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Impact of pancreatic enzyme replacement therapy on short- and long-term outcomes in advanced pancreatic cancer: meta-analysis of randomised controlled trials

Lookup NU author(s): Professor John LeedsORCiD, Jeremy French, Dr Manu Nayar, Professor Kofi Oppong, Professor Sanjay PandanaboyanaORCiD

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Abstract

ObjectivesPancreatic exocrine insufficiency (PEI) is frequent in unresectable and metastatic pancreatic cancer (advanced pancreatic cancer, APC) but the effect of pancreatic enzyme replacement therapy (PERT) on short- and long-term outcomes is not clear. We analysed randomised controlled trials (RCTs) to assess the impact of PERT on weight change, quality of life and overall survival (OS).MethodsAll RCTs indexed in PubMed, Medline, Scopus, and Cochrane databases reporting PEI in APC and the effect of PERT were included up to August 2020. The primary outcome measure was OS and secondary outcome measures were weight change and quality of life. Standard mean differences (SMD) were calculated for each outcome.ResultsFour RCTs including 194 patients (107 males) were analysed. 98 (50.5%) patients received PERT treatment. Treatment with PERT in APC did not show a significant effect on OS (SMD 0.12, 95% confidence interval -0.46 - 0.70, p=0.46). There was also no difference in change in body weight (SMD 0.53, 95% confidence interval -0.72 - 1.77, p=0.21). Quality of life was not significantly different in those taking PERT compared to controls.ConclusionsThe present meta-analysis found no significant difference in OS, change in weight or quality of life with use of PERT in APC. However, non-uniform designs and different end points of these studies, along with smaller number of patients limits a more in-depth analysis of outcomes. Further RCT’s including larger numbers of patients are warranted to support evidence of routine use of PERT in APC.

Publication metadata

Author(s): Ammar Khaled, Leeds J, Ratnayake Bathiya, French Jeremy, Nayar Manu, Oppong Kofi, Loveday Benjamin, Pandanaboyana Sanjay

Publication type: Article

Publication status: Published

Journal: Expert Reviews In Gastroenterology and Hepatology

Year: 2021

Volume: 15

Issue: 8

Pages: 941-948

Online publication date: 31/01/2021

Acceptance date: 29/01/2021

ISSN (print): 1747-4124

ISSN (electronic): 1747-4132

Publisher: Taylor & Francis

URL: https://doi.org/10.1080/17474124.2021.1884544

DOI: 10.1080/17474124.2021.1884544

PubMed id: 33522321

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