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A comparison of two pancreatin microsphere preparations in cystic fibrosis
R B Elliott1, L C Escobar, H R Lees
1Department of Paediatrics, University of Auckland School of Medicine.
Insights
Creon and Pancrease demonstrate equal efficacy in cystic fibrosis patients at equivalent lipase doses. However, Creon is preferred due to fewer capsules, reduced symptoms, and improved fat absorption in severe cases.
Area of Science:
- Gastroenterology
- Pediatrics
- Pulmonology
Background:
- Cystic fibrosis (CF) is a genetic disorder affecting multiple organs, including the pancreas.
- Pancreatic enzyme replacement therapy (PERT) is crucial for managing maldigestion in CF patients.
- Microsphere preparations of pancreatin are commonly used for PERT.
Purpose of the Study:
- To compare the efficacy and tolerance of Creon and Pancrease in pediatric and young adult CF patients.
- To evaluate key indicators of digestive function and patient-reported outcomes.
Main Methods:
- A double-blind, crossover study involving 27 pediatric CF patients.
- Comparison of two pH-sensitive pancreatin microsphere preparations (Creon and Pancrease) at equivalent lipase dosages.
- Assessment of coefficient of fat absorption (CFA), coefficient of nitrogen absorption (CNA), weight gain, and subjective symptoms.
Main Results:
- No significant differences in CFA, CNA, weight gain, or energy intake between Creon and Pancrease.
- Three patients with CFA <70% on Pancrease improved with Creon; no patients had CFA <70% on Creon.
- Significant reduction in daily capsule count from 25 (Pancrease) to 15 (Creon).
- 70% of patients preferred Creon, citing reduced abdominal pain, stool frequency, and fewer capsules.
Conclusions:
- Creon and Pancrease show equal effectiveness at equivalent lipase activity doses.
- Creon offers improved patient preference due to a lower capsule burden, fewer gastrointestinal symptoms, and potential benefits for severe steatorrhea.
- This suggests Creon may offer a more convenient and comfortable PERT option for CF patients.
Objectives:
to compare the efficacy and tolerance of Creon and Pancrease in children and young adults with cystic fibrosis.
Methods:
a double blind, crossover study of two pH sensitive microsphere preparations of pancreatin (Creon, Pancrease), given in equivalent lipase dosage to 27 children with cystic fibrosis, was conducted.
Results:
at similar lipase activity no significant difference was found in the following: coefficient of fat absorption (CFA), coefficient of nitrogen absorption (CNA), weight gain, mean adequate daily intake for energy, and subjective symptoms. Three children who had a CFA less than 70% while receiving Pancrease all improved on Creon. No children had a CFA less than 70% while receiving Creon. A significant reduction in the number of capsules required daily to achieve similar control was possible when changing from Pancrease (mean 25/day) to Creon (mean 15/day). Seventy percent of patients preferred Creon and this was likely to be related to a perceived reduction in abdominal pain and stool frequency, and need for less capsules per day.
Conclusion:
Creon and Pancrease are equally effective at doses providing equal lipase activity, however, the reduced number of capsules, fewer symptoms, and possible improvement of more severe steatorrhoea result in an increased patient preference for Creon.
