Shufei Zang1, Jin Chen2, Yu Song1, Lang Bai3, Jinjun Chen4, Xiaoling Chi5, Fangping He6, Huiping Sheng7, Jing Wang8, Shilong Xie9, Wen Xie10, Yongfeng Yang11, Jing Zhang12, Minghua Zheng13, Zhengsheng Zou14, Bingyuan Wang15, Junping Shi16. 1. Department of Endocrinology, Hangzhou Normal University Affiliated Hospital, Hangzhou, Zhejiang, China. 2. Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China. 3. West China Hospital, Sichuan University, Chengdu, Sichuan, China. 4. Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China. 5. Guangdong Provincial Chinese Medicine Hospital, Guangzhou, Guangdong, China. 6. The First Affiliated Hospital of Xinjiang Medical, Urumqi, Xinjiang, China. 7. General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China. 8. Department of Hepatobiliary Disease, Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University, Luzhou, Sichuan, China. 9. Zhejiang Medicine Co. Ltd, Hangzhou, Zhejiang, China. 10. Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China. 11. The Second Hospital of Nanjing, Nanjing, Jiangsu, China. 12. Beijing You An Hospital Capital Medical University, Beijing, China. 13. Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China. 14. Beijing 302 Military Hospital of China, Beijing, China. 15. The First Hospital of China Medical University, Shenyang, Liaoning, China. wangby0908@163.com. 16. Department of Hepatology, Hangzhou Normal University Affiliated Hospital, Hangzhou, Zhejiang, China. davidshi0571@126.com.
Abstract
INTRODUCTION:Vitamin E is one of the most promising agents for nonalcoholic steatohepatitis (NASH) treatment, and its drug responsiveness may be closely associated with haptoglobin (Hp) genotype. However, its efficacy and safety remain unknown in China. This clinical trial of vitamin E versus placebo for the treatment of nondiabetic patients with nonalcoholic steatohepatitis (VENS) is conducted to evaluate (a) the efficacy and safety of treatment with vitamin E softgel (300 mg/day) determined from standardized histologic scoring of liver biopsies, (b) whether treatment with vitamin E improves biochemical parameters, cytokines, anthropometric parameters, controlled attenuation parameter (CAP), and transient elastography (TE) values determined by Fibroscan and health-related quality of life (SF-36), (c) whether the efficacy of vitamin E treatment is associated with the Hp genotype in nondiabetic adults with NASH. METHODS:VENS is a multicenter, randomized, double-masked, placebo parallel controlled trial to evaluate the efficacy and safety of treatment with vitamin E softgel in nondiabetic adults with NASH versus treatment with placebo in China. Liver biopsies are read by a pathological evaluation committee independently according to the NASH Clinical Research Network (CRN) scoring system. The NAFLD activity score (NAS) represents the sum of scores for steatosis, lobular inflammation, and hepatocyte ballooning. The definition of histologic improvement requires all three of the following criteria to be met: (a) either improvement in NAS by at least 2 points or post-treatment NAS score no higher than 3, (b) at least 1-point improvement in the score for ballooning, and (c) no worsening of fibrosis stages. We plan to recruit 120 biopsy-proven NASH patients from13 centers in China. Participants will be randomly assigned to groups treated with either with vitamin E (100 mg, tid) or placebo for 96 weeks then followed by 24 weeks of post-treatment observation. Biochemical parameters, cytokines, anthropometric parameters, CAP and TE values, Hp genotype, and several questionnaires will be collected as per the schedule. This protocol was approved by the Ethics Committee of Hangzhou Normal University Affiliated Hospital to ensure patients safety, and R&G Pharmastudies Co., Ltd. was established for monitoring the accumulated interim data to review efficacy and quality of data collection and overall study management. RESULTS: As a preliminary study, a mobile phone application (app) for lifestyle modification and database recording ( http://laiyivens.365hy.com ) was exploited for every participant. The percentage of NAFLD patients with Hp 2-2 allele is much higher than that of Western patients (65.71% vs 36%, respectively), which suggests that the Chinese benefit more from vitamin E treatment. CONCLUSION:VENS is the first randomized controlled trial (RCT) to evaluate the efficacy of Vitamin E in treating nondiabetic NASH patients in China. TRIAL REGISTRATION: This study registered at https://clinicaltrials.gov (registration number: NCT02962297). FUNDING: Zhejiang Medicine Co., Ltd.
RCT Entities:
INTRODUCTION: Vitamin E is one of the most promising agents for nonalcoholic steatohepatitis (NASH) treatment, and its drug responsiveness may be closely associated with haptoglobin (Hp) genotype. However, its efficacy and safety remain unknown in China. This clinical trial of vitamin E versus placebo for the treatment of nondiabeticpatients with nonalcoholic steatohepatitis (VENS) is conducted to evaluate (a) the efficacy and safety of treatment with vitamin E softgel (300 mg/day) determined from standardized histologic scoring of liver biopsies, (b) whether treatment with vitamin E improves biochemical parameters, cytokines, anthropometric parameters, controlled attenuation parameter (CAP), and transient elastography (TE) values determined by Fibroscan and health-related quality of life (SF-36), (c) whether the efficacy of vitamin E treatment is associated with the Hp genotype in nondiabetic adults with NASH. METHODS: VENS is a multicenter, randomized, double-masked, placebo parallel controlled trial to evaluate the efficacy and safety of treatment with vitamin E softgel in nondiabetic adults with NASH versus treatment with placebo in China. Liver biopsies are read by a pathological evaluation committee independently according to the NASH Clinical Research Network (CRN) scoring system. The NAFLD activity score (NAS) represents the sum of scores for steatosis, lobular inflammation, and hepatocyte ballooning. The definition of histologic improvement requires all three of the following criteria to be met: (a) either improvement in NAS by at least 2 points or post-treatment NAS score no higher than 3, (b) at least 1-point improvement in the score for ballooning, and (c) no worsening of fibrosis stages. We plan to recruit 120 biopsy-proven NASH patients from13 centers in China. Participants will be randomly assigned to groups treated with either with vitamin E (100 mg, tid) or placebo for 96 weeks then followed by 24 weeks of post-treatment observation. Biochemical parameters, cytokines, anthropometric parameters, CAP and TE values, Hp genotype, and several questionnaires will be collected as per the schedule. This protocol was approved by the Ethics Committee of Hangzhou Normal University Affiliated Hospital to ensure patients safety, and R&G Pharmastudies Co., Ltd. was established for monitoring the accumulated interim data to review efficacy and quality of data collection and overall study management. RESULTS: As a preliminary study, a mobile phone application (app) for lifestyle modification and database recording ( http://laiyivens.365hy.com ) was exploited for every participant. The percentage of NAFLDpatients with Hp 2-2 allele is much higher than that of Western patients (65.71% vs 36%, respectively), which suggests that the Chinese benefit more from vitamin E treatment. CONCLUSION: VENS is the first randomized controlled trial (RCT) to evaluate the efficacy of Vitamin E in treating nondiabetic NASH patients in China. TRIAL REGISTRATION: This study registered at https://clinicaltrials.gov (registration number: NCT02962297). FUNDING: Zhejiang Medicine Co., Ltd.
Authors: Oluyemi Komolafe; Elena Buzzetti; Audrey Linden; Lawrence Mj Best; Angela M Madden; Danielle Roberts; Thomas Jg Chase; Dominic Fritche; Suzanne C Freeman; Nicola J Cooper; Alex J Sutton; Elisabeth Jane Milne; Kathy Wright; Chavdar S Pavlov; Brian R Davidson; Emmanuel Tsochatzis; Kurinchi Selvan Gurusamy Journal: Cochrane Database Syst Rev Date: 2021-07-19
Authors: Michal S Beeri; Hung-Mo Lin; Mary Sano; Ramit Ravona-Springer; Xiaoyu Liu; Barbara B Bendlin; Carey E Gleason; Elizabeth Guerrero-Berroa; Laili Soleimani; Lenore J Launer; Scott Ehrenberg; Orit Lache; Yaakov K Seligman; Andrew P Levy Journal: JAMA Netw Open Date: 2018-11-02