Managing
EPI

EPI is a manageable condition1,2

Although Exocrine Pancreatic Insufficiency (EPI) may be a chronic condition, it can be managed. Once an EPI diagnosis has been made, there are a number of things to consider regarding a management plan.

Comprehensive EPI management plan1,3-5

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PERT

  • Pancreatic enzyme replacement therapies (PERTs) are the standard of care for EPI treatment
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Lifestyle modifications

  • Eating a well-balanced diet
  • Avoiding or limiting alcohol intake
  • Smoking cessation
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Vitamin supplements

  • Consider vitamin supplementation, including vitamins A, D, E, and K

PERTs are the standard of care for EPI treatment1,5

PERTs help break down fats, proteins, and carbohydrates so they can be absorbed within the intestines and into the bloodstream.6

PERTs1:

  • Replace pancreatic enzymes in patients with EPI
  • Contain lipase, amylase, and protease

It’s important to remind patients to take PERTs with every meal and snack.3

Dosing PERTs can start with patient weight7

According to Cystic Fibrosis Foundation guidelines, enzyme dosing should begin at 500 lipase units/kg/meal for patients ≥4 years of age.

Example of weight-based dosing of a PERT7*

Patient weight Minimum dose
110 lb (49.9 kg) 24,950 lipase units/meal
160 lb (72.6 kg) 36,300 lipase units/meal
200 lb (90.7 kg) 45,350 lipase units/meal

*Always follow the prescribing information of the product you are prescribing for exact dosing information.

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36% of adult PERT patients are started on a dose meant for a patient weighing <100 lb8†

Source: SHS data (2018-2020), 2020. n=sample of 101,612 non-CF PERT patients with at least 1 PERT script present in a given month observed between April 2018 and April 2020; only non-CF patients aged 18+ included; prescribed lipase units per day based on each patient’s average script size over the 2-year study period.

Source: SHS data (2018-2020), 2020. n=sample of 101,612 non-CF PERT patients with at least 1 PERT script present in a given month observed between April 2018 and April 2020; only non-CF patients aged 18+ included; prescribed lipase units per day based on each patient’s average script size over the 2-year study period.

Individualize and adjust PERT dosage based on7,9:

  • Clinical symptoms
  • Fat content of the diet
  • Degree of steatorrhea

Follow up with patients several days after treatment initiation to discuss symptoms and assess the need for a dose adjustment.7

References: 1. Fieker A, Philpott J, Armand M. Enzyme replacement therapy for pancreatic insufficiency: present and future. Clin Exp Gastroenterol. 2011;4:55-73. 2. Alkaade S, Vareedayah AA. A primer on exocrine pancreatic insufficiency, fat malabsorption, and fatty acid abnormalities. Am J Manag Care. 2017;23(12)(suppl):S203-S209. 3. Domínguez-Muñoz JE. Pancreatic enzyme therapy for pancreatic exocrine insufficiency. Curr Gastroenterol Rep. 2007;9(2):116-122. 4. Lindkvist B. Diagnosis and treatment of pancreatic exocrine insufficiency. World J Gastroenterol. 2013;19(42):7258-7266. 5. Taylor JR, Gardner TB, Waljee AK, DiMagno MJ, Schoenfeld PS. Systematic review: efficacy and safety of pancreatic enzyme supplements for exocrine pancreatic insufficiency. Aliment Pharmacol Ther. 2010;31(1):57-72. doi:10.1111/j.1365-2036.2009.04157.x 6. Pancreatic enzymes. Pancreatic Cancer Action website. https://www.pancan.org/facing-pancreatic-cancer/living-with-pancreatic-cancer/diet-and-nutrition/pancreatic-enzymes/. Accessed December 15, 2020. 7. Use of pancreatic enzyme supplements for patients with cystic fibrosis in the context of fibrosing colonopathy. Cystic Fibrosis Foundation website. https://www.cff.org/uploadedFiles/Content/For_Caregivers/Clinical_Care_Guidelines/Nutrition_and_GI_Clinical_Care_Guidelines/Consensus-Statement-Pancreatic-Enzyme-Replacement-March-1995.pdf. Accessed August 20, 2018. 8. Data on file. AbbVie Inc. Source: SHS data (2018-2020), 2020. 9. Windsor JA. Pancreatic enzyme replacement therapy in chronic pancreatitis: a long way to go. Gut. 2017;66(8):1354-1355.