Phillips Anna Evans, Tang Gong, Wang Xianling, Forsmark Christopher E, Yadav Dhiraj
Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, 200 Lothrop Street, Mezzanine Level, M-2, Pittsburgh, PA, 15213, USA.
Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
Dig Dis Sci. 2023 May;68(5):1754-1761. doi: 10.1007/s10620-022-07750-y. Epub 2022 Nov 12.
Pancreatic enzyme replacement therapy (PERT) is most commonly used to treat exocrine insufficiency related to pancreatic diseases, but can be used for non-pancreatic digestive conditions (NPDC). We aimed to determine the prevalence of PERT use and describe prescription patterns in individuals with NPDC.
A nationally representative claims database of 48.6 million enrollees was used to identify individuals who received PERT prescription(s) in the absence of any pancreas-related diagnosis. Data on demographics, enrolment, comorbidities, exocrine function testing, treatment and potential indications for PERT were retrieved, and compared with individuals who received PERT for primary diagnosis of chronic pancreatitis (CP).
A total of 29,234 individuals (64.1% female, mean age 52.4 ± 16.5 years) received PERT for NPDC. The overall estimated US population prevalence rate for PERT use for NDPC was 60.2/100,000 persons. Rates increased significantly with age and were higher in women in all age groups except 1-20 years old. When compared with CP, individuals with NPDC receiving PERT were more likely to be older (52.4 vs. 50.1 years), female (64.1% vs. 51.0%), have lower prevalence of alcoholism (3.6% vs. 25.0%), tobacco abuse (8.4% vs. 30.1%), and received PERT for shorter mean duration (5.3 vs. 8.2 months) (all p < 0.001). Median dose of PERT in individuals with NPDC was 2880 lipase units/day.
Although proportionally low, a sizable population receives PERT for NPDC. PERT for NPDC is usually prescribed at a low dose and for shorter duration, suggesting it is used mostly as a trial for or until resolution of symptoms.
胰酶替代疗法（PERT）最常用于治疗与胰腺疾病相关的外分泌功能不全，但也可用于非胰腺消化疾病（NPDC）。我们旨在确定PERT在NPDC患者中的使用 prevalence，并描述其处方模式。
使用一个具有全国代表性的包含4860万参保人的索赔数据库，以识别在无任何胰腺相关诊断的情况下接受PERT处方的个体。检索了有关人口统计学、参保情况、合并症、外分泌功能测试、治疗以及PERT潜在适应症的数据，并与因慢性胰腺炎（CP）的初步诊断而接受PERT的个体进行了比较。
共有29234名个体（64.1%为女性，平均年龄52.4±16.5岁）因NPDC接受了PERT。美国NDPC患者中PERT使用的总体估计患病率为60.2/10万。患病率随年龄显著增加，除1-20岁年龄组外，所有年龄组女性的患病率均更高。与CP患者相比，接受PERT的NPDC患者年龄更大（52.4岁对50.1岁）、女性比例更高（64.1%对51.0%）、酒精中毒患病率更低（3.6%对25.0%）、烟草滥用患病率更低（8.4%对30.1%），且接受PERT的平均持续时间更短（5.3个月对8.2个月）（所有p<0.001）。NPDC患者PERT的中位剂量为2880脂肪酶单位/天。
尽管比例较低，但有相当数量的人群因NPDC接受PERT。NPDC的PERT通常以低剂量和较短疗程开具，这表明它主要用作症状试验或直至症状缓解。
