The use of pancreatic enzyme replacement therapy in patients with a diagnosis of chronic pancreatitis and pancreatic cancer in the US is infrequent and inconsistent

Abstract

Background: Patients with chronic pancreatitis or pancreatic cancer commonly develop exocrine pancreatic insufficiency, and may not be adequately treated with pancreatic enzyme replacement therapy (PERT). Aims:To estimate the frequency of diagnostic testing for exocrine insufficiency, and appropriate use of PERT, in a commercially insured population in the US. Methods:We utilised a nationally representative administrative database representing 48.67 million individuals in over 80 US healthcare plans to assess testing for and treatment of exocrine insufficiency in patients who received a diagnosis of chronic pancreatitis (n = 37 061) or pancreatic cancer (n = 32 461) from 2001 to 2013. We identified the details of any testing for exocrine insufficiency and PERT use. We defined appropriate PERT use as a dosage of ≥120 000 USP units of lipase daily. Multiple logistic regression was used to identify predictors of appropriate use of PERT. Results:In patients with chronic pancreatitis, 6.5% had any testing for exocrine insufficiency, 30.4% filled a prescription for PERT, and 8.5% were prescribed an adequate dose. In those with pancreatic cancer, 1.9% had testing for exocrine insufficiency, 21.9% filled a prescription for PERT, and 5.5% were prescribed an adequate dose.Number of comorbidities, testing for exocrine insufficiency, pancreatic surgery and duration of enrolment were independent predictors for use and appropriate dosing. Conclusions:Testing for exocrine insufficiency, and appropriate dosing of PERT in patients with chronic pancreatitis or pancreatic cancer, is infrequent and inconsistent in an insured US population. Efforts are needed to educate medical providers on the best practices for managing exocrine pancreatic insufficiency in these patients. | 959FORSMARK et Al.

Pancreatic exocrine insufficiency and pancreatic enzyme replacement therapy in patients with advanced pancreatic cancer: A systematic review and meta‐analysis

“…While PERT has been shown to increase body weight, quality of life and survival in patients with Heterogeneity: Chi 2 = 1.10, df = 2 (P = 0.58); I 2 = 0% Test for overall effect: Z = 3.49 (P = 0.0005) Heterogeneity: Tau 2 = 1.70, Chi 2 = 2.53, df = 1 (P = 0.11); I 2 = 60% Test for overall effect: Z = 1.41 (P = 0.16) PC, 13,14,29 its use is not widespread. Forsmark et al 35 noticed that only 21.9% of PC patients received PERT and that prescription was adequate in only 5.5%. Similar findings were reported in a study on APC patients from Australia in which only 21% of patients with malabsorption were prescribed PERT.…”

Editorial: management of exocrine pancreatic insufficiency remains a challenge—can we do better?

“…This study 9 emphasises that EPI is not investigated in most PC and CP patients. Furthermore, only a minority of patients received adequate PERT, which can improve outcomes.…”

“…Forsmark et al 9 assessed the use and dosing of PERT in insured US patients with CP or PC from a national administrative database of over 48 million individuals between 2001 and 2013. At least one CP claim was made for 37,061 individuals.…”

Advanced Pancreatic Ductal Adenocarcinoma: Moving Forward

“…Several European studies have reported that many patients receive far less PERT or do not receive PERT at all [69,70]. Recently a retrospective study covering over 80 U.S. healthcare patients showed that only one in five patients with PDAC was prescribed PERT, whereas a minimally effective PERT dosage was prescribed in less than 10% [71].…”