Treatment of MASH in Patients Without Type 2 Diabetes Mellitus

Metabolic dysfunction-associated steatohepatitis (MASH) in non-diabetic patients represents a clinically distinct setting. Randomised controlled trial evidence supports specific oral pharmacological options for this population, with histological endpoints as the primary measure of response.

Clinical Scenario

Metabolic dysfunction-associated steatohepatitis (MASH) in a patient without type 2 diabetes mellitus. Vitamin E has been shown to improve steatohepatitis specifically in this population; pioglitazone has demonstrated benefit in MASH patients regardless of diabetic status.

Treatment Approach

Oral pharmacotherapy is available for this scenario. One studied approach involves antioxidant supplementation; the complete set of options, clinical decision criteria, and any relevant sequencing are detailed in the full structured protocol.

Clinical Goals

The therapeutic target is improvement of intrahepatic inflammation and steatohepatitis on liver histology, with resolution of NASH as the primary success criterion.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.3350/cmh.2025.0045

Vitamin E can be expected to improve steatohepatitis in patients with MASH without T2DM, and pioglitazone can be expected to improve steatohepatitis in patients with MASH regardless of T2DM.
In the large-scale randomized phase III PIVENS study, high-dose vitamin E (800 IU/day) administration for 96 weeks showed significant improvement in intrahepatic inflammation as measured by histological examination compared to the control group (43% vs. 19%, P=0.001).
The resolution rate of NASH, a secondary endpoint, was 36% in vitamin E, which was higher than 21% in the control group.

View source ↗