title: Pancreatic enzyme products: digesting the changes.
abstract: OBJECTIVE
  To review the pharmacology, dosage regimens, efficacy, and safety of currently marketed pancreatic enzyme products (PEPs).
  
  
  METHODS
  Studies were identified by PubMed (1966-January 2011), clinicaltrials.gov, fda.gov, and International Pharmaceutical Abstracts. Search terms included pancreatic enzyme, lipase, Creon, Zenpep, Pancreaze, and exocrine pancreatic insufficiency (EPI).
  
  
  METHODS
  All human studies evaluating the efficacy of currently approved or potential PEPs were reviewed.
  
  
  RESULTS
  PEPs are composed of porcine lipase, amylase, and protease and are used in patients with EPI secondary to cystic fibrosis, chronic pancreatitis, and pancreatectomy. In 1938, PEPs were exempted from the Food, Drug, and Cosmetic Act of 1938 and never underwent a formal Food and Drug Administration (FDA) review process. In response to reports of treatment failures during product interchange, the FDA conducted a review of available PEP products. This review found a large variability of response between the unapproved PEP products, which resulted in the FDA requiring approval of all PEP products by April 2010. The 3 delayed-release, enteric-coated PEPs currently approved by the FDA (Creon, Zenpep, and Pancreaze) have demonstrated efficacy and safety in EPI secondary to cystic fibrosis. Creon has also demonstrated safety and efficacy in EPI secondary to chronic pancreatitis and pancreatectomy. Cost difference between the 3 products is minimal. Treatment-related adverse events in clinical studies for all PEPs were less than or similar to those with placebo.
  
  
  CONCLUSIONS
  At this time, Creon is an appropriate first-line agent, as it has been approved for chronic pancreatitis, pancreatectomy, and cystic fibrosis.
authors.affiliation: Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, St. John Hospital and Medical Center, Detroit, MI.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Giuliano
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Dehoorne-Smith
authors.forename: Pramodini B
authors.initials: PB
authors.lastname: Kale-Pradhan
mesh_terms: D010188:Exocrine Pancreatic Insufficiency / Q000188:drug therapy*; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D010179:Pancreas / Q000201:enzymology*; D020799:Pancrelipase / Q000009:adverse effects / Q000494:pharmacology*
chemical_list: D005765:Gastrointestinal Agents; D020799:Pancrelipase