PERT for Pancreatic Insufficiency

(PERQ-UP Trial)

Not currently recruiting at 5 trial locations
MM
PK
PM
Overseen ByProject Manager
Age: 18+
Sex: Any
Trial Phase: Academic
Sponsor: Sunnybrook Health Sciences Centre
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if starting pancreatic enzyme replacement therapy (PERT) immediately after pancreas surgery benefits patients at risk of developing pancreatic exocrine insufficiency (PEI). PEI occurs when the pancreas fails to release enough enzymes for proper digestion. The trial will compare two groups: one receiving PERT soon after surgery and another following usual care, which delays PERT until PEI symptoms appear. Candidates include those scheduled for pancreas surgery who can take oral medication. As an unphased trial, this study allows patients to contribute to important research that could enhance post-surgery care.

Will I have to stop taking my current medications?

The trial information does not specify if you need to stop taking your current medications, but you cannot participate if you are currently using pancreatic enzyme replacement therapy (PERT).

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that pancreatic enzyme replacement therapy (PERT) is generally safe and well-tolerated by patients. Studies have found that PERT helps people with exocrine pancreatic insufficiency (EPI), a condition where the pancreas doesn't produce enough digestive enzymes. Patients using PERT report good tolerance, and no major safety issues have emerged in these studies.

One study found that a specific brand of PERT, PANCREAZE®, was safe for treating EPI, particularly in patients with cystic fibrosis. Although this study focused on a specific group, it supports the overall safety of PERT.

The timing for starting PERT can vary, but the treatment is considered safe after pancreas surgery. Therefore, participants considering this trial can feel confident about the safety of PERT.12345

Why are researchers excited about this trial?

Researchers are excited about PERT (Pancreatic Enzyme Replacement Therapy) for pancreatic insufficiency because it offers immediate intervention post-surgery, unlike the standard approach that waits for symptoms to appear before starting treatment. This proactive strategy could potentially reduce the severity and duration of symptoms by providing necessary enzymes right after pancreaticoduodenectomy. Additionally, the flexibility of dose escalation based on symptom presentation allows for a more personalized approach, tailoring the treatment to individual patient needs.

What evidence suggests that PERT might be an effective treatment for pancreatic insufficiency?

Research shows that Pancreatic Enzyme Replacement Therapy (PERT) effectively treats pancreatic exocrine insufficiency (PEI). Studies have found that PERT improves digestion and nutrient absorption in people with PEI. A review of research highlighted that PERT can reduce symptoms like diarrhea and weight loss. Another study found that PERT is generally safe and helps maintain body weight and nutrition. In this trial, one group will receive PERT plus standard care, while another group will receive only standard care until PEI symptoms appear. These findings support using PERT to manage PEI, especially after pancreas surgery.678910

Who Is on the Research Team?

PK

Paul Karanicolas, MD, PhD

Principal Investigator

Sunnybrook Health Sciences Centre

Are You a Good Fit for This Trial?

This trial is for adults over 18 who've had pancreas surgery and are set to leave the hospital within 21 days. They must be able to consent or have someone do it for them. It's not for those already on PERT, with a history of fibrosing colonopathy, current PERT users, those unable to take oral meds, or allergic to porcine protein.

Inclusion Criteria

Planned PD for any indication AND, at randomization
I am older than 18 years.
Willing and able to provide informed consent and/or have a substitute decision maker (SDM) provide informed consent on behalf of the participant
See 2 more

Exclusion Criteria

I am currently using pancreatic enzyme replacement therapy.
I cannot take medicine by mouth.
I am currently using pancreatic enzyme replacement therapy.
See 2 more

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

Baseline

Treatment

Participants receive PERT or standard of care post pancreaticoduodenectomy

3 months
Visits at 1 month and 3 months postoperatively

Follow-up

Participants are monitored for safety and effectiveness after treatment

1.5 years

What Are the Treatments Tested in This Trial?

Interventions

  • PERT
Trial Overview The study tests if starting pancreatic enzyme replacement therapy (PERT) right after pancreas surgery helps patients better than the usual care without immediate PERT. The goal is to see if this approach can improve quality of life post-surgery.
How Is the Trial Designed?
2Treatment groups
Experimental Treatment
Group I: Standard of CareExperimental Treatment1 Intervention
Group II: PERT plus Standard of CareExperimental Treatment2 Interventions

Find a Clinic Near You

Who Is Running the Clinical Trial?

Sunnybrook Health Sciences Centre

Lead Sponsor

Trials
693
Recruited
1,569,000+

Published Research Related to This Trial

Pancreatic enzyme replacement therapy (PERT) significantly improves fat absorption in patients with chronic pancreatitis, with a coefficient of fat absorption increasing from 63.1 to 83.7, indicating its efficacy in treating exocrine pancreatic insufficiency.
PERT also enhances overall nutritional status and quality of life without significant adverse events, suggesting it is a safe and effective treatment, especially when higher doses or enteric-coated formulations are used.
Efficacy of pancreatic enzyme replacement therapy in chronic pancreatitis: systematic review and meta-analysis.de la Iglesia-García, D., Huang, W., Szatmary, P., et al.[2022]
Pancreatic enzyme replacement therapy (PERT) significantly improves fat absorption (CFA) in patients with exocrine pancreatic insufficiency (EPI), with a mean difference of 26.56 compared to baseline and 17.97 compared to placebo, based on a meta-analysis of 7 randomized controlled trials involving 282 patients.
The study found that PERT is effective and well-tolerated, with no significant differences in adverse events compared to placebo, suggesting it is a safe treatment option for EPI.
Efficacy and safety of pancreatic enzyme replacement therapy on exocrine pancreatic insufficiency: a meta-analysis.Gan, C., Chen, YH., Liu, L., et al.[2022]
In a study involving 54 patients with exocrine pancreatic insufficiency (EPI) due to chronic pancreatitis or pancreatic surgery, pancrelipase significantly improved fat absorption (CFA) and nitrogen absorption (CNA) compared to placebo, indicating its efficacy in treating maldigestion.
The safety profile of pancrelipase was comparable to that of placebo, with similar rates of treatment-emergent adverse events, suggesting it is a safe option for patients with EPI.
Pancrelipase delayed-release capsules (CREON) for exocrine pancreatic insufficiency due to chronic pancreatitis or pancreatic surgery: A double-blind randomized trial.Whitcomb, DC., Lehman, GA., Vasileva, G., et al.[2022]

Citations

1.pubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov/40169459/
Pancreatic Enzyme Replacement Therapy in ...Pancreatic Enzyme Replacement Therapy in Pancreatic Exocrine Insufficiency-Real-World's Dosing and Effectiveness: A Systematic Review. Dig ...
Efficacy and safety of pancreatic enzyme replacement ...The exacerbation of pancreatic endocrine dysfunction by potent pancreatic exocrine supplements in patients with chronic pancreatitis.
A Systematic Review | Digestive Diseases and SciencesPancreatic Enzyme Replacement Therapy in Pancreatic Exocrine Insufficiency—Real-World's Dosing and Effectiveness: A Systematic Review. Review ...
Pancreatic-enzyme replacement therapy with pancrelipase ...... pancreatic adenocarcinoma with cachexia and exocrine pancreatic insufficiency (PANCAX-3). ... Efficacy results include PR (6.7%, 2/30), SD (66.7%, ...
AGA Clinical Practice Update on the Epidemiology ...Exocrine pancreatic insufficiency (EPI) is a disorder caused by the failure of the pancreas to deliver a minimum/threshold level of specific ...
Efficacy and safety of pancreatic enzyme replacement ...PERT is demonstrated to be effective and tolerable in patients with EPI, especially using standard administration of PERT.
Exocrine Pancreatic Insufficiency (EPI)Pancreatic enzyme replacement therapy (PERT): This prescription medication is a substitute for the missing digestive enzymes. You take PERT with meals to help ...
Pancreatic Enzyme Replacement Therapy: A Concise ...Pancreatic enzyme replacement therapy is safe and effective at treating pancreatic exocrine insufficiency. There are multiple causes of pancreatic exocrine ...
Efficacy and safety of PANCREAZE® for treatment ...This study demonstrated PANCREAZE® was effective in treating EPI due to CF and was safe and well tolerated.
Exocrine Pancreatic Insufficiency After Acute ...Pancreatic enzyme replacement therapy (PERT) is the only treatment currently available in EPI, but the timing for start and duration of this therapy in acute ...
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