Impact of the pancreatic enzyme replacement therapy (PERT) shortage on prescribing in England: Analysis of national data

Abstract

Aim

Pancreatic enzyme replacement therapy (PERT) is essential for the management of pancreatic exocrine insufficiency. Since June 2023, the United Kingdom has been affected by a global shortage of PERT. We investigated the impact of this shortage on national prescribing trends for Creon, Nutrizym, Pancrex and Pangrol.

Methods

We analysed primary and secondary care prescribing data in England from January 2019 to February 2026 and used linear regression with an interrupted time series approach to assess the impact of the shortage.

Results

Creon 25 000 was the most prescribed PERT with an increasing trend. Following the onset of the shortage, prescribing in primary care increased to 12 192 (95% CI: 11 682–12 702) thousand capsules across 43 203 (41 549–44 856) prescriptions per month but remained below predicted levels (p < 0.001). Secondary care prescribing was higher than predicted (p < 0.001). Prescribing of Creon 10 000 also increased, with an excess of 912 (493–1330) thousand capsules and 2202 (1308–3097) prescriptions per month in primary care and 235 (192–279) thousand capsules in secondary care (approximately threefold higher than predicted, p < 0.001). Nutrizym more than doubled in primary care to 841 (743–940) and tripled in secondary care to 30 (24–35) thousand capsules per month (p < 0.001). Pancrex doubled in primary care (p = 0.001) but remained below predicted levels in secondary care (p = 0.005). The number of capsules per prescription increased for Creon 10 000 by 15 (6–23; p = 0.002) but decreased for all other formulations (p < 0.001).

Conclusion

Although prescribing remained highest for Creon 25 000, the shortage was associated with a shift towards Creon 10 000 and an increase in alternative products, particularly Nutrizym.