Care Gaps in Pancreatic Enzyme Replacement Therapy: A Survey of Real-World Practice Patterns in the United States.

Abstract

Objectives: To describe real-world clinical practice patterns among U.S.-based healthcare providers (HCPs) regarding the use of pancreatic enzyme replacement therapy (PERT) in the management of exocrine pancreatic insufficiency (EPI).

Methods: A cross-sectional, online, double-blinded survey was conducted among a panel of HCPs, including physicians, nurse practitioners, and physician assistants, with ≥3 years of experience treating EPI and recent PERT prescribing activity. The survey collected de-identified data on HCP demographics, aggregated patient characteristics, PERT prescribing patterns, and follow-up practices. Descriptive statistics were used to summarize the data.

Results: Of the 354 HCPs screened, 250 completed the survey. Participants were mainly physicians (88%), predominantly in private practice (69%), with an average of 20 years of clinical experience. Initial PERT doses prescribed were <30,000 lipase units (LU) per meal (12%), 30,000-59,000 LU/meal (58%), and ≥60,000 LU/meal (14%). Only 60% of HCPs included snack dosing instructions, and follow-up for dose titration occurred most frequently at one month post-initiation (60%). PERT underdosing and omitted dosing instructions for snacks were common.

Conclusion: Real-world PERT prescribing for EPI in the U.S. frequently falls short of guideline-recommended dosing and follow-up is often delayed. Providing patients with instructions snack dosing and early reassessment represent gaps in EPI care, underscoring the importance of HCP training and education to optimize outcomes of EPI treatment.