Vitamin E Improves Transplant‐free Survival and Hepatic Decompensation among Patients with NASH and Advanced Fibrosis

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.