COMPARISON OF VITAMIN E AND URSODEOXYCHOLIC ACID IN NON-ALCOHOLIC STEATOHEPATITIS (NASH)

Background: Non-alcoholic steatohepatitis (NASH) is a progressive phenotype of non-alcoholic fatty liver disease characterized by hepatocellular injury, elevated transaminases, and a substantive risk of fibrosis progression. Antioxidant therapy (vitamin E) and bile acid–based therapy (ursodeoxycholic acid, UDCA) are commonly used, yet their short-term comparative biochemical effectiveness remains uncertain. Objective: To compare the effectiveness of vitamin E versus UDCA in reducing serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels over eight weeks in adults with NAFLD/NASH. Study design: Randomized controlled trial. Settings: Department of Medicine, Sir Ganga Ram Hospital, Lahore, Pakistan. Duration of study: 22 March 2025 to 22 June 2025. Methods: Ninety adult patients with NAFLD/NASH were randomized into two groups: UDCA 15 mg/kg/day or vitamin E 200 IU/day for eight weeks. Liver function tests (ALT, AST, alkaline phosphatase (ALP), total bilirubin, albumin) were recorded at baseline and eight weeks. Between-group comparisons of mean change from baseline were assessed using the Student's t-test with two-sided α=0.05.Results: Both interventions produced significant within-group reductions in ALT and AST at eight weeks. Vitamin E achieved greater mean reductions than UDCA in ALT (31.5 vs 25.2 U/L; p=0.002) and AST (27.6 vs 22.6 U/L; p=0.001). A significant decrease in ALP was also observed in the vitamin E group, whereas changes in total bilirubin and albumin were minimal in both groups. Conclusion: Over eight weeks, vitamin E produced larger reductions in serum transaminases than UDCA in adults with NAFLD/NASH, with additional improvement in ALP. Vitamin E may be preferred for short-term biochemical optimization in NASH, pending confirmation in longer-duration trials with histological endpoints.