Pancreatic Enzyme Use Reduces Pancreatitis Frequency in Children With Acute Recurrent or Chronic Pancreatitis: A Report From INSPPIRE

Alvin Jay Freeman¹, Kenneth Ng², Fuchenchu Wang³, Maisam A Abu-El-Haija⁴, Ankur Chugh⁵, Gretchen A Cress⁶, Douglas S Fishman⁷, Cheryl E Gariepy¹, Matthew J Giefer⁸, Praveen Goday¹, Tanja Y Gonska⁹, Amit S Grover¹⁰, Douglas Lindblad¹¹, Quin Y Liu¹², Asim Maqbool¹³, Jacob A Mark¹⁴, Brian A McFerron¹⁵, Megha S Mehta¹⁶, Veronique D Morinville¹⁷, Robert A Noel¹⁸, Chee Y Ooi¹⁹, Emily R Perito²⁰, Sarah Jane Schwarzenberg²¹, Zachary M Sellers²², Michael Wilschanski²³, Yuhua Zheng²⁴, Ying Yuan³, Dana K Andersen²⁵, Mark E Lowe²⁶, Aliye Uc⁶; Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC)

Affiliations

¹ Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA.
² Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
³ The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.
⁴ Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
⁵ Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
⁶ University of Iowa, Stead Family Children's Hospital, Iowa City, Iowa, USA.
⁷ Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.
⁸ Ochsner Hospital for Children, New Orleans, Louisiana, USA.
⁹ Hospital for Sick Children, Toronto, Ontario, Canada.
¹⁰ Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
¹¹ Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
¹² Cedars-Sinai Medical Center, Los Angeles, California, USA.
¹³ Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
¹⁴ University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, USA.
¹⁵ Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA.
¹⁶ University of Texas Southwestern Medical School, Dallas, Texas, USA.
¹⁷ Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
¹⁸ Baylor College of Medicine, San Antonio, Texas, USA.
¹⁹ University of New South Wales, Sydney Children's Hospital Randwick, Sydney, Australia.
²⁰ University of California San Francisco, San Francisco, California, USA.
²¹ University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA.
²² Stanford University, Palo Alto, California, USA.
²³ Hadassah Hebrew University Hospital, Jerusalem, Israel.
²⁴ Children's Hospital Los Angeles, Los Angeles, California, USA.
²⁵ Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, Maryland, USA.
²⁶ Washington University School of Medicine, St. Louis, Missouri, USA.

PMID: 38517077
PMCID: PMC11452285
DOI: 10.14309/ajg.0000000000002772

Pancreatic Enzyme Use Reduces Pancreatitis Frequency in Children With Acute Recurrent or Chronic Pancreatitis: A Report From INSPPIRE

Alvin Jay Freeman et al. Am J Gastroenterol. 2024.

. 2024 Oct 1;119(10):2094-2102.

doi: 10.14309/ajg.0000000000002772. Epub 2024 Mar 22.

Authors

Affiliations

¹ Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA.
² Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
³ The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.
⁴ Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
⁵ Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
⁶ University of Iowa, Stead Family Children's Hospital, Iowa City, Iowa, USA.
⁷ Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.
⁸ Ochsner Hospital for Children, New Orleans, Louisiana, USA.
⁹ Hospital for Sick Children, Toronto, Ontario, Canada.
¹⁰ Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
¹¹ Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
¹² Cedars-Sinai Medical Center, Los Angeles, California, USA.
¹³ Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
¹⁴ University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, USA.
¹⁵ Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA.
¹⁶ University of Texas Southwestern Medical School, Dallas, Texas, USA.
¹⁷ Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
¹⁸ Baylor College of Medicine, San Antonio, Texas, USA.
¹⁹ University of New South Wales, Sydney Children's Hospital Randwick, Sydney, Australia.
²⁰ University of California San Francisco, San Francisco, California, USA.
²¹ University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA.
²² Stanford University, Palo Alto, California, USA.
²³ Hadassah Hebrew University Hospital, Jerusalem, Israel.
²⁴ Children's Hospital Los Angeles, Los Angeles, California, USA.
²⁵ Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, Maryland, USA.
²⁶ Washington University School of Medicine, St. Louis, Missouri, USA.

PMID: 38517077
PMCID: PMC11452285
DOI: 10.14309/ajg.0000000000002772

Abstract

Introduction: Among children who suffer from acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP), acute pancreatitis (AP) episodes are painful, often require hospitalization, and contribute to disease complications and progression. Despite this recognition, there are currently no interventions to prevent AP episodes. In this retrospective cohort study, we assessed the impact of pancreatic enzyme therapy (PERT) use on clinical outcomes among children with pancreatic-sufficient ARP or CP.

Methods: Children with pancreatic-sufficient ARP or CP in the INSPPIRE-2 cohort were included. Clinical outcomes were compared for those receiving vs not receiving PERT, as well as frequency of AP before and after PERT. Logistic regression was used to study the association between development of AP episodes after starting PERT and response predictors.

Results: Among 356 pancreatic-sufficient participants, 270 (76%) had ARP, and 60 (17%) received PERT. Among those on PERT, 42% did not have a subsequent AP episode, during a mean 2.1 years of follow-up. Children with a SPINK1 mutation ( P = 0.005) and those with ARP (compared with CP, P = 0.008) were less likely to have an AP episode after starting PERT. After initiation of PERT, the mean AP annual incidence rate decreased from 3.14 down to 0.71 ( P < 0.001).

Discussion: In a retrospective analysis, use of PERT was associated with a reduction in the incidence rate of AP among children with pancreatic-sufficient ARP or CP. These results support the need for a clinical trial to evaluate the efficacy of PERT to improve clinical outcomes among children with ARP or CP.

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Conflict of interest statement

A.J.F. is a consultant for Takeda and Alcresta, receives research funding from the Cystic Fibrosis Foundation and Anagram Therapeutics, and is a board member for CAPER. T.G. received a research grant from Vertex Pharmaceuticals, and she is a consultant for Cystic Fibrosis Foundation (CFF). A.U. is a consultant for CFF and Abbvie. M.E.L. is a consultant for CFF and UpToDate. S.J.S. is a consultant for UpToDate, Nestle, Abbvie, and the Cystic Fibrosis Foundation, and she has a grant from Gilead. V.D.M. is an Associate Editor for JPGN Reports. M.A.H. is the President of CAPER, The remaining authors report no conflicts of interest.

Figures

**Figure 1:**
Box and whiskers plot showing significant decrease in annual incidence rate of AP before and after initiation of pancreatic enzymes among children with ARP and CP

See this image and copyright information in PMC

References

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Pancreatic Enzyme Use Reduces Pancreatitis Frequency in Children With Acute Recurrent or Chronic Pancreatitis: A Report From INSPPIRE

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Pancreatic Enzyme Use Reduces Pancreatitis Frequency in Children With Acute Recurrent or Chronic Pancreatitis: A Report From INSPPIRE

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