Interferon- for chronic hepatitis B is often ineffective and is associated with drawbacks, such as prolonged parenteral schedules, high costs, and side effects [1]. Oral vitamin E is an inexpensive antioxidant that can stimulate the immune response and does not induce side effects [2]. We evaluated vitamin E supplementation as therapy for chronic hepatitis B.

Twenty-four patients (12 were positive for hepatitis B e antigen [HBeAg] and 12 were infected by the "e" minus mutant) with elevated serum alanine aminotransferase (ALT) levels and serum hepatitis B virus DNA (Abbott Laboratories, North Chicago, Illinois) were randomly assigned to receive vitamin E, 300 mg twice daily for 3 months (n = 12), or no treatment (n = 12). They were followed monthly for 9 months. Nineteen patients (10 in the vitamin E group and 9 controls) had been unsuccessfully treated with interferon-. At study entry, the study groups were similar with respect to demographic, clinical, and laboratory features. Four HBeAb-positive patients discontinued vitamin E therapy because of severe increases in ALT levels (>10-fold the normal upper limit). A similar finding was seen in 2 controls. The biochemical and virologic responses after 3 and 9 months are shown in the (Table 1). Of the 5 patients with complete response, 2 were positive for HBeAb and 3 were positive for HBeAg at study entry. The HBeAg-positive patients seroconverted to HBeAb during the study period, whereas none of the controls seroconverted from HBeAg to HBeAb. Three of 5 patients with complete response had not responded to previous interferon- treatment. Treatment with vitamin E had no side effects. These results suggest that vitamin E is a safe and useful treatment for chronic hepatitis B. Although the mechanism through which these results were achieved is unknown, the stimulatory effect of vitamin E on the immune system probably played a major role. Further studies are needed to confirm these data and to evaluate the effects of a possible combination with other antiviral drugs.