- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01430234
Enzyme Suppletion in Exocrine Pancreatic Dysfunction (SAPES)
Enzyme Substitution in Exocrine Pancreatic Insufficiency; Self Administration Against a Fixed Dose Regimen
Study Overview
Status
Intervention / Treatment
Detailed Description
This is a prospective, open, comparative study with a linear design with two sequential phases (observatory, then patient-monitored).
The research population consists of patients who are treated with pancreatic enzymes (< 6 capsules p/d containing 25,000 units of lipase) for exocrine insufficiency caused by chronic pancreatitis.
After inclusion, patients will discontinue taking pancreatic enzymes during one week (wash-out period). The last four days of this week, a fecal fat balance test will be performed to quantify the fecal fat loss without enzyme correction. If the fecal fat excretion is less than 15%, this is considered normal and therefore the patient will be excluded from the study. Subsequently, the next three weeks of the trial the patient will restart using the same dose of pancreatic enzymes the way it was prescribed before inclusion. The last four days of the fourth week, a fecal fat balance test will be repeated to quantify the fecal fat loss with enzyme correction. After this test the intervention takes place, consisting of a standardised education of the patient by a dietician. In the second phase of four weeks, patients are stimulated to use this information to self-dose the amount of pancreatic enzymes according to the fat content of their diet. In the last week of the study a fecal fat balance test will be repeated.
The primary endpoint is the fecal fat excretion. Secondary endpoints are the change in enzyme dose after intervention, improvement of complaints (e.g. steatorrhoea related complaints, abdominal cramps, abdominal pain), change in dietary habits, patient satisfaction, quality of life, evaluation of the nutritional status, and the occurrence of side effects.
Because the maximum amount of 16 capsules of pancreatic enzymes a day according to the standard guidelines will not be exceeded in this trial, no risks are foreseen. The anticipated benefit of the study is that patients will be treated more effectively for their EPI. The burden of this trial for patients is the repeated fecal fat balance test.
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
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Zuid-Holland
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Rotterdam, Zuid-Holland, Netherlands, 3000 WB
- Erasmus Medical Center
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- age ≥ 18 years.
- EPI caused by CP.
- Treated with enzyme therapy (≤ 6 capsules of 25.000 FIP-E units of lipase per day).
- Fecal elastase < 0.200 mg/g
- fecal fat-absorption < 85% without using enzymes.
Exclusion Criteria:
- Subjects who are unwilling or unable to understand and participate in the study and/or sign the informed consent.
- Any known gastro-intestinal disease or major gastrointestinal or pancreatic surgery that could potentially affect the intestinal absorption or metabolism of fat
- Gastroparesis of any aetiology
- Hypersensitivity to pork protein
- Acute pancreatitis
- Limited life-expectancy of ≤ 6 months
- Malignancy of the pancreas
- Pregnancy/lactation
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Crossover Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: Panzytrat fixed dose vs. self-dosing
In Phase I (week 1-4) patients will use the fixed amount of lipase as was prescribed by their treating physician.
Phase II (week 5-9) patients will start the self-dosage regimen with pancreatic enzymes (without exceeding the maximum amount of 16 capsules per day).
They are properly educated by the researcher and dietician how to adjust the amount of pancreatic enzymes to the fat intake in their diet.
|
patients will experiment with Panzytrat (containing 25.000 units of lipase) to a maximum of 16 capsules a day according to general guidelines.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Fecal Fat percentage
Time Frame: week 1, 5 and 9
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difference in efficacy measured by the fecal fat content during treatment with pancreatic enzymes in a self-dosage regimen after extensive patient-education in comparison to the standard treatment for patients with EPI due to chronic pancreatitis
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week 1, 5 and 9
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
enzyme dose
Time Frame: On a weekly base during 9 weeks
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Change in enzyme dose
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On a weekly base during 9 weeks
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Improvement of steatorrhea-related complaints
Time Frame: On a weekly base during 9 weeks
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Improvement of complaints (e.g.
steatorrhoea, abdominal cramps, abdominal pain).
|
On a weekly base during 9 weeks
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Change in dietary habits
Time Frame: Week 1, 5 and 9
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Change in dietary habits by means of a food diary
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Week 1, 5 and 9
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Patient satisfaction
Time Frame: Week 4 and 9
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Patient satisfaction by means of a SF36 questionnaire
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Week 4 and 9
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Quality of life
Time Frame: week 4 and 9
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Quality of life by means of a SF36 questionnaire
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week 4 and 9
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Evaluation of the nutritional status
Time Frame: week 5 and 9
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Evaluation of the nutritional status in the blood and calculating the Body Mass Index (BMI)
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week 5 and 9
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Marco Bruno, MD, PhD, Department of Gastroeneterology and Hepatology, Erasmus University Medical Center
Publications and helpful links
General Publications
- Ramo OJ, Puolakkainen PA, Seppala K, Schroder TM. Self-administration of enzyme substitution in the treatment of exocrine pancreatic insufficiency. Scand J Gastroenterol. 1989 Aug;24(6):688-92. doi: 10.3109/00365528909093110.
- Czako L, Takacs T, Lonovics J, Lakner L, Dobronte Z, Pronai L, Tulassay Z. [Quality of life in the course of enzyme replacement therapy for chronic pancreatitis]. Orv Hetil. 2002 Jun 23;143(25):1521-7. Hungarian.
- Delhaye M, Meuris S, Gohimont AC, Buedts K, Cremer M. Comparative evaluation of a high lipase pancreatic enzyme preparation and a standard pancreatic supplement for treating exocrine pancreatic insufficiency in chronic pancreatitis. Eur J Gastroenterol Hepatol. 1996 Jul;8(7):699-703.
- Bruno MJ, Tytgat GN. [4 patients with painless diarrhea and weight loss]. Ned Tijdschr Geneeskd. 1994 Dec 17;138(51):2529-33. No abstract available. Dutch.
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- SAPES
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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