Randomized Placebo-Controlled Trial of Ursodeoxycholic Acid With Vitamin E in Nonalcoholic Steatohepatitis

The diagnosis and management of non-alcoholic fatty liver disease: Practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association

“…Vitamin E is an anti-oxidant and has been investigated to treat NASH. [124][125][126][127][128] Comparison between these trials is difficult due to varying criteria for entry into the study, different doses of vitamin E and unclear formulations of vitamin E used which could affect its bioavailability, the additional use of other anti-oxidants or other drugs and limited histologic data to assess outcomes. Also, most studies were relatively under-powered and did not meet or publish CONSORT criteria for clinical trials.…”

“…(Strength -1, Quality -B) 22. Until further data supporting its effectiveness become available, vitamin E is not recommended to treat NASH in diabetic patients, NAFLD without liver biopsy, NASH cirrhosis, or cryptogenic cirrhosis (Strength -1, Quality -C) Ursodeoxycholic acid (UDCA), Omega-3 fatty acids, and Miscellaneous Agents Several studies 126,[137][138][139][140] investigated UDCA (conventional and high doses) to improve aminotransferases and steatosis in patients with NAFLD and liver histology in patients with NASH. All but one study 139 have been proof-of-concept studies with small numbers of participants and/or surrogate endpoints.…”

EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease

“…Vitamin E may be used in non-cirrhotic non-diabetic NASH patients but further studies are needed before firm recommendations can be made. Ursodeoxycholic acid (UDCA) has been investigated in several RCTs, at different doses and for up to 2 years, but only showed some biochemical but no histological improvements [83,87,96].…”

Impact of current treatments on liver disease, glucose metabolism and cardiovascular risk in non-alcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis of randomised trials

“…TGR5 is a G-protein-coupled receptor (expressed in brown adipose tissue muscle and gut), activation of which by bile acids increases energy expenditure and glucagonlike peptide-1 (GLP-1) secretion and attenuates diet-induced obesity [89,90].…”