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Pancreatic Enzyme Replacement Therapy (PERT): How It Works & Real-World Patient Experience
04/08/2024
In this short video, you’ll learn more about PERT, how it works, and identifying the unmet needs of patients with exocrine pancreatic insufficiency (EPI) treated with PERT.
Transcript:
Welcome, and thank you for watching this video series on the patient experience and clinical insights into PERT, pancreatic enzyme replacement therapy. I'm Dr Allison Yang. I'm a board-certified gastroenterologist specializing in pancreatic diseases. I'm excited to review this important topic. So, let's get started.
This is the first video of a 3-part series. In this video, we'll discuss PERT and the real-world patient experience with this treatment.
Let's start by reviewing exocrine pancreatic insufficiency, or EPI, for which PERT is used. EPI is the reduced production, secretion, or activity of pancreatic enzymes and/or bicarbonate. This deficiency in digestive enzymes leads to the malabsorption of nutrients.
PERT is the mainstay of treatment for EPI. Pancreatic enzymes are a combination of porcine-derived lipase, protease, and amylase. The goal of PERT is to reduce maldigestion.
Pancreatic enzymes digest all 3 macronutrients – fats, proteins, and carbohydrates. It’s the inability to digest fats that leads to steatorrhea, or oily and fatty stools; this is the cardinal sign of EPI. If left untreated, EPI can lead to maldigestion, malnutrition, weight loss, and deficiencies in fat-soluble vitamins.
Let's move on to the real-world patient experience of managing EPI with PERT.
Successful treatment of EPI depends on PERT being dosed appropriately and taken correctly. This requires ongoing patient–provider conversations and education to ensure patient understanding. Several gaps currently exist in both patient understanding of EPI and their experience with PERT.
An online survey was conducted looking at real-world patient understanding of EPI and PERT, behaviors related to taking PERT, and the follow-up received from clinicians. The survey was conducted among 75 members of the Inspire™ Pancreatitis or Pancreatic Cancer Support communities who had EPI as of December 2020.
The survey results highlighted several important factors among patients who currently take or have taken PERT, including the prevalence of underdosing, a lack of follow-up by healthcare providers, and gaps in patient education. Thirty-six percent of respondents reported taking inadequate PERT doses, and 21% of respondents reported purposely skipping doses.
The top reasons for skipping a PERT dose were that patients did not feel PERT was necessary or they felt that skipping doses did not have health consequences. The lack of perceivable health consequences was also why patients reported decreasing PERT dosages without consulting their doctors. There is a clear gap in patient education on EPI and the need for PERT. One in 4 patients reported not receiving detailed information about EPI from their prescribing provider, and the directions often varied greatly with regards to how to take PERT. More than one-third of survey respondents reported that they received no follow-up from their healthcare provider after starting treatment.
In my experience, follow-up visits are critical to assess patient response to therapy and to clarify and reinforce adherence to instructions. There clearly remains a significant unmet need in both patient education and follow-up. Less than half of survey respondents strongly agreed with the statement that taking PERT should be part of their daily routine, which suggests that patients may not be aware of the importance of PERT.
Non-adherence and discontinuation rates further point to the lack of patient education. Of the 15 respondents who had stopped taking PERT, 67% reported making the decision without consulting their provider. The study did have several limitations, so the results should be interpreted with this in mind. The diagnosis of EPI was based on the respondents’ answers alone and not confirmed with their clinicians. Additionally, the members sampled likely reflected patients who are more engaged with their disease and may not be representative of the general EPI population.
In summary, both underdosing and gaps in patient education with PERT are common, and this may hinder treatment success. Patient education is an essential tool that can help overcome gaps in understanding EPI, emphasizing the importance of PERT and how it works, and making PERT a part of a daily routine.
Thank you for listening. I encourage you to test your knowledge with the post-test question and view the next video in our series.
ABBV-US-01477-MC
Approved 04/2024
AbbVie Medical Affairs
Allison Yang, MD, MPH
Dr Allison Yang is the medical director of the Pancreas Program at Weill Cornell Medicine. She is an Assistant Professor of Medicine at Weill Cornell Medical College and Attending Physician at New York Presbyterian Hospital/Weill Cornell Medical Center. She is a clinical gastroenterologist with a focus on the multi-disciplinary care of patients with pancreatic disease.
Dr Yang received her BA from Columbia University in New York, her MD from the University of Illinois, and her MPH from the Harvard School of Public Health. She completed her internal medicine residency training at the Mayo Clinic, and her gastroenterology fellowship at Brigham and Women’s Hospital/Harvard Medical School.
Dr Yang’s primary clinical and research interests are in the effective diagnosis and treatment of pancreatic disease including acute and chronic pancreatitis, recognition and treatment of cystic neoplasms of the pancreas, and management of high-risk pancreas patients.
