Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL, USA.
Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
Aliment Pharmacol Ther. 2020 May;51(10):958-967. doi: 10.1111/apt.15698. Epub 2020 Apr 6.
Patients with chronic pancreatitis or pancreatic cancer commonly develop exocrine pancreatic insufficiency, and may not be adequately treated with pancreatic enzyme replacement therapy (PERT).
To estimate the frequency of diagnostic testing for exocrine insufficiency, and appropriate use of PERT, in a commercially insured population in the US.
We utilised a nationally representative administrative database representing 48.67 million individuals in over 80 US healthcare plans to assess testing for and treatment of exocrine insufficiency in patients who received a diagnosis of chronic pancreatitis (n = 37 061) or pancreatic cancer (n = 32 461) from 2001 to 2013. We identified the details of any testing for exocrine insufficiency and PERT use. We defined appropriate PERT use as a dosage of ≥120 000 USP units of lipase daily. Multiple logistic regression was used to identify predictors of appropriate use of PERT.
In patients with chronic pancreatitis, 6.5% had any testing for exocrine insufficiency, 30.4% filled a prescription for PERT, and 8.5% were prescribed an adequate dose. In those with pancreatic cancer, 1.9% had testing for exocrine insufficiency, 21.9% filled a prescription for PERT, and 5.5% were prescribed an adequate dose. Number of comorbidities, testing for exocrine insufficiency, pancreatic surgery and duration of enrolment were independent predictors for use and appropriate dosing.
Testing for exocrine insufficiency, and appropriate dosing of PERT in patients with chronic pancreatitis or pancreatic cancer, is infrequent and inconsistent in an insured US population. Efforts are needed to educate medical providers on the best practices for managing exocrine pancreatic insufficiency in these patients.
患有慢性胰腺炎或胰腺癌的患者通常会出现外分泌胰腺功能不全，并且可能无法通过胰腺酶替代疗法（PERT）充分治疗。
评估美国商业保险人群中外分泌不足的诊断检测频率以及 PERT 的合理使用情况。
我们利用一个具有代表性的全国性行政数据库，该数据库代表了 80 多个美国医疗保健计划中的 4867 万多人，以评估在 2001 年至 2013 年期间被诊断患有慢性胰腺炎（n=37061）或胰腺癌（n=32461）的患者中进行外分泌不足的检测和治疗情况。我们确定了任何外分泌不足检测和 PERT 使用的详细信息。我们将 PERT 的合理使用定义为每天使用≥120000 USP 单位的脂肪酶。采用多变量逻辑回归分析确定 PERT 合理使用的预测因素。
在慢性胰腺炎患者中，有 6.5%的患者进行了任何外分泌不足的检测，30.4%的患者开具了 PERT 的处方，8.5%的患者开具了足够剂量的 PERT。在胰腺癌患者中，有 1.9%的患者进行了外分泌不足的检测，21.9%的患者开具了 PERT 的处方，5.5%的患者开具了足够剂量的 PERT。合并症的数量、外分泌不足的检测、胰腺手术以及参保时间的长短是使用和适当剂量的独立预测因素。
在有保险的美国人群中，慢性胰腺炎或胰腺癌患者进行外分泌不足的检测以及 PERT 的适当剂量治疗的情况并不常见且不一致。需要努力教育医疗服务提供者，以掌握管理这些患者的外分泌胰腺功能不全的最佳实践。
