Management of Pancreatic Enzyme Replacement Therapy (PERT) Shortages in a large UK Adult Cystic Fibrosis (CF) Centre: an imPERaTive approach.
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All Authors
Shimmin, D.
Farrell, E.
Heenan, N.
Moull, A.
Shaw, N.
Williams, E.
Clifton, I.
Etherington, C.
Sawant, A.
Spoletini, G.
LTHT Author
Shimmin, Deirdre
Farrell, Emma
Heenan, Niamh
Moull, Alice
Shaw, Nicola
Williams, E.
Clifton, Ian
Etherington, Christine
Sawant, Akhil
Spoletini, Giulia
Peckham, Daniel
Farrell, Emma
Heenan, Niamh
Moull, Alice
Shaw, Nicola
Williams, E.
Clifton, Ian
Etherington, Christine
Sawant, Akhil
Spoletini, Giulia
Peckham, Daniel
LTHT Department
Nutrition & Dietetics
Medicines Management & Pharmacy Services
Clinical Pharmacy
Cardio-Respiratory
Respiratory Medicine
Cystic Fibrosis
Medicines Management & Pharmacy Services
Clinical Pharmacy
Cardio-Respiratory
Respiratory Medicine
Cystic Fibrosis
Non Medic
Consultant Dietitian
Specialist Dietitian
Dietitian
Dietitian
Advanced Clinical Pharmacist
Specialist Dietitian
Dietitian
Dietitian
Advanced Clinical Pharmacist
Publication Date
2025
Item Type
Conference Abstract
Language
Subject
Subject Headings
Abstract
Background: Since May 2024 there has been global supply constraints of PERT(1). Creon®, the UK’s largest PERT supplier, limited Creon 25,000 (Cr25k) for community use and directed Creon 10,000 (Cr10K) supplies via hospital pharmacies. People with exocrine pancreatic insufficiency (EPI) were at risk of exhausted PERT supplies, potentially impacting on physical and mental health (2).
Objective: We present our CF centre management of PERT shortages to a cohort of 400 adults with CF (awCF)
Methods: Patient were identified from electronic patient records (June-Nov.2024). CF dietitians led on PERT management, collating data on patient encounters, ‘To Take Out’ (TTO) prescriptions from hospital pharmacy for PERT brands Creon® (Cr) and Nutrizym® 22 (Nu22) and FP10 outpatient prescriptions (Rx). AwCF on Cr10K were assessed and if suitable guided to switch to Cr25K or co-supplement Cr10K + Cr25K. General Practitioners (GP’s) were informed. Dietetic and pharmacy time estimated at 0.5 and 0.25 hours per query respectively. Centre drug cost (June-Nov 2024) was compared to drug cost June-Nov 2023.
Results: 376 awCF with EPI were identified. 48 %, 50%, 1.5%, 0.5% of subjects were on Cr10K, Cr25K, Cr10K +Cr25K or Nu22 respectively. Post shortage, Cr10k +Cr 25K Rx increased 95% (6 v 133), Cr10K Rx decreased 70% (180 vs 53), Cr25K and Nu22 Rx remained unchanged. PERT shortages resulted in 479 extra patient encounters, 404 extra TTOs, with 55,400 Cr10K, 117,100 Cr25K, and 500 Nu22 capsules being prescribed. 127 letters were written to GP’s and 44 FP10 prescriptions provided to individuals at risk of exhausted supplies. CF Centre drug cost increased by 440%. An extra 240 and 101 hours of dietetic and pharmacy time was diverted respectively to supporting PERT access and minimising shortages.
Conclusion: The responsive management of PERT, ensuring sustained patient supplies is associated with substantial increases in hospital drug costs and staffing time.