S51 Potential Gaps in the Care of Patients Taking Pancreatic Enzyme Replacement Therapy: A Survey of Real-World Clinical Practice Patterns in the United States

Introduction: Exocrine pancreatic insufficiency (EPI) is characterized by impairment in the production, activity, or delivery of pancreatic enzymes resulting in maldigestion. Practice guidelines recommend starting pancreatic enzyme replacement therapy (PERT) between 40,000-50,000 lipase units (LU) per meal and a half dose for snacks. Underdosing or poor follow-up may contribute to over a third of patients discontinuing PERT after just 1 month. The aim of this study was to describe real-world clinical practice among U.S. HCPs using PERT in the treatment of EPI, addressing the limited data on this topic. Methods: HCPs were recruited from an HCP panel and required to have ≥3 years treating EPI and prescribed PERT to ≥10 patients in the past year. A double-blind online survey collected de-identified data on HCP demographics, aggregated patient characteristics, and PERT prescribing patterns. Data were summarized with descriptive statistics. Results: Responses were received from 250 HCPs; 219 (88%) physicians (124 [57%] specialists, 95 [43%] general physicians) and 31 (12%) physician assistants or nurse practitioners. HCPs worked primarily in private practice (69%) with a median 20 years of experience and 30 PERT-treated patients in the past year. HCPs treated primarily adults (94%) and reported chronic pancreatitis, alcohol use disorder, and pancreatectomy as the most common underlying conditions for EPI. PERT was dosed with meals 94% of the time; snack instructions were omitted 34% of the time. HCPs reported prescribing an initial dose of <30,000 LU/meal 12% of the time and ≥60,000 LU/meal only 14% of the time. Most HCPs waited ≥1 month for 1st follow-up after PERT initiation. Conclusion: This study provides real-world insights into clinical practice trends and potential gaps in treatment of EPI. In contrast to many EPI clinical studies, this study included mostly physicians working in private practice with diverse representation from all regions of the continental U.S. Variability in patient follow-up may be improved by telehealth, nurse, by a nurse or pharmacist visit in certain cases. Adhering to guidelines for initial PERT dosing per meal and snacks may improve PERT efficacy, potentially benefiting persistence and outcomes. This real-world survey data underscores opportunities to improve patient care through optimized PERT dosing, dosing with snacks, and timely follow-up in patients with EPI, which may be good targets for future education interventions.