Bril F, et al. - In this proof-of-concept, randomized, double-blind, placebo-controlled trial, researchers ascertained if histology in type 2 diabetes mellitus (T2DM) and nonalcoholic steatohepatitis (NASH) patients can be improved with vitamin E, alone or in combination with pioglitazone. For this trial conducted from 2010 to 2016, the primary outcome was a two-point reduction in the nonalcoholic fatty liver disease activity score and secondary outcomes were resolved NASH without worsening of fibrosis. They observed that more patients on combination therapy achieved the primary outcome vs placebo, but not compared to vitamin E alone. Compared with placebo, both groups showed improvements in resolution of NASH. Steatosis improved with combination therapy and vitamin E alone. Inflammation and ballooning solely improved with combination therapy. In patients with NASH and T2DM, combination therapy was superior to placebo in improving liver histology while vitamin E alone was not significant in changing the primary histology of the liver.