Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 28, 2017; 9(6): 333-342
Published online Feb 28, 2017. doi: 10.4254/wjh.v9.i6.333
Vitamin E for the treatment of children with hepatitis B e antigen-positive chronic hepatitis: A systematic review and meta-analysis
Sirio Fiorino, Maria Letizia Bacchi-Reggiani, Paolo Leandri, Elisabetta Loggi, Pietro Andreone
Sirio Fiorino, Paolo Leandri, Unità Operativa di Medicina Interna C, Ospedale Maggiore, AUSL Bologna, 40100 Bologna, Italy
Maria Letizia Bacchi-Reggiani, Unità Operativa Malattie Cardiovascolari, Azienda Ospedaliero Universitaria di Bologna, Policlinico Sant’Orsola-Malpighi, 40100 Bologna, Italy
Elisabetta Loggi, Pietro Andreone, Dipartimento di Scienze Mediche e Chirurgiche, Azienda Ospedaliero Universitaria di Bologna, Policlinico Sant’Orsola-Malpighi, 40100 Bologna, Italy
Author contributions: Fiorino S conceived the study, coordinated and supervised the search activity, evaluated the quality of the selected studies, wrote the final draft of the manuscript and checked the accuracy of data collection; Bacchi-Reggiani ML and Andreone P extracted and tabulated all relevant data from the included studies by means of a standardized method, evaluated the quality of the selected studies; Bacchi-Reggiani ML also analyzed the data; Leandri P and Loggi E performed the literature search, identified and screened the articles by consulting the above-reported database and evaluated the quality of the selected studies; Andreone P commented on drafts of the manuscript and was responsible for the final approval of the manuscript; all authors approved the final version of the article, including the authorship list.
Conflict-of-interest statement: Nothing to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Sirio Fiorino, MD, Unità Operativa di Medicina Interna C, Ospedale Maggiore, AUSL Bologna, Largo Nigrisoli 2, 40100 Bologna, Italy.
Telephone: +39-5-16478656 Fax: +39-5-13172993
Received: October 3, 2016
Peer-review started: October 8, 2016
First decision: November 10, 2016
Revised: December 24, 2016
Accepted: January 16, 2017
Article in press: January 18, 2017
Published online: February 28, 2017

To assess vitamin E efficacy, defined as its ability to induce hepatitis B e antigen (HBeAg) seroconversion, in children with HBeAg-positive persistent hepatitis.


In July 2016, we extracted articles published in MEDLINE and the Cochrane Library using the following search terms: “chronic hepatitis B”, “children”, “childhood”, “therapy”, “treatment”, “vitamin E”, “tocopherols”, “tocotrienols”. Only randomized controlled trials (RCTs) published in English language were collected.


Three RCTs met inclusion criteria and were considered in the present meta-analysis. Overall, 23/122 children in the treatment group underwent HBeAg seroconversion vs 3/74 in the control group (OR = 3.96, 95%CI: 1.18-13.25, P = 0.025).


Although our meta-analysis has several limits, including the very small number of available studies and enrolled children with HBeAg positivity-related hepatitis, it suggests that vitamin E use may enhance the probability to induce HBeAg seroconversion in these patients. Further well designed and adequately sized trials are required to confirm or deny these very preliminary results.

Keywords: Hepatitis B, Pediatric hepatology, Viral hepatitis, Immunology

Core tip: Treatment of chronic hepatitis B in children is still an area of uncertainty. Vitamin E, based on immunostimulatory anti-inflammatory activity, has been evaluated in the treatment of pediatric hepatitis B virus infection. These few experiences seem to be encouraging as they suggest a potential role of vitamin E in inducing HBeAg seroconversion, but they need to be confirmed in well-designed and adequately-sized trials.