EASL Clinical Practice Guidelines

Methodology

These EASL CPGs have been developed by a panel of experts chosen by the EASL Governing Board. The recommendations were peer-reviewed by external expert reviewers and approved by the EASL Governing Board. The CPGs were established using data collected from PubMed and Cochrane database searches. The CPGs have been based as far as possible on evidence from existing publications, and, if evidence was unavailable, the experts' personal experiences and opinion. Where possible, the level of evidence and recommendation are cited. The evidence and recommendations in these guidelines have been graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The strength of recommendations thus reflects the quality of underlying evidence. The principles of the GRADE system have been enunciated [26]. The quality of the evidence in the CPG has been classified into one of three levels: high (A), moderate (B) or low (C). The GRADE system offers two grades of recommendation: strong (1) or weak (2) (Table 1). The CPGs thus consider the quality of evidence: the higher the quality of evidence, the more likely a strong recommendation is warranted; the greater the variability in values and preferences, or the greater the uncertainty, the more likely a weaker recommendation is warranted.

Table 1
Evidence grading used in the EASL HCV Clinical Practice Guidelines (adapted from the GRADE system).

The HCV CPG Panel has considered the following questions:
How should acute and chronic hepatitis C be diagnosed?

  • What are the goals and endpoints of treatment?
  • What are the results of current therapies and the predictors of response?
  • How should patients be assessed before therapy?
  • What are the contra-indications to therapy?
  • Who should be treated with current licensed drugs?
  • For whom can treatment be deferred?
  • What first-line treatment should be prescribed?
  • How should treatment be managed?
  • How should treatment be tailored to the virological response?
  • How can SVR rates of antiviral treatment be improved?
  • How should patients with SVR be followed?
  • What should be offered to those who fail to achieve SVR?
  • How should patients with severe liver disease be treated?
  • How should special groups of patients be treated?
  • How should patients, infected after substance use, be treated?
  • How should we treat patients with acute hepatitis C?
  • How should untreated patients and non-sustained responders be followed?
  • What are the perspectives of new treatments?