Pioglitazone vs vitamin E for NASH

Non-alcoholic steatohepatitis (NASH) is a common liver disease that is difficult to treat and often progresses to cirrhosis. A new study compares the thiazolidinedione pioglitazone (30 mg daily) to vitamin E (800 IU daily) in a placebo-controlled trial for 96 weeks in 247 nondiabetic NASH patients. The primary outcomes were standardized scores for steatosis, lobar inflammation, hepatocellular ballooning, and fibrosis as determined by liver biopsy. Vitamin E therapy was associated with a significant improvement in non-alcoholic steatohepatitis (43% vs 19%; P = 0.001), but pioglitazone did not show statistical improvement (34% vs 19%; P = 0.04). Serum transaminases improved with both treatments, and both reduced hepatic steatosis and lobular inflammation, but neither improved fibrosis. Pioglitazone caused significant weight gain compared to vitamin E or placebo. The authors conclude that vitamin E was superior to placebo for the treatment of NASH in adults without diabetes (N Engl J Med2010;362:1675-1685).