Abstract
Vitamin E improves liver histology in non-diabetic adults with nonalcoholic steatohepatitis (NASH), but its impact on long-term patient outcomes is unknown. We evaluated whether vitamin E treatment improves clinical outcomes of NASH patients with bridging fibrosis or cirrhosis. Two hundred and thirty-six patients with biopsy-proven NASH and bridging fibrosis or cirrhosis seen at Indiana University Medical Center between October 2004, and January 2016 were included. Ninety of them took 800 IU/day of vitamin E for ≥ 2 years (vitamin E users) and were propensity matched to 90 adults who did not take vitamin E (controls) after adjusting for fibrosis severity, age, gender, body mass index, comorbidities and their treatment, LDL cholesterol, liver biochemistries and length of follow-up on vitamin E. Covariate-adjusted cox and competing risk regression models were assessed to evaluate association between vitamin E treatment and patient outcomes. The median follow-up was 5.62 (IQR: 4.3-7.5) and 5.6 (IQR: 4-6.9) years for vitamin E users and controls respectively. Vitamin E users had higher adjusted transplant-free survival (78% vs. 49%, P<.01) and lower rates of hepatic decompensation (37% vs. 62%, P=.04) than controls. After controlling for severity of fibrosis, calendar year of patient enrollment and other potential confounders, vitamin E treatment decreased the risk of death or transplant (adj. HR: 0.30, 95% CI: 0.12-0.74, P<.01) and hepatic decompensation (adj. sHR: 0.52, 95% CI: 0.28-0.96, P=.036). These benefits were evident in both diabetics as well as non-diabetics. Adjusted 10-year cumulative probability of HCC, vascular events and non-hepatic cancers were not different between vitamin E exposed and controls. CONCLUSION: vitamin E use was associated with improved clinical outcomes in patients with NASH and bridging fibrosis or cirrhosis.