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EPI is a manageable condition1-4

Once you have made a diagnosis of EPI, a comprehensive management plan should include pancreatic enzyme replacement therapy (PERT), certain lifestyle modifications, and potentially vitamin supplementation. PERT is the standard of care for EPI treatment.

Comprehensive EPI management plan1-4

Once an EPI diagnosis has been made, there are a number of things to consider regarding a management plan.

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PERT

  • 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
Vitamin supplement bottles Vitamin supplement bottles

Vitamin Supplements

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

PERT is the standard of care for EPI treatment2,4

PERTs help break down fats, proteins, and carbohydrates so they can be absorbed within the intestines and into the bloodstream.5

PERTs2:

  • CONTAIN lipase, amylase, and protease
  • REPLACE pancreatic enzymes not produced, secreted, or active in patients with EPI

Tell your EPI patients to take PERT with meals and snacks.1

When dosing PERTs, consider patient weight and adjust dose based on clinical symptoms, degree of steatorrhea, and fat content of the diet6

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

Example of weight-based dosing of PERT6*
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 lb7†

†Source: SHS data (2018-2020), 2020. n=sample of 101,612 non-CF PERT patients with at least 1 PERT script present in 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.

Individualize and adjust PERT dosage based on6,8:

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

Follow up with patients several days after treatment initiation to discuss symptoms and assess the need for a dose adjustment.6

References: 1. Domínguez-Muñoz JE. Pancreatic enzyme therapy for pancreatic exocrine insufficiency. Curr Gastroenterol Rep. 2007;9(2):116-122. 2. Fieker A, Philpott J, Armand M. Enzyme replacement therapy for pancreatic insufficiency: present and future. Clin Exp Gastroenterol. 2011;4:55-73. 3. Lindkvist B. Diagnosis and treatment of pancreatic exocrine insufficiency. World J Gastroenterol. 2013;19(42):7258-7266. 4. 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. 5. Pancreatic Cancer Action Network. Pancreatic enzymes. https://www.pancan.org/facing-pancreatic-cancer/living-with-pancreatic-cancer/diet-and-nutrition/pancreatic-enzymes/#:~:text=Pancreatic%20enzymes%20help%20break%20down,it%20enters%20the%20small%20intestine. Accessed December 15, 2020. 6. Cystic Fibrosis Foundation. Use of Pancreatic Enzyme Supplements for Patients with Cystic Fibrosis in the Context of Fibrosing Colonopathy. Paper presented at the: Consensus Conference; March 23, 1995. Accessed August 20, 2018. 7. Data on file. AbbVie Inc. Source: SHS data (2018-2020), 2020. 8. Windsor JA. Pancreatic enzyme replacement therapy in chronic pancreatitis: a long way to go. Gut. 2017;66(8):1354-1355.