanomaopdivo as monotherapy is indicated for the adjuvant treatment of adults and adolescents 12 years of age and older with melanoma with involvement of lymph nodes or metastatic disease who have undergone complete resection. non-small cell lung cancer (nsclc)opdivo in combination with ipilimumab and 2 cycles of platinum-based chemotherapy is indicated for the first-line treatment of metastatic non-small cell lung cancer in adults whose tumours have no sensitising egfr mutation or alk translocation. opdivo as monotherapy is indicated for the treatment of locally advanced or metastatic non-small cell lung cancer after prior chemotherapy in adults. neoadjuvant treatment of nsclcopdivo in combination with platinum-based chemotherapy is indicated for the neoadjuvant treatment of resectable non-small cell lung cancer at high risk of recurrence in adult patients whose tumours have pd-l1 expression ≥ 1%. malignant pleural mesothelioma (mpm)opdivo in combination with ipilimumab is indicated for the first-line treatment of adult patients with unresectable malignant pleural mesothelioma. neoadjuvant treatment of nsclcopdivo in combination with platinum-based chemotherapy is indicated for the neoadjuvant treatment of resectable non-small cell lung cancer at high risk of recurrence in adult patients whose tumours have pd-l1 expression ≥ 1%. renal cell carcinoma (rcc)opdivo as monotherapy is indicated for the treatment of advanced renal cell carcinoma after prior therapy in adults. opdivo in combination with ipilimumab is indicated for the first-line treatment of adult patients with intermediate/poor risk advanced renal cell carcinoma. opdivo in combination with cabozantinib is indicated for the first-line treatment of adult patients with advanced renal cell carcinoma. classical hodgkin lymphoma (chl)opdivo as monotherapy is indicated for the treatment of adult patients with relapsed or refractory classical hodgkin lymphoma after autologous stem cell transplant (asct) and treatment with brentuximab vedotin. squamous cell cancer of the head and neck (scchn)opdivo as monotherapy is indicated for the treatment of recurrent or metastatic squamous cell cancer of the head and neck in adults progressing on or after platinum based therapy. urothelial carcinomaopdivo as monotherapy is indicated for the treatment of locally advanced unresectable or metastatic urothelial carcinoma in adults after failure of prior platinum containing therapy. adjuvant treatment of urothelial carcinomaopdivo as monotherapy is indicated for the adjuvant treatment of adults with muscle invasive urothelial carcinoma (miuc) with tumour cell pd-l1 expression ≥ 1%, who are at high risk of recurrence after undergoing radical resection of miuc. mismatch repair deficient (dmmr) or microsatellite instability-high (msi-h) colorectal cancer (crc)opdivo in combination with ipilimumab is indicated for the treatment of adult patients with mismatch repair deficient or microsatellite instability-high metastatic colorectal cancer after prior fluoropyrimidine based combination chemotherapy. oesophageal squamous cell carcinoma (oscc)opdivo in combination with ipilimumab is indicated for the first-line treatment of adult patients with unresectable advanced, recurrent or metastatic oesophageal squamous cell carcinoma with tumour cell pd-l1 expression ≥ 1%. opdivo in combination with fluoropyrimidine- and platinum-based combination chemotherapy is indicated for the first-line treatment of adult patients with unresectable advanced, recurrent or metastatic oesophageal squamous cell carcinoma with tumour cell pd-l1 expression ≥ 1%. opdivo as monotherapy is indicated for the treatment of adult patients with unresectable advanced, recurrent or metastatic oesophageal squamous cell carcinoma after prior fluoropyrimidine- and platinum-based combination chemotherapy. adjuvant treatment of oesophageal or gastro-oesophageal junction cancer (oc or gejc)opdivo as monotherapy is indicated for the adjuvant treatment of adult patients with oesophageal or gastro-oesophageal junction cancer who have residual pathologic disease following prior neoadjuvant chemoradiotherapy. gastric, gastro‑oesophageal junction (gej) or oesophageal adenocarcinomaopdivo in combination with fluoropyrimidine- and platinum-based combination chemotherapy is indicated for the first‑line treatment of adult patients with her2‑negative advanced or metastatic gastric, gastro‑oesophageal junction or oesophageal adenocarcinoma whose tumours express pd-l1 with a combined positive score (cps) ≥ 5.

Jorveza Европейски съюз - български - EMA (European Medicines Agency)

jorveza

dr. falk pharma gmbh - Будезонидом - Болести на хранопровода - Антидиариен средства, причинителите на чревни противовъзпалителни / antiinfective - jorveza е показан за лечение на еозинофилен езофагит (eoe) при възрастни (на възраст над 18 години).

Angiox Европейски съюз - български - EMA (European Medicines Agency)

angiox

the medicines company uk ltd - Бивалирудин - Остър коронарен синдром - Антитромботични агенти - angiox включен като антикоагуланти при възрастни пациенти, подложени на чрескожное коронарна интервенция (ЧКВ), включително и при пациенти с st-сегмента височина на инфаркт на миокарда (stemi) минавайки през първичния ЧКВ. angiox също така е показан за лечение на възрастни пациенти с нестабилна стенокардия / липса на сегмента st инфарктом на миокарда (eli / ОИМ без вдигане на st сегмент), планирани за спешно или ранна интервенция. angiox трябва да предпише аспирин и клопидогрел.

Lonsurf Европейски съюз - български - EMA (European Medicines Agency)

lonsurf

les laboratoires servier - trifluridine, tipiracil хидрохлорид - Колоректални неоплазми - Антинеопластични средства - colorectal cancerlonsurf is indicated in combination with bevacizumab for the treatment of adult patients with metastatic colorectal cancer (crc) who have received two prior anticancer treatment regimens including fluoropyrimidine-, oxaliplatin- and irinotecan-based chemotherapies, anti-vegf agents, and/or anti-egfr agents. lonsurf is indicated as monotherapy for the treatment of adult patients with metastatic colorectal cancer (crc) who have been previously treated with, or are not considered candidates for, available therapies including fluoropyrimidine-, oxaliplatin- and irinotecan-based chemotherapies, anti-vegf agents, and anti egfr agentsgastric cancerlonsurf is indicated as monotherapy for the treatment of adult patients with metastatic gastric cancer including adenocarcinoma of the gastroesophageal junction, who have been previously treated with at least two prior systemic treatment regimens for advanced disease.

Amgevita Европейски съюз - български - EMA (European Medicines Agency)

amgevita

amgen europe b.v. - адалимумаб - arthritis, psoriatic; colitis, ulcerative; arthritis, juvenile rheumatoid; spondylitis, ankylosing; psoriasis; crohn disease; arthritis, rheumatoid - Имуносупресори - rheumatoid arthritis  amgevita in combination with methotrexate, is indicated for: , the treatment of moderate to severe, active rheumatoid arthritis in adult patients when the response to disease-modifying anti-rheumatic drugs including methotrexate has been inadequate. лечение на тежък активен и прогресивното ревматоиден артрит при възрастни, не по-рано лекувани с метотрексат. ,  amgevita can be given as monotherapy in case of intolerance to methotrexate or when continued treatment with methotrexate is inappropriate. amgevita намалява скоростта на прогресия на увреждане на ставите как се измерва с рентгенови и подобрява физическите функции, при назначаването в комбинация с метотрексат. juvenile idiopathic arthritis polyarticular juvenile idiopathic arthritis amgevita in combination with methotrexate is indicated for the treatment of active polyarticular juvenile idiopathic arthritis, in patients from the age of 2 years who have had an inadequate response to one or more disease-modifying anti-rheumatic drugs (dmards). amgevita може да бъде дадено като монотерапии в случай на непоносимост към метотрексат или при продължително лечение с метотрексат е неподходящо (при ефективност в монотерапии виж раздел 5. Адалимумаб не е проучена обстойно при пациенти на възраст по-малко от 2 години. enthesitis-related arthritis amgevita is indicated for the treatment of active enthesitis-related arthritis in patients, 6 years of age and older, who have had an inadequate response to, or who are intolerant of, conventional therapy (see section 5. axial spondyloarthritis ankylosing spondylitis (as) amgevita is indicated for the treatment of adults with severe active ankylosing spondylitis who have had an inadequate response to conventional therapy. axial spondyloarthritis without radiographic evidence of as amgevita is indicated for the treatment of adults with severe axial spondyloarthritis without radiographic evidence of as but with objective signs of inflammation by elevated crp and/or mri, who have had an inadequate response to, or are intolerant to non-steroidal anti-inflammatory drugs. psoriatic arthritis amgevita is indicated for the treatment of active and progressive psoriatic arthritis in adults when the response to previous disease-modifying anti-rheumatic drug therapy has been inadequate. amgevita намалява скоростта на прогресия на периферната ставите, измерена с помощта на рентген при пациенти с полиартикулярным вариант симетрични подтипове на заболяване (виж раздел 5. 1) и подобрява физическите функции. psoriasis amgevita is indicated for the treatment of moderate to severe chronic plaque psoriasis in adult patients who are candidates for systemic therapy. paediatric plaque psoriasis amgevita is indicated for the treatment of severe chronic plaque psoriasis in children and adolescents from 4 years of age who have had an inadequate response to or are inappropriate candidates for topical therapy and phototherapies. hidradenitis suppurativa (hs) amgevita is indicated for the treatment of active moderate to severe hidradenitis suppurativa (acne inversa) in adults and adolescents from 12 years of age with an inadequate response to conventional systemic hs therapy (see sections 5. 1 и 5. crohn’s disease amgevita is indicated for treatment of moderately to severely active crohn’s disease, in adult patients who have not responded despite a full and adequate course of therapy with a corticosteroid and/or an immunosuppressant; or who are intolerant to or have medical contraindications for such therapies. paediatric crohn's disease amgevita is indicated for the treatment of moderately to severely active crohn's disease in paediatric patients (from 6 years of age) who have had an inadequate response to conventional therapy including primary nutrition therapy and a corticosteroid and/or an immunomodulator, or who are intolerant to or have contraindications for such therapies. ulcerative colitis amgevita is indicated for treatment of moderately to severely active ulcerative colitis in adult patients who have had an inadequate response to conventional therapy including corticosteroids and 6-mercaptopurine (6-mp) or azathioprine (aza), or who are intolerant to or have medical contraindications for such therapies. uveitis amgevita is indicated for the treatment of non-infectious intermediate, posterior and panuveitis in adult patients who have had an inadequate response to corticosteroids, in patients in need of corticosteroid-sparing, or in whom corticosteroid treatment is inappropriate. paediatric uveitis amgevita is indicated for the treatment of paediatric chronic non-infectious anterior uveitis in patients from 2 years of age who have had an inadequate response to or are intolerant to conventional therapy, or in whom conventional therapy is inappropriate.

Imraldi Европейски съюз - български - EMA (European Medicines Agency)

imraldi

samsung bioepis nl b.v. - адалимумаб - spondylitis, ankylosing; arthritis, rheumatoid; uveitis; colitis, ulcerative; psoriasis; arthritis, psoriatic; crohn disease; hidradenitis suppurativa; arthritis - Имуносупресори - Ревматоиден arthritisimraldi в комбинация с метотрексат е показан за лечение на умерен до тежък, активен ревматоиден артрит при възрастни пациенти, когато отговорът към болест-модифициращи противоревматических медикаменти, включително метотрексат, е неадекватен. лечение на тежък активен и прогресивното ревматоиден артрит при възрастни, не по-рано лекувани с метотрексат. imraldi може да бъде дадено като монотерапии в случай на непоносимост към метотрексат или при продължително лечение с метотрексат е неподходящо. Адалимумаб, както е показано, за да се намали скоростта на прогресия на увреждане на ставите как се измерва с рентгенови и подобряване на физическата функция при назначаването в комбинация с метотрексат. juvenile idiopathic arthritispolyarticular juvenile idiopathic arthritisimraldi in combination with methotrexate is indicated for the treatment of active polyarticular juvenile idiopathic arthritis, in patients from the age of 2 years who have had an inadequate response to one or more disease-modifying anti-rheumatic drugs (dmards). imraldi can be given as monotherapy in case of intolerance to methotrexate or when continued treatment with methotrexate is inappropriate (for the efficacy in monotherapy see section 5. Адалимумаб не е проучена обстойно при пациенти на възраст по-малко от 2 години. enthesitis-related arthritisimraldi is indicated for the treatment of active enthesitis-related arthritis in patients, 6 years of age and older, who have had an inadequate response to, or who are intolerant of, conventional therapy (see section 5. axial spondyloarthritisankylosing spondylitis (as)imraldi is indicated for the treatment of adults with severe active ankylosing spondylitis who have had an inadequate response to conventional therapy. axial spondyloarthritis without radiographic evidence of asimraldi is indicated for the treatment of adults with severe axial spondyloarthritis without radiographic evidence of as but with objective signs of inflammation by elevated crp and / or mri, who have had an inadequate response to, or are intolerant to non-steroidal anti-inflammatory drugs (nsaids). Псориатичен arthritisimraldi е показан за лечение на активна и прогресивното псориатичен артрит при възрастни, когато в отговор на предишния заболевани-дорабатывая анти-ревматични лекарства терапия е неадекватна.. adalimumab has been shown to reduce the rate of progression of peripheral joint damage as measured by x-ray in patients with polyarticular symmetrical subtypes of the disease (see section 5. 1) и за подобряване на физическата функция. psoriasisimraldi е показан за лечение на умерена до тежка хронична плака псориазис при възрастни пациенти, които са кандидати за системната терапия. Детска плака psoriasisimraldi е показан за лечение на тежки форми на хронични бляшечного на псориазис при деца и юноши от 4-те години, които са имали недостатъчен отговор или неподходящи кандидати за локално лечение и phototherapies. hidradenitis suppurativa (hs)imraldi is indicated for the treatment of active moderate to severe hidradenitis suppurativa (acne inversa) in adults and adolescents from 12 years of age with an inadequate response to conventional systemic hs therapy (see sections 5. 1 и 5. Крон diseaseimraldi е показан за лечение на ревматоиден болест на Крон, при възрастни пациенти, които не е отговорено, въпреки пълен и адекватен курс на лечение с кортикостероиди и/или иммунодепрессанты; или които не понасят или имат медицински противопоказания за такава терапия. paediatric crohn's diseaseimraldi is indicated for the treatment of moderately to severely active crohn's disease in paediatric patients (from 6 years of age) who have had an inadequate response to conventional therapy including primary nutrition therapy and a corticosteroid and/or an immunomodulator, or who are intolerant to or haveulcerative colitisimraldi is indicated for treatment of moderately to severely active ulcerative colitis in adult patients who have had an inadequate response to conventional therapy including corticosteroids and mercaptopurine (6-mp) or azathioprine (aza), or who are intolerant to or have medical contraindications for such therapies. paediatric ulcerative colitisimraldi is indicated for the treatment of moderately to severely active ulcerative colitis in paediatric patients (from 6 years of age) who have had an inadequate response to conventional therapy including corticosteroids and/or 6-mercaptopurine (6-mp) or azathioprine (aza), or who are intolerant to or have medical contraindications for such therapies. uveitisimraldi is indicated for the treatment of non-infectious intermediate, posterior and panuveitis in adult patients who have had an inadequate response to corticosteroids, in patients in need of corticosteroidsparing, or in whomcorticosteroid treatment is inappropriate. paediatric uveitisimraldi is indicated for the treatment of paediatric chronic non-infectious anterior uveitis in patients from 2 years of age who have had an inadequate response to or are intolerant to conventional therapy, or in whom conventional therapy is inappropriate.

Tecentriq Европейски съюз - български - EMA (European Medicines Agency)

tecentriq

roche registration gmbh - atezolizumab - carcinoma, transitional cell; carcinoma, non-small-cell lung; urologic neoplasms; breast neoplasms; small cell lung carcinoma - Антинеопластични средства - urothelial carcinomatecentriq as monotherapy is indicated for the treatment of adult patients with locally advanced or metastatic urothelial carcinoma (uc):- after prior platinum containing chemotherapy, or - who are considered cisplatin ineligible, and whose tumours have a pd-l1 expression ≥ 5% (see section 5. non-small cell lung cancer tecentriq, in combination with bevacizumab, paclitaxel and carboplatin, is indicated for the first-line treatment of adult patients with metastatic non-squamous non small cell lung cancer (nsclc). in patients with egfr mutant or alk-positive nsclc, tecentriq, in combination with bevacizumab, paclitaxel and carboplatin, is indicated only after failure of appropriate targeted therapies (see section 5. tecentriq, in combination with nab paclitaxel and carboplatin, is indicated for the first line treatment of adult patients with metastatic non-squamous nsclc who do not have egfr mutant or alk positive nsclc (see section 5. tecentriq as monotherapy is indicated for the first-line treatment of adult patients with metastatic non-small cell lung cancer (nsclc) whose tumours have a pd-l1 expression ≥ 50% tumour cells (tc) or ≥ 10% tumour-infiltrating immune cells (ic) and who do not have egfr mutant or alk-positive nsclc (see section 5. tecentriq като монотерапии е предназначен за лечение на възрастни пациенти с локално-напреднал или метастазирал НМРЛ след като по-рано химиотерапия. patients with egfr mutant or alk positive nsclc should also have received targeted therapies before receiving tecentriq (see section 5. small cell lung cancertecentriq, in combination with carboplatin and etoposide, is indicated for the first-line treatment of adult patients with extensive-stage small cell lung cancer (es-sclc) (see section 5. hepatocellular carcinomatecentriq, in combination with bevacizumab, is indicated for the treatment of adult patients with advanced or unresectable hepatocellular carcinoma (hcc) who have not received prior systemic therapy (see section 5. urothelial carcinomatecentriq as monotherapy is indicated for the treatment of adult patients with locally advanced or metastatic urothelial carcinoma (uc):- after prior platinum containing chemotherapy, or- who are considered cisplatin ineligible, and whose tumours have a pd-l1 expression ≥ 5% (see section 5. non-small cell lung cancertecentriq as monotherapy is indicated for the first-line treatment of adult patients with metastatic non-small cell lung cancer (nsclc) whose tumours have a pd-l1 expression ≥ 50% tumour cells (tc) or ≥ 10% tumour-infiltrating immune cells (ic) and who do not have egfr mutant or alk-positive nsclc (see section 5. tecentriq като монотерапии е предназначен за лечение на възрастни пациенти с локално-напреднал или метастазирал НМРЛ след като по-рано химиотерапия. patients with egfr mutant or alk positive nsclc should also have received targeted therapies before receiving tecentriq (see section 5. triple-negative breast cancertecentriq in combination with nab-paclitaxel is indicated for the treatment of adult patients with unresectable locally advanced or metastatic triple-negative breast cancer (tnbc) whose tumours have pd-l1 expression ≥ 1% and who have not received prior chemotherapy for metastatic disease.

Hefiya Европейски съюз - български - EMA (European Medicines Agency)

hefiya

sandoz gmbh - адалимумаб - spondylitis, ankylosing; hidradenitis suppurativa; psoriasis; arthritis, juvenile rheumatoid; uveitis - Имуносупресори - Ревматоиден arthritishefiya в комбинация с метотрексат е показан за лечение на умерен до тежък, активен ревматоиден артрит при възрастни пациенти, когато отговорът към болест-модифициращи противоревматических медикаменти, включително метотрексат, е неадекватен. лечение на тежък активен и прогресивното ревматоиден артрит при възрастни, не по-рано лекувани с метотрексат. hefiya може да бъде дадено като монотерапии в случай на непоносимост към метотрексат или при продължително лечение с метотрексат е неподходящо. Адалимумаб, както е показано, за да се намали скоростта на прогресия на увреждане на ставите как се измерва с рентгенови и подобряване на физическата функция при назначаването в комбинация с метотрексат. arthritispolyarticular младежката идиопатична младежката идиопатична артрит hefiya в комбинация с метотрексат е показан за лечение на активна ювенильного идиопатического артрит при пациенти на възраст 2 години, които е бил недостатъчен отговор на един или няколко заболевани-дорабатывая анти-ревматични лекарства (dmards). hefiya може да бъде дадено като монотерапии в случай на непоносимост към метотрексат или при продължително лечение с метотрексат е неподходящо (при ефективност в монотерапии виж раздел 5. Адалимумаб не е проучена обстойно при пациенти на възраст по-малко от 2 години. Артрит, асоцииран с энтезитом hefiya е показан за лечение на активна артрит, асоцииран с энтезитом при пациенти на възраст 6 години и по-възрастни, които са имали недостатъчен отговор или непоносимост към традиционна терапия (виж раздел 5. Аксиален spondyloarthritisankylosing спондилитом (АС) hefiya е показан за лечение на възрастни пациенти с тежък активен анкилозирующим спондилитом, при които е бил недостатъчен отговор към традиционната терапия. Аксиальный спондилит без рентгенологических признаци като hefiya е показан за лечение на възрастни и деца с тежка аксиальный спондилит без рентгенологических признаци, но обективните признаци на възпаления, повишаване на нивата на crp и / или ядрено-магнитен резонанс, които са имали недостатъчен отговор или непоносимост към нестероидни противовъзпалителни лекарства. Псориатичен arthritishefiya е показан за лечение на активна и прогресивното псориатичен артрит при възрастни, когато в отговор на предишния заболевани-дорабатывая анти-ревматични лекарства терапия е неадекватна.. Адалимумаб, както е показано, за да се намали скоростта на прогресия на периферната ставите, измерена с помощта на рентген при пациенти с полиартикулярным вариант симетрични подтипове на заболяване (виж раздел 5. 1) и за подобряване на физическата функция. psoriasishefiya е показан за лечение на умерена до тежка хронична плака псориазис при възрастни пациенти, които са кандидати за системната терапия. Детска плака psoriasishefiya е показан за лечение на тежки форми на хронични бляшечного на псориазис при деца и юноши от 4-те години, които са имали недостатъчен отговор или неподходящи кандидати за локално лечение и phototherapies. Детска плака psoriasishefiya е показан за лечение на тежки форми на хронични бляшечного на псориазис при деца и юноши от 4-те години, които са имали недостатъчен отговор или неподходящи кандидати за локално лечение и phototherapies. Основен клиничен отговор (tos)hefiya е показан за лечение на умерени или тежки активен основен клиничен отговор (акне Инверса) при възрастни и юноши на 12-годишна възраст с неадекватен отговор на обичайната система yt терапия. Крон diseasehefiya се предписват за лечение на умерено или силно активна на болестта на Крон при възрастни пациенти, които не е отговорено, въпреки пълен и адекватен курс на лечение с кортикостероиди и / или иммунодепрессанты; или които не понасят или имат медицински противопоказания за такава терапия. Педиатрични на Крон diseasehefiya се предписват за лечение на умерено или силно активна болест на Крон педиатрични пациенти (от 6 години), които са били в неадекватном отговор на традиционна терапия, включително и на основна храна и терапия с кортикостероиди и / или имуномодулатор, или които са с непоносимост или противопоказания за такава терапия. paediatric ulcerative colitishefiya is indicated for the treatment of moderately to severely active ulcerative colitis in paediatric patients (from 6 years of age) who have had an inadequate response to conventional therapy including corticosteroids and/or 6-mercaptopurine (6-mp) or azathioprine (aza), or who are intolerant to or have medical contraindications for such therapies.  ulcerative colitis hefiya is indicated for treatment of moderately to severely active ulcerative colitis in adult patients who have had an inadequate response to conventional therapy including corticosteroids and 6-mercaptopurine (6-mp) or azathioprine (aza), or who are intolerant to or have medical contraindications for such therapies.  uveitis hefiya is indicated for the treatment of non-infectious intermediate, posterior and panuveitis in adult patients who have had an inadequate response to corticosteroids, in patients in need of corticosteroid-sparing, or in whom corticosteroid treatment is inappropriate.  paediatric uveitis hefiya is indicated for the treatment of paediatric chronic non-infectious anterior uveitis in patients from 2 years of age who have had an inadequate response to or are intolerant to conventional therapy, or in whom conventional therapy is inappropriate.