Real-World Prescribing Patterns of PERT in Exocrine Pancreatic Insufficiency

New research is shedding light on healthcare provider (HCP) perceptions and prescribing patterns of pancreatic enzyme replacement therapy (PERT) for exocrine pancreatic insufficiency (EPI).1

The real-world survey findings suggest HCPs consider multiple factors when determining an appropriate PERT choice and indicate prescribing a variety of PERT products, influenced most heavily by abdominal and bowel symptom control, affordability, and formulary or insurance coverage.1

A condition in which the small intestine cannot digest food completely because of problems with digestive enzymes from the pancreas, EPI management relies heavily on PERT to substitute for the missing digestive enzymes. PERT products like Creon, Zenpep, Pancreaze, Viokace, and Pertzye are all composed of pancrelipase but differ in formulation-specific attributes and access/coverage considerations.2,3

“HCPs must consider multiple factors when selecting a PERT product for a given patient,” Jodie Barkin, MD, an associate professor of Clinical Medicine at the University of Miami Miller School of Medicine, and colleagues wrote.1 “Understanding their decision-making process and preferences for different PERT products can offer valuable insights into real-world clinical practice and support optimal care for patients with EPI. However, the current literature lacks comprehensive real-world studies describing how HCPs in the United States manage PERT therapy and perceive different PERT products.”

To assess real-world EPI management practice and HCP perceptions of PERT products in the United States, investigators carried out an online survey with HCPs who had treated patients with EPI for ≥ 3 years and prescribed PERT products to ≥ 10 patients over a 12-month period.

The survey collected de-identified data on HCP characteristics, prescribing patterns, and perceptions of PERT products across the domains of efficacy, convenience, and access. Of note, survey responses were self-reported by HCPs. No patient-level data were collected; all responses were based on HCP recollection, including aggregated patient characteristics using questions that asked respondents to report the characteristics of their patients.

A total of 250 HCPs were surveyed, including 124 specialists, 95 generalists, and 31 advanced practice providers. HCPs managed a median of 30 patients with EPI on PERT in the 12 months preceding the survey.

Results showed the most commonly prescribed PERT products were Creon (84.0%), Zenpep (60.4%), and Pancreaze (59.2%), with fewer HCPs prescribing Viokace (27.2%) and Pertzye (16.0%). Specific factors considered in prescribing decisions included improvement in abdominal and bowel symptoms (83.6%), affordability (72.4%), and formulary/insurance coverage (72.0%).

Investigators noted a significantly greater proportion of HCPs reported favorable perceptions of Creon over other PERT products.

Perceptions of formulary/insurance coverage across PERT products varied, with 8.0–56.0% of HCPs agreeing or strongly agreeing that a prescribed product had good coverage.

Investigators pointed out these findings were generally consistent across different provider types.

“This US-based survey study offered valuable insights into HCPs considerations when managing patients with EPI using PERT products, as well as their perceptions of individual products,” investigators concluded.1 “These findings may help to inform decision-making by clinicians and healthcare payers that could ultimately support improved quality and continuity of care for EPI patients. Various factors may contribute to barriers in treatment access and should be addressed to ensure equitable and timely access to PERT.”

References

1. Ashkar M, Geremia J, Baldwin Z, et al. Prescribing Patterns and Perceptions of Pancreatic Enzyme Replacement Therapy among Healthcare Providers: A Prospective United States Healthcare Providers Survey. Adv Ther. Published online January 12, 2026. doi:10.1007/s12325-025-03454-7

2. NIDDK. Exocrine Pancreatic Insufficiency (EPI). Accessed February 12, 2026. https://www.niddk.nih.gov/health-information/digestive-diseases/exocrine-pancreatic-insufficiency/definition-facts

3. Cleveland Clinic. Exocrine Pancreatic Insufficiency (EPI). Accessed February 12, 2026. https://my.clevelandclinic.org/health/diseases/21577-exocrine-pancreatic-insufficiency-epi