Impact of the pancreatic enzyme replacement therapy (PERT) shortage on prescribing in England: Analysis of national data
5 affiliations
- 1Faculty of Health and Medical Sciences University of Surrey Guildford UK
- 2Nutrition and Dietetics Royal Surrey Hospital NHS Foundation Trust Guildford UK
- 3Bennett Institute for Applied Data Science University of Oxford Oxford UK
- 4HPB Surgical Unit Royal Surrey NHS Foundation Trust Guildford Surrey UK
- 5Imperial Clinical Trials Unit, School of Public Health Imperial College London London UK
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.
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BibTeX
@article{varghese2026impact,
title = {{Impact of the pancreatic enzyme replacement therapy (PERT) shortage on prescribing in England: Analysis of national data}},
author = {Teena S. Varghese and Mary E. Phillips and Louis Fisher and Helen Fitt and Adam Frampton and Christopher Wood and Agnieszka Lemanska},
journal = {British Journal of Clinical Pharmacology},
year = {2026},
month = jul,
doi = {10.1002/bcp.70703},
url = {https://doi.org/10.1002/bcp.70703},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Impact of the pancreatic enzyme replacement therapy (PERT) shortage on prescribing in England: Analysis of national data
AU - Teena S. Varghese
AU - Mary E. Phillips
AU - Louis Fisher
AU - Helen Fitt
AU - Adam Frampton
AU - Christopher Wood
AU - Agnieszka Lemanska
PY - 2026
DA - 2026/07/15
JO - British Journal of Clinical Pharmacology
DO - 10.1002/bcp.70703
UR - https://doi.org/10.1002/bcp.70703
AB - 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.
SN - 0306-5251
SN - 1365-2125
ER -