CREON Capsule containing gastro-resistant granules Ref.[8466] Active ingredients: Pancreatin

Multienzymes (amylase, lipase, protease)
ATC code: A09AA02

Creon contains porcine pancreatin formulated as enteric-coated (acid-resistant) minimicrospheres within gelatine capsules.

The capsules dissolve rapidly in the stomach releasing plenty of minimicrospheres, a multidose principle which is designed to achieve good mixing with the chyme, emptying from the stomach together with the chyme and after release, good distribution of enzymes within the chyme.

When the minimicrospheres reach the small intestine the coating rapidly disintegrates (at pH>5.5) to release enzymes with lipolytic, amylolytic and proteolytic activity to ensure the digestion of fats, starches and proteins. The products of pancreatic digestion are then either absorbed directly, or following further hydrolysis by intestinal enzymes.

Clinical efficacy

Overall 30 studies investigating the efficacy of Creon (Creon capsules with 10000, 25000 or 40000 Ph. Eur units of lipase and Creon 5000) in patients with pancreatic exocrine insufficiency have been conducted. Ten of these were placebo controlled studies performed in patients with cystic fibrosis, chronic pancreatitis or post surgical conditions.

In all randomized, placebo-controlled, efficacy studies, the pre-defined primary objective was to show superiority of Creon over placebo on the primary efficacy parameter, the coefficient of fat absorption (CFA).

The coefficient of fat absorption determines the percentage of fat that is absorbed into the body taking into account fat intake and faecal fat excretion. In the placebo-controlled PEI studies, the CFA (, mean±SD) was higher with Creon treatment (83.0±12.6) as compared to placebo (62.6±21.8%). The median treatment duration was 7 days on both treatments. In all studies, irrespective of the design, the mean CFA (%) at the end of the treatment period with Creon was similar to the mean CFA values for Creon in the placebo controlled studies.

Treatment with Creon markedly improves the symptoms of pancreatic exocrine insufficiency including stool consistency, abdominal pain, flatulence and stool frequency, independent of the underlying disease.

In placebo-controlled studies in which symptoms have been collected on diaries, the percentage of subjects with ‘no abdominal pain’ as most frequently reported rating was higher (73%) during Creon treatment than during placebo treatment (52%). The most frequently reported stool consistency was ‘formed/normal’ in 63% of the subjects during Creon treatment and in 17% of the subjects during placebo treatment. During Creon treatment, the percentage of subjects with ‘no flatulence’ as most frequently reported rating was higher (30%) than during placebo treatment (19%). The average number of daily stools was lower during Creon treatment than during placebo treatment (mean±SD: 1.89±0.87 vs 3.16±1.51).

In subjects with PEI due to CF in these studies, the percentage of subjects with ‘no abdominal pain’ as most frequently reported rating was 94% during Creon treatment and 60% during placebo treatment. The most frequently reported stool consistency was ‘formed/normal’ in 73% of the subjects during Creon treatment and in 18% of the subjects during placebo treatment. The percentage of subjects with ‘no flatulence’ as most frequently reported rating was 37% during Creon treatment and 26% during placebo treatment. The average number of daily stools (mean±SD) was 1.78±0.78 during Creon treatment and 3.24±1.49 during placebo treatment.

In subjects with PEI due to CP in these studies, the percentage of subjects with ‘no abdominal pain’ as most frequently reported rating was 55% during Creon treatment and 46% during placebo treatment. The most frequently reported stool consistency was ‘formed/normal’ in 45% of the subjects during Creon treatment and in 18% of the subjects during placebo treatment. The percentage of subjects with ‘no flatulence’ as most frequently reported rating was 26% during Creon treatment and 13% during placebo treatment. The average number of daily stools (mean±SD) was 2.07±1.08 during Creon treatment and 2.89±1.55 during placebo treatment.

Paediatric population

In cystic fibrosis (CF) the efficacy of Creon was demonstrated in 288 paediatric patients covering an age range from newborns to adolescents. In all studies, the mean end-of treatment CFA values exceeded 80% on Creon comparably in all paediatric age groups.