Vitamin E (mixed tocopherols) has been investigated as a supportive therapy for hepatitis, particularly nonalcoholic steatohepatitis (NASH), a form of nonalcoholic fatty liver disease. The rationale for its use is largely based on its role as a potent lipid-soluble antioxidant, which may help counteract the oxidative stress implicated in the pathogenesis of liver inflammation and fibrosis. Several randomized controlled trials, such as the PIVENS trial (Sanyal et al., 2010, NEJM), have shown that high-dose vitamin E (800 IU/day) can improve liver histology in adults with NASH who do not have diabetes. These studies found reductions in steatosis, inflammation, and ballooning but not necessarily in fibrosis. However, the evidence for its use in viral hepatitis (such as hepatitis B or C) is minimal and inconsistent, with limited clinical trials and no strong recommendations from major hepatology societies.

The American Association for the Study of Liver Diseases (AASLD) recommends considering vitamin E for nondiabetic adults with biopsy-proven NASH, but not for other forms of hepatitis. There are concerns about long-term safety at high doses, including possible increased risk of all-cause mortality and hemorrhagic stroke. In summary, while there is some scientific evidence supporting vitamin E for certain types of hepatitis (specifically NASH), its value for viral hepatitis is not well established, and overall evidence quality is moderate at best.