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Comparison of Effectiveness of Pancreatic Enzyme Preparations in Cystic Fibrosis FREE

Elaine H. Mischler, MD; Sara Parrell, RN; Philip M. Farrell, MD, PhD; Gerard B. Odell, MD
[+] Author Affiliations

Reprint requests to Department of Pediatrics, University of Wisconsin, Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792 (Dr Mischler).


Am J Dis Child. 1982;136(12):1060-1063. doi:10.1001/archpedi.1982.03970480026006.
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• To evaluate claims that entericcoated pancreatic enzyme preparations are more effective than conventional digestants in managing malabsorption In cystic fibrosis (CF), we conducted a trial comparing the efficacy of pancrealipase (enzyme supplement containing lipase, amylase, and protease) in the form of pH-sensitive microspheres (Pancrease) with that in the form of encapsulated enzyme powder (Cotazym). Ten boys with CF received equivalent dosages in a controlled, double-blind fashion using a random sequence of capsule administration with crossover and "washout" periods. Patients experienced significantly enhanced nitrogen and fat absorption while receiving either enzyme when compared with placebo. The enteric-coated product promoted significantly improved fat absorption as compared with the conventional enzyme capsule. Both enzyme preparations caused significantly improved protein absorption as compared with placebo, but there was no significant difference between the two products in the degree of effect on azotorrhea.

(Am J Dis Child 1982;136:1060-1063)

REFERENCES

Di Sant' Agnese PA:  Fibrocystic disease of the pancreas with normal or partial pancreatic function . Pediatrics 1955;;15:683-697.
DiMagno EP, Malagela JR, Go VL, et al:  Fate of orally ingested enzymes in pancreatic insufficiency: Comparison of two dosage schedules . N Engl J Med 1977;;296:1318-1322.
Khaw KT, Adeniyi-Jones S, Gordon D, et al:  Comparative effectiveness of Viokase, Cotazym, and Pancrease in children with cystic fibrosis . CF Club Abstracts 1977;;18-57.
Suskind R, Adeniyi-Jones S, Gordon D, et al:  Nutritional status, nutrient intake and response to enzyme replacement in children with cystic fibrosis . CF Club Abstracts 1978;;19:95.
Nassif EG, Younoszai MK, Weinberger MM, et al:  Comparative effects of antacids, enteric coating, and bile salts on the efficacy of oral pancreatic enzyme therapy in cystic fibrosis . J Pediatr 1981;;98:320-323.
 Pancreatin capsules (methods of analysis) , in: The United States Pharmacopeia: National Formulary . Rockville, Md, United States Pharmocopeial Convention Inc, 19, vol 14, pp 525-526.
Van de Kamer JH, van Bokkelhuinink H, Weyer HA:  Rapid method for determination of fat in feces . J Biol Chem 1949;;177:347-355.
Fleck A, Munro HN:  The determination of organic nitrogen in biological materials: A review . Clin Chem Acta 1965;;11:2-12.
Bligh EG, Dyer WJ:  A rapid method of total lipid extraction and purification . Can J Biochem Physiol 1959;;37:911-917.
Stapleton FB, Kennedy J, Nousia-Arvanitakis S, et al:  Hyperuricosuria due to high-dose pancreatic extract therapy in cystic fibrosis . N Engl J Med 1976;;295:246-248.
Davidson GP, Morad Hassel F, Crozier D, et al:  Iatrogenic hyperuricemia in children with cystic fibrosis . J Pediatr 1978;;93:976-980.
Graham DY:  Enzyme replacement therapy of exocrine pancreatic insufficiency in man: Relations between in vitro enzyme activities and in vivo potency in commercial pancreatic extracts . N Engl J Med 1977;;296:1314-1317.
Barbero GJ, Shwachman H, Grand R, et al:  Gastrointestinal and nutritional manifestations of cystic fibrosis , in Mangos JA, Talamo RC, (eds): Cystic Fibrosis: Projections Into the Future . New York, Stratton Intercontinental Medical Book Corp, 1976;, pp 83-111.

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References

Di Sant' Agnese PA:  Fibrocystic disease of the pancreas with normal or partial pancreatic function . Pediatrics 1955;;15:683-697.
DiMagno EP, Malagela JR, Go VL, et al:  Fate of orally ingested enzymes in pancreatic insufficiency: Comparison of two dosage schedules . N Engl J Med 1977;;296:1318-1322.
Khaw KT, Adeniyi-Jones S, Gordon D, et al:  Comparative effectiveness of Viokase, Cotazym, and Pancrease in children with cystic fibrosis . CF Club Abstracts 1977;;18-57.
Suskind R, Adeniyi-Jones S, Gordon D, et al:  Nutritional status, nutrient intake and response to enzyme replacement in children with cystic fibrosis . CF Club Abstracts 1978;;19:95.
Nassif EG, Younoszai MK, Weinberger MM, et al:  Comparative effects of antacids, enteric coating, and bile salts on the efficacy of oral pancreatic enzyme therapy in cystic fibrosis . J Pediatr 1981;;98:320-323.
 Pancreatin capsules (methods of analysis) , in: The United States Pharmacopeia: National Formulary . Rockville, Md, United States Pharmocopeial Convention Inc, 19, vol 14, pp 525-526.
Van de Kamer JH, van Bokkelhuinink H, Weyer HA:  Rapid method for determination of fat in feces . J Biol Chem 1949;;177:347-355.
Fleck A, Munro HN:  The determination of organic nitrogen in biological materials: A review . Clin Chem Acta 1965;;11:2-12.
Bligh EG, Dyer WJ:  A rapid method of total lipid extraction and purification . Can J Biochem Physiol 1959;;37:911-917.
Stapleton FB, Kennedy J, Nousia-Arvanitakis S, et al:  Hyperuricosuria due to high-dose pancreatic extract therapy in cystic fibrosis . N Engl J Med 1976;;295:246-248.
Davidson GP, Morad Hassel F, Crozier D, et al:  Iatrogenic hyperuricemia in children with cystic fibrosis . J Pediatr 1978;;93:976-980.
Graham DY:  Enzyme replacement therapy of exocrine pancreatic insufficiency in man: Relations between in vitro enzyme activities and in vivo potency in commercial pancreatic extracts . N Engl J Med 1977;;296:1314-1317.
Barbero GJ, Shwachman H, Grand R, et al:  Gastrointestinal and nutritional manifestations of cystic fibrosis , in Mangos JA, Talamo RC, (eds): Cystic Fibrosis: Projections Into the Future . New York, Stratton Intercontinental Medical Book Corp, 1976;, pp 83-111.

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