Flexible Dosing Improves Treatment Efficacy of Pancreatic Enzyme Supplementation

Chronic pancreatitis is a leading cause of exocrine pancreatic insufficiency (EPI), a condition characterized by a deficiency in exocrine pancreatic enzymes. A lack of these enzymes impedes digestion, increasing the risk of malnutrition and steatorrhea-related symptoms. In patients with EPI, pancreatic enzyme supplementation can prevent these problems. Although the optimal dose of pancreatic enzymes depends on dietary factors (eg, dietary fat intake) and individual patient factors (eg, clinical symptoms, remaining pancreatic function), many patients are prescribed a fixed dose to improve medication compliance and because healthcare providers are not always informed about the need to supplement exocrine insufficiency in a flexible, patient-tailored manner. During the DDW meeting, researchers from the Netherlands reported that patient education on flexible dosing is an important strategy for improving the odds of patients receiving an optimal dose.

The researchers prospectively evaluated if patient education on flexible dosing improves treatment efficacy in EPI from chronic pancreatitis. The study included 10 patients with EPI (50% male; median age, 53 years) who were using a fixed enzyme dose of one to six capsules daily between August 2010 and October 2012. During phase 1 of the study, which included the first 4 weeks of the trial, study participants continued their normal dosage. On week 5, they received education on flexible dosing and learned how to determine their optimal intake depending on their fat intake and their symptoms of steatorrhea. Patients could vary the number of capsules taken up to a maximum of 16 capsules daily. This flexible regimen was applied in phase 2 of the study, which comprised the last 4 weeks of the trial.

Patients’ fecal fat absorption was measured at the end of both phases of the trial. Their enzyme dose, steatorrhea-related symptoms, and body mass index (BMI) were also assessed at the end of both phases and after 3 and 6 months. Steatorrhea symptoms were assessed using a scoring system that asked participants about their stool frequency, consistency, and stickiness, and whether they had any abdominal cramps or flatulence. The scores ranged from 0 to 8, with more severe symptoms indicated by higher scores.

The researchers found that with flexible dosing, participants’ median fecal fat absorption improved from 87% to 90% (P=.23). The mean enzyme dose increased from three to 10 capsules daily and steatorrhea-related symptoms improved. Both of these effects were significant and persisted. Although BMI did not change during the first 9 weeks, it significantly improved thereafter. Based on these findings, the researchers conclude that flexible dosing should be routinely applied in enzyme supplementation therapy.—Christina T. Loguidice