Unia Europejska - estoński - EMA (European Medicines Agency)

tetris pharma b.v - glucagon - diabeet mellitus - pankrease hormoonid, hormoonid glycogenolytic - ogluo is indicated for the treatment of severe hypoglycaemia in adults, adolescents, and children aged 2 years and over with diabetes mellitus.

Unia Europejska - estoński - EMA (European Medicines Agency)

les laboratoires servier - irinotecan anhydrous free-base - pankrease neoplasmid - antineoplastilised ained - metastaatilise ravi, koos 5-fluorouratsiili (5-fu) ja leukovoriiniga (lv), täiskasvanud patsientidel, kelle haigus pärast gemtsitabiini ravi põhineb ravi.

Unia Europejska - estoński - EMA (European Medicines Agency)

viatris healthcare limited - imikvimod - condylomata acuminata; keratosis; keratosis, actinic; carcinoma, basal cell - antibiootikumid ja kemoterapeutikumid dermatoloogiliseks kasutamiseks - imiquimod cream is indicated for the topical treatment of :external genital and perianal warts (condylomata acuminata) in adults. small superficial basal cell carcinomas (sbccs) in adults. clinically typical, nonhyperkeratotic, nonhypertrophic actinic keratoses (aks) on the face or scalp in immunocompetent adult patients when size or number of lesions limit the efficacy and/or acceptability of cryotherapy and other topical treatment options are contraindicated or less appropriate.

Unia Europejska - estoński - EMA (European Medicines Agency)

teva pharma b.v. - clopidogrel (as hydrogen sulfate) - acute coronary syndrome; peripheral vascular diseases; myocardial infarction; stroke - antitrombootilised ained - sekundaarseks ennetamiseks atherothrombotic eventsclopidogrel on näidustatud:täiskasvanud patsientidel, kes põevad müokardiinfarkt (paar päeva kuni vähem kui 35 päeva), ischaemic insult (7 päeva kuni vähem kui 6 kuud) või väljakujunenud perifeersete arterite haigus. täiskasvanud patsientidel, kes põevad äge koronaarsündroom:- mitte-st-segmendi elevatsiooniga äge koronaarsündroom (ebastabiilne stenokardia või mitte-q-wave müokardiinfarkt), k.a patsiendid toimumas stent paigutuse perkutaanse koronaarse interventsiooni, koos atsetüülsalitsüülhape (asa). - st segmendi elevatsiooniga ägeda müokardi infarkti korral kombinatsioonis asa on meditsiiniliselt ravitud patsientide abikõlblikud trombolüütiline ravi. ennetamine atherothrombotic ja trombembooliliste sündmuste kodade fibrillationin täiskasvanud patsientidel, kellel on kodade virvendus, kes on vähemalt üks riskifaktor veresoonkonna sündmused, ei sobi ravi k-vitamiini antagonistidega (vka) ja kellel on väiksem verejooksu risk, mis on clopidogrel on näidustatud kombinatsioonis asa ennetamise atherothrombotic ja trombembooliliste sündmuste, sealhulgas insult.

Unia Europejska - estoński - EMA (European Medicines Agency)

norton healthcare ltd. - paklitakseel - sarcoma, kaposi; carcinoma, non-small-cell lung; ovarian neoplasms; breast neoplasms - antineoplastilised ained - paxene on näidustatud patsientide raviks:• kaugelearenenud aids-iga seotud kaposi on sarkoom (aids-ks), kes on jätnud enne liposomal anthracycline ravi;• metastaatilise kartsinoomi, rinnanäärme (mbc), kes ei ole suutnud või ei ole kandidaadid standard anthracycline sisaldavad ravi;• kaugelearenenud kartsinoomi on munasarjadele (aoc) või koos ülejäänud haigus (> 1 cm) pärast esialgse laparotoomia, koos cisplatin kui esimese rea ravi;• metastaatilise kartsinoomi on munasarjadele (mop) pärast ebaõnnestumist plaatina sisaldavate kombineeritud ravi ilma taxanes kui teise rea ravi;• mitteväikerakk-kopsu kartsinoomi (mitteväikerakk-kopsuvähi), kes ei ole kandidaadid potentsiaalselt tervendav kirurgia ja/või kiiritusravi, koos cisplatin. piiratud efektiivsuse andmed toetavad seda näidustust (vt lõik 5).

Unia Europejska - estoński - EMA (European Medicines Agency)

sandoz gmbh - adalimumab - arthritis, rheumatoid; arthritis, psoriatic; spondylitis, ankylosing; uveitis; hidradenitis suppurativa; colitis, ulcerative; arthritis, juvenile rheumatoid; crohn disease; skin diseases, papulosquamous - immunosupressandid - rheumatoid arthritishyrimoz 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. - the treatment of severe, active and progressive rheumatoid arthritis in adults not previously treated with methotrexate. hyrimoz saab antud monotherapy juhul, talu metotreksaati või kui jätkuv ravi metotreksaadi on kohatu. adalimumab on näidanud, et vähendada määra progressioon ühise kahju, mida mõõdetakse x-ray ja parandab füüsilist funktsiooni, kui antud koos metotreksaadi. juvenile idiopathic arthritis- polyarticular juvenile idiopathic arthritishyrimoz 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). hyrimoz saab antud monotherapy juhul, talu metotreksaati või kui jätkuv ravi metotreksaadi on kohatu. adalimumab ei ole uuritud patsientidel vanuses alla 2 aastat. - enthesitis-related arthritishyrimoz 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. axial spondyloarthritis- ankylosing spondylitis (as)hyrimoz 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 ashyrimoz 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 nonsteroidal anti-inflammatory drugs. psoriatic arthritishyrimoz 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. adalimumab on näidanud, et vähendada määra progressioon perifeersete ühine kahju, mida mõõdetakse x-ray patsientidel polüartikulaarse sümmeetriline alatüüpide haiguse ja füüsilise funktsiooni parandamiseks. psoriasishyrimoz is indicated for the treatment of moderate to severe chronic plaque psoriasis in adult patients who are candidates for systemic therapy. paediatric plaque psoriasishyrimoz 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)hyrimoz 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. crohn’s diseasehyrimoz 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 diseasehyrimoz 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.  paediatric ulcerative colitishyrimoz 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 colitishyrimoz 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. uveitishyrimoz 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 uveitishyrimoz 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.

Unia Europejska - estoński - EMA (European Medicines Agency)

biontech manufacturing gmbh - single-stranded, 5’-capped messenger rna produced using a cell-free in vitro transcription from the corresponding dna templates, encoding the viral spike (s) protein of sars-cov-2 - covid-19 virus infection - vaktsiinid - comirnaty 30 micrograms/dose concentrate for dispersion for injection is indicated for active immunisation to prevent covid-19 caused by sars-cov-2, in individuals 12 years of age and older.  comirnaty 30 micrograms/dose dispersion for injection is indicated for active immunisation to prevent covid-19 caused by sars-cov-2, in individuals 12 years of age and older.  comirnaty 10 micrograms/dose concentrate for dispersion for injection is indicated for active immunisation to prevent covid-19 caused by sars-cov-2, in children aged 5 to 11 years.  comirnaty 3 micrograms/dose concentrate for dispersion for injection is indicated for active immunisation to prevent covid-19 caused by sars-cov-2, in infants and children aged 6 months to 4 years.  comirnaty original/omicron ba. 1 (15/15 micrograms)/dose dispersion for injection is indicated for active immunisation to prevent covid-19 caused by sars-cov-2, in individuals 12 years of age and older who have previously received at least a primary vaccination course against covid-19. comirnaty original/omicron ba. 4-5 (15/15 micrograms)/dose dispersion for injection is indicated for active immunisation to prevent covid-19 caused by sars-cov-2, in individuals 12 years of age and older. comirnaty original/omicron ba. 4-5 (5/5 micrograms)/dose concentrate for dispersion for injection is indicated for active immunisation to prevent covid-19 caused by sars-cov-2, in children aged 5 to 11 years. comirnaty original/omicron ba. 4-5 (5/5 micrograms)/dose dispersion for injection is indicated for active immunisation to prevent covid-19 caused by sars-cov-2, in children aged 5 to 11 years.  comirnaty original/omicron ba. 4-5 (1. 5/1. 5 micrograms)/dose concentrate for dispersion for injection is indicated for active immunisation to prevent covid-19 caused by sars-cov-2, in infants and children aged 6 months to 4 years.  comirnaty omicron xbb. 5 30 micrograms/dose dispersion for injection is indicated for active immunisation to prevent covid-19 caused by sars-cov-2, in individuals 12 years of age and older. comirnaty omicron xbb. 5 10 micrograms/dose concentrate for dispersion for injection is indicated for active immunisation to prevent covid-19 caused by sars-cov-2, in children aged 5 to 11 years. comirnaty omicron xbb. 5 10 micrograms/dose dispersion for injection is indicated for active immunisation to prevent covid-19 caused by sars-cov-2, in children aged 5 to 11 years. comirnaty omicron xbb. 5 3 micrograms/dose concentrate for dispersion for injection is indicated for active immunisation to prevent covid-19 caused by sars-cov-2, in infants and children aged 6 months to 4 years. kasutamist see vaktsiin peaks olema kooskõlas ametlike soovitustega.

Unia Europejska - estoński - EMA (European Medicines Agency)

hospira uk limited - dotsetakseel trihüdraat - stomach neoplasms; prostatic neoplasms; breast neoplasms; head and neck neoplasms; carcinoma, non-small-cell lung - antineoplastilised ained - rindade cancertaxespira koos doxorubicin ja tsüklofosfamiidiga on näidustatud abiaine ravi patsientidel, kellel on:toimiv node-positiivne rinnanäärmevähk;toimiv node-negatiivne rinnanäärmevähk. patsientidel, kellel on toimiv node-negatiivne rinnanäärmevähk, abiainet ravi peaks olema piiratud, et patsientidel on õigus saada keemiaravi vastavalt rahvusvaheliselt kehtestatud kriteeriumid esmane ravi varajases rinnavähi. taxespira koos doxorubicin on näidustatud ravi patsientidel, kellel on lokaalselt kaugelearenenud või metastaatilise rinnavähi kes ei ole varem saanud tsütotoksilist ravi selle tingimuse. taxespira monotherapy on näidustatud ravi patsientidel, kellel on lokaalselt kaugelearenenud või metastaatilise rinnavähi pärast rikke tsütotoksiline ravi. eelmine keemiaravi peaks sisaldama antratsükliini või alküülivat ainet. taxespira koos trastuzumab on näidustatud ravi metastaatilise rinnavähi, kelle kasvajad üle express her2 ja kes eelnevalt ei ole saanud keemiaravi jaoks metastaatilise haiguse. taxespira koos capecitabine on näidustatud ravi patsientidel, kellel on lokaalselt kaugelearenenud või metastaatilise rinnavähi pärast rikke tsütotoksilist keemiaravi. eelnev ravi peaks sisaldama antratsükliini. non-small cell lung cancer taxespira näidustatud ravi patsientidel, kellel on lokaalselt kaugelearenenud või metastaatilise mitteväikerakk-kopsuvähi pärast rikke enne keemiaravi. taxespira koos cisplatin on näidustatud patsientide raviks unresectable, lokaalselt kaugelearenenud või metastaatilise mitteväikerakk-kopsuvähi raviks patsientidel, kes ei ole varem saanud keemiaravi selle seisukord. eesnäärme vähk taxespira kombinatsioonis prednisooni või prednisolooni on näidustatud patsientide raviks hormoon tulekindlad metastaatilise eesnäärmevähiga. mao adenocarcinoma taxespira koos cisplatin ja 5-fluorouratsiili on näidustatud ravi metastaatilise mao adenocarcinoma, sealhulgas adenocarcinoma kohta gastroesophageal ristmikul, kes ei ole eelnevalt saanud keemiaravi jaoks metastaatilise haiguse. pea ja kaelapiirkonna vähk taxespira koos cisplatin ja 5-fluorouratsiili on näidustatud induktsiooni ravi patsientidel, kellel on lokaalselt kaugelearenenud soomusrakuline kartsinoom pea ja kael.

Unia Europejska - estoński - EMA (European Medicines Agency)

merck sharp & dohme b.v. - pembrolizumab - melanoma; hodgkin disease; carcinoma, renal cell; carcinoma, non-small-cell lung; carcinoma, transitional cell; squamous cell carcinoma of head and neck; urologic neoplasms; endometrial neoplasms - antineoplastilised ained - melanomakeytruda as monotherapy is indicated for the treatment of adults and adolescents aged 12 years and older with advanced (unresectable or metastatic) melanoma. keytruda as monotherapy is indicated for the adjuvant treatment of adults and adolescents aged 12 years and older with stage iib, iic, or with stage iii melanoma and lymph node involvement who have undergone complete resection. non small cell lung carcinoma (nsclc)keytruda as monotherapy is indicated for the adjuvant treatment of adults with non-small cell lung carcinoma who are at high risk of recurrence following complete resection and platinum based chemotherapy (for selection criteria, see section 5. keytruda as monotherapy is indicated for the first line treatment of metastatic non small cell lung carcinoma in adults whose tumours express pd l1 with a ≥ 50% tumour proportion score (tps) with no egfr or alk positive tumour mutations. keytruda, in combination with pemetrexed and platinum chemotherapy, is indicated for the first-line treatment of metastatic non squamous non small cell lung carcinoma in adults whose tumours have no egfr or alk positive mutations. keytruda, in combination with carboplatin and either paclitaxel or nab paclitaxel, is indicated for the first line treatment of metastatic squamous non small cell lung carcinoma in adults. keytruda  as monotherapy is indicated for the treatment of locally advanced or metastatic non small cell lung carcinoma in adults whose tumours express pd l1 with a ≥ 1% tps and who have received at least one prior chemotherapy regimen. patsiendid, kellel on egfr-või kristallimise positiivne kasvaja mutatsioonid peaks ka saanud suunatud ravi enne saanud keytruda. classical hodgkin lymphoma (chl)keytruda as monotherapy is indicated for the treatment of adult and paediatric patients aged 3 years and older with relapsed or refractory classical hodgkin lymphoma who have failed autologous stem cell transplant (asct) or following at least two prior therapies when asct is not a treatment option. urothelial carcinomakeytruda as monotherapy is indicated for the treatment of locally advanced or metastatic urothelial carcinoma in adults who have received prior platinum containing chemotherapy. keytruda as monotherapy is indicated for the treatment of locally advanced or metastatic urothelial carcinoma in adults who are not eligible for cisplatin containing chemotherapy and whose tumours express pd l1 with a combined positive score (cps) ≥ 10. head and neck squamous cell carcinoma (hnscc)keytruda, as monotherapy or in combination with platinum and 5 fluorouracil (5 fu) chemotherapy, is indicated for the first line treatment of metastatic or unresectable recurrent head and neck squamous cell carcinoma in adults whose tumours express pd l1 with a cps ≥ 1. keytruda as monotherapy is indicated for the treatment of recurrent or metastatic head and neck squamous cell carcinoma in adults whose tumours express pd l1 with a ≥ 50% tps and progressing on or after platinum containing chemotherapy. renal cell carcinoma (rcc)keytruda, in combination with axitinib, is indicated for the first line treatment of advanced renal cell carcinoma in adults. keytruda  as monotherapy is indicated for the adjuvant treatment of adults with renal cell carcinoma at increased risk of recurrence following nephrectomy, or following nephrectomy and resection of metastatic lesions (for selection criteria, please see section 5. microsatellite instability high (msi-h) or mismatch repair deficient (dmmr) cancerscolorectal cancer (crc)keytruda as monotherapy is indicated for theadults with msi-h or dmmr colorectal cancer in the following settings:first line treatment of metastatic microsatellite instability high (msi h) or mismatch repair deficient (dmmr) colorectal cancer in adults;treatment of unresectable or metastatic colorectal cancer after previous fluoropyrimidine based combination therapy.  non-colorectal cancerskeytruda as monotherapy is indicated for the treatment of the following msi h or dmmr tumours in adults with:advanced or recurrent endometrial carcinoma, who have disease progression on or following prior treatment with a platinum containing therapy in any setting and who are not candidates for curative surgery or radiation;unresectable or metastatic gastric, small intestine, or biliary cancer, who have disease progression on or following at least one prior therapy. oesophageal carcinomakeytruda, in combination with platinum and fluoropyrimidine based chemotherapy, is indicated for the first-line treatment of locally advanced unresectable or metastatic carcinoma of the oesophagus or her-2 negative gastroesophageal junction adenocarcinoma, in adults whose tumours express pd l1 with a cps ≥ 10. triple negative breast cancer (tnbc)keytruda, in combination with chemotherapy as neoadjuvant treatment, and then continued as monotherapy as adjuvant treatment after surgery, is indicated for the treatment of adults with locally advanced, or early stage triple negative breast cancer at high risk of recurrence. keytruda, in combination with chemotherapy, is indicated for the treatment of locally recurrent unresectable or metastatic triple negative breast cancer in adults whose tumours express pd l1 with a cps ≥ 10 and who have not received prior chemotherapy for metastatic disease. endometrial carcinoma (ec)keytruda, in combination with lenvatinib, is indicated for the treatment of advanced or recurrent endometrial carcinoma in adults who have disease progression on or following prior treatment with a platinum containing therapy in any setting and who are not candidates for curative surgery or radiation. cervical cancerkeytruda, in combination with chemotherapy with or without bevacizumab, is indicated for the treatment of persistent, recurrent, or metastatic cervical cancer in adults whose tumours express pd l1 with a cps ≥ 1. gastric or gastro-oesophageal junction (gej) adenocarcinomakeytruda, in combination with trastuzumab, fluoropyrimidine and platinum-containing chemotherapy, is indicated for the first-line treatment of locally advanced unresectable or metastatic her2-positive gastric or gastro-oesophageal junction adenocarcinoma in adults whose tumours express pd-l1 with a cps ≥ 1.

Unia Europejska - estoński - EMA (European Medicines Agency)

amgen europe b.v. - adalimumab - arthritis, psoriatic; colitis, ulcerative; arthritis, juvenile rheumatoid; spondylitis, ankylosing; psoriasis; crohn disease; arthritis, rheumatoid - immunosupressandid - 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. ravi raske, aktiivse ja progresseeruva reumatoidartriidi raviks täiskasvanutel, mis ei ole varem ravitud metotreksaadi. ,  amgevita can be given as monotherapy in case of intolerance to methotrexate or when continued treatment with methotrexate is inappropriate. amgevita vähendab määra progressioon ühise kahju, mida mõõdetakse x-ray ja parandab füüsilist funktsiooni, kui antud koos metotreksaadi. 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 saab antud monotherapy juhul, talu metotreksaati või kui jätkuv ravi metotreksaadi on kohatu (eest efektiivsuse monotherapy vt lõik 5. adalimumab ei ole uuritud patsientidel vanuses alla 2 aastat. 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 vähendab määra progressioon perifeersete ühine kahju, mida mõõdetakse x-ray patsientidel polüartikulaarse sümmeetriline alatüüpide haigus (vt lõik 5. 1) ja parandab füüsilist funktsiooni. 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 ja 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.