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Delayed release pancrelipase for treatment of pancreatic exocrine insufficiency associated with chronic pancreatitis.

Krishnamurty DM, Rabiee A, Jagannath SB, Andersen DK - Ther Clin Risk Manag (2009)

Bottom Line: In patients with treatment failure, apart from evaluating drug and dietary interactions and compliance, physicians should keep in mind that patients may benefit from switching to a different formulation.There is no current standard test for evaluating adequacy of therapy in CP patients and studies have shown that optimization of therapy based on symptoms may be inadequate.Goals of therapy based on overall patient presentation and specific laboratory tests rather than mere correction of steatorrhea are needed.

View Article: PubMed Central - PubMed

Affiliation: Johns Hopkins University School of Medicine; Department of Medicine.

ABSTRACT
Pancreatic enzyme supplements (PES) are used in chronic pancreatitis (CP) for correction of pancreatic exocrine insufficiency (PEI) as well as pain and malnutrition. The use of porcine pancreatic enzymes for the correction of exocrine insufficiency is governed by the pathophysiology of the disease as well as pharmacologic properties of PES. Variability in bioequivalence of PES has been noted on in vitro and in vivo testing and has been attributed to the differences in enteric coating and the degree of micro-encapsulation. As a step towards standardizing pancreatic enzyme preparations, the Food and Drug Administration now requires the manufacturers of PES to obtain approval of marketed formulations by April 2010. In patients with treatment failure, apart from evaluating drug and dietary interactions and compliance, physicians should keep in mind that patients may benefit from switching to a different formulation. The choice of PES (enteric coated versus non-enteric coated) and the need for acid suppression should be individualized. There is no current standard test for evaluating adequacy of therapy in CP patients and studies have shown that optimization of therapy based on symptoms may be inadequate. Goals of therapy based on overall patient presentation and specific laboratory tests rather than mere correction of steatorrhea are needed.

No MeSH data available.


Related in: MedlinePlus

Plasma glucose (A), plasma insulin (B), and plasma C-peptide (C) concentrations in patients with chronic pancreatitis (CP) and pancreatic exocrine insufficiency (PEI) following ingestion of a liquid meal over 15 min (0–15 min) with pancreatic enzyme substitution (PES; day 1, ▪) and without PES (day 2, □). Punctuated curves (▴) represent healthy control subjects (Ctrl) given an equal liquid meal without PES. Data are mean values ± SE. Insets: AUC values. *Significant difference (p < 0.05). Reproduced with permission from Knop FK, Vilsboll T, Larsen S, et al 2007. Increased postprandial responses of GLP-1 and GIP in patients with chronic pancreatitis and steatorrhea following pancreatic enzyme substitution. Am J Physiol Endocrinol Metab, 292:E324–30. Copyright © 2007 American Physiological Society.
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f2-tcrm-5-507: Plasma glucose (A), plasma insulin (B), and plasma C-peptide (C) concentrations in patients with chronic pancreatitis (CP) and pancreatic exocrine insufficiency (PEI) following ingestion of a liquid meal over 15 min (0–15 min) with pancreatic enzyme substitution (PES; day 1, ▪) and without PES (day 2, □). Punctuated curves (▴) represent healthy control subjects (Ctrl) given an equal liquid meal without PES. Data are mean values ± SE. Insets: AUC values. *Significant difference (p < 0.05). Reproduced with permission from Knop FK, Vilsboll T, Larsen S, et al 2007. Increased postprandial responses of GLP-1 and GIP in patients with chronic pancreatitis and steatorrhea following pancreatic enzyme substitution. Am J Physiol Endocrinol Metab, 292:E324–30. Copyright © 2007 American Physiological Society.

Mentions: Incretins (mainly GLP-1 (glucagon like peptide-1) and GIP (glucose-dependent insulinotropic polypeptide)) are insulinotropic intestinal peptide hormones released in response to simple carbohydrates and lipids, that cause an increase in the amount of insulin released from the beta cells in the pancreas.52 PES has been shown to restore the GIP response in CP patients.53 An increase in GLP-1 has also been described following PES.54 The increase in incretin levels was accompanied by an increase in plasma insulin and c-peptide levels, but without a significant lowering of plasma glucose levels (Figure 2). Knop et al concluded that the postprandial response of incretins is preserved in CP patients, and may be enhanced by the increased absorption of nutrients facilitated by pancreatic enzyme replacement.


Delayed release pancrelipase for treatment of pancreatic exocrine insufficiency associated with chronic pancreatitis.

Krishnamurty DM, Rabiee A, Jagannath SB, Andersen DK - Ther Clin Risk Manag (2009)

Plasma glucose (A), plasma insulin (B), and plasma C-peptide (C) concentrations in patients with chronic pancreatitis (CP) and pancreatic exocrine insufficiency (PEI) following ingestion of a liquid meal over 15 min (0–15 min) with pancreatic enzyme substitution (PES; day 1, ▪) and without PES (day 2, □). Punctuated curves (▴) represent healthy control subjects (Ctrl) given an equal liquid meal without PES. Data are mean values ± SE. Insets: AUC values. *Significant difference (p < 0.05). Reproduced with permission from Knop FK, Vilsboll T, Larsen S, et al 2007. Increased postprandial responses of GLP-1 and GIP in patients with chronic pancreatitis and steatorrhea following pancreatic enzyme substitution. Am J Physiol Endocrinol Metab, 292:E324–30. Copyright © 2007 American Physiological Society.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2710383&req=5

f2-tcrm-5-507: Plasma glucose (A), plasma insulin (B), and plasma C-peptide (C) concentrations in patients with chronic pancreatitis (CP) and pancreatic exocrine insufficiency (PEI) following ingestion of a liquid meal over 15 min (0–15 min) with pancreatic enzyme substitution (PES; day 1, ▪) and without PES (day 2, □). Punctuated curves (▴) represent healthy control subjects (Ctrl) given an equal liquid meal without PES. Data are mean values ± SE. Insets: AUC values. *Significant difference (p < 0.05). Reproduced with permission from Knop FK, Vilsboll T, Larsen S, et al 2007. Increased postprandial responses of GLP-1 and GIP in patients with chronic pancreatitis and steatorrhea following pancreatic enzyme substitution. Am J Physiol Endocrinol Metab, 292:E324–30. Copyright © 2007 American Physiological Society.
Mentions: Incretins (mainly GLP-1 (glucagon like peptide-1) and GIP (glucose-dependent insulinotropic polypeptide)) are insulinotropic intestinal peptide hormones released in response to simple carbohydrates and lipids, that cause an increase in the amount of insulin released from the beta cells in the pancreas.52 PES has been shown to restore the GIP response in CP patients.53 An increase in GLP-1 has also been described following PES.54 The increase in incretin levels was accompanied by an increase in plasma insulin and c-peptide levels, but without a significant lowering of plasma glucose levels (Figure 2). Knop et al concluded that the postprandial response of incretins is preserved in CP patients, and may be enhanced by the increased absorption of nutrients facilitated by pancreatic enzyme replacement.

Bottom Line: In patients with treatment failure, apart from evaluating drug and dietary interactions and compliance, physicians should keep in mind that patients may benefit from switching to a different formulation.There is no current standard test for evaluating adequacy of therapy in CP patients and studies have shown that optimization of therapy based on symptoms may be inadequate.Goals of therapy based on overall patient presentation and specific laboratory tests rather than mere correction of steatorrhea are needed.

View Article: PubMed Central - PubMed

Affiliation: Johns Hopkins University School of Medicine; Department of Medicine.

ABSTRACT
Pancreatic enzyme supplements (PES) are used in chronic pancreatitis (CP) for correction of pancreatic exocrine insufficiency (PEI) as well as pain and malnutrition. The use of porcine pancreatic enzymes for the correction of exocrine insufficiency is governed by the pathophysiology of the disease as well as pharmacologic properties of PES. Variability in bioequivalence of PES has been noted on in vitro and in vivo testing and has been attributed to the differences in enteric coating and the degree of micro-encapsulation. As a step towards standardizing pancreatic enzyme preparations, the Food and Drug Administration now requires the manufacturers of PES to obtain approval of marketed formulations by April 2010. In patients with treatment failure, apart from evaluating drug and dietary interactions and compliance, physicians should keep in mind that patients may benefit from switching to a different formulation. The choice of PES (enteric coated versus non-enteric coated) and the need for acid suppression should be individualized. There is no current standard test for evaluating adequacy of therapy in CP patients and studies have shown that optimization of therapy based on symptoms may be inadequate. Goals of therapy based on overall patient presentation and specific laboratory tests rather than mere correction of steatorrhea are needed.

No MeSH data available.


Related in: MedlinePlus