Non-alcoholic steatohepatitis (NASH)

ICD-10 K76.01 drug

Drugs used for this condition

CAlpha-tocopherolCase-by-case decision · Fat-soluble vitamin EThe one evidence-based use of vitamin E. The PIVENS RCT (NEJM 2010) in non-diabetic adults showed resolution of steatohepatitis at 800 IU/day, though without improvement in fibrosis; the paediatric TONIC RCT (JAMA 2011) missed its primary endpoint of sustained ALT reduction. AASLD 2023 and EASL-EASD-EASO guidelines list vitamin E as an option in biopsy-proven non-alcoholic steatohepatitis without diabetes, not as first-line therapy: weight loss and lifestyle come first. Long-term high doses are linked to increased all-cause mortality, so the decision is individual and made under hepatology supervision.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit