Current clinical care compared with new Dutch guidelines for hepatitis C treatment.
BACKGROUND
Recently, the Dutch Association of Gastroenterology and Hepatology issued new guidelines for the treatment of chronic hepatitis C virus (HCV). These guidelines reflect the current standard of care. Before these guidelines were published and implemented we (1) studied the current clinical care of HCV patients among Dutch physicians, and (2) identified areas for future refinement in the current treatment.


METHODS
We conducted a non-targeted survey among Dutch medical specialists in Gastroenterology, Hepatology and Internal Medicine who actively treat HCV patients. The questionnaire contained items about facility, duration and dosing of treatment, and side effect management using clinical vignettes followed by short questions.


RESULTS
We received 49 questionnaires from treating HCV specialists. The majority (65%) of respondents treat HCV patients during regular outpatient clinics, while 35% treat these patients in a separate setting dedicated to the care of HCV patients. The majority of physicians follow the stipulated dosage regimens of pegylated interferon (88%) and ribavirin (83%). A minority (13%) exceed the advised dosage of ribavirin. Side effects such as neutropenia are mostly managed by decreasing the interferon dosage (42%). Some 35% of physicians reduce ribavirin if haemoglobin levels drop below 5.4 mmol/l, and 41% initiate erythropoietin treatment.


CONCLUSIONS
Dutch clinical practice reflects the recently issued HCV guidelines. An important area of refinement in treatment of HCV is the management of side effects.
Slavenburg
S
S
Departments of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. S.Slavenburg@MDL.umcn.nl
Lamers
M H
MH
Roomer
R
R
de Knegt
R J
RJ
van Oijen
M G H
MG
Drenth
J P H
JP
D000998:Antiviral Agents / Q000008:administration & dosage; D005838:Genotype; D019983:Guideline Adherence / Q000706:statistics & numerical data; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000628:therapy*; D006801:Humans; D009426:Netherlands; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012254:Ribavirin / Q000008:administration & dosage; D012955:Societies, Medical; D011795:Surveys and Questionnaires; D019562:Viral Load
D000998:Antiviral Agents; D012254:Ribavirin