Issue: 2009 > May > original article

Current clinical care compared with new Dutch guidelines for hepatitis C treatment

S. Slavenburg, M.H. Lamers, R. Roomer, R.J. de Knegt, M.G.H. van Oijen, J.P.H. Drenth


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.
Conclusion: Dutch clinical practice reflects the recently
issued HCV guidelines. An important area of refinement
in treatment of HCV is the management of side effects.