Table 3a.

Meta-analyses and systematic reviews

Intermediary of health effect	References	Specification Ginkgo biloba+dose (PASSCLAIM criterion 1 + 2E)	Study design + duration (PASSCLAIM criterion 2)	Study population (N, age group) (PASSCLAIM criteria 2A + 2B)	Information on background diet, matrix and compliance? (PASSCLAIM criteria 2D + 2F + 2G)
Blood circulation: patient studies
Intermittent claudication	Nicolai et al. (23)	Standardized Ginkgo biloba extract, in most studies EGb761	Meta-analysis; 14 randomized, controlled trials	Patients (18 years and older) with intermittent claudication, stage II according to Fontaine, stages 1–3 according to Rutherford	For some studies information is included
Peripheral arterial occlusive disease (PAOD)	Horsch and Walther (21)	EGb761; daily dose: 120 mg (five studies) or 160 mg (four studies); study period: 1×6 weeks, 1×3 months, 6×6 months	Meta-analysis; 9 clinical trials, randomized, double-blind, placebo-controlled. Total 619 patients criteria: randomized, double-blind, placebo-controlled, clinical studies, oral application form of EGb761, assessment of pain-free walking distance.	Patients with the indication peripheral arterial occlusive disease (PAOD) in stage II according to Fontaine	No information
Intermittent claudication	Pittler and Ernst (22)	Ginkgo biloba extract, 3×EGb761, other studies GB extract not further specified daily dose: 5×120 mg; 3×160 mg	Meta-analysis, 8 studies. Inclusion criteria: randomized, double-blind, placebo controlled, no combination with other medications or remedies, assess walking distance, no language restrictions. Methodologic quality assessed by scoring system.	Patients with intermittent claudication (n=415), categorized according to the Fontaine criteria.	No information
		Study period: 1×6 weeks, 1×12 weeks, 6×24 weeks
Cerebral insufficiency	Hopfenmuller (82)	Mostly used of 150 mg/day Ginkgo biloba extract (LI1370)	Meta-analysis 8 placebo controlled, randomized double-blind studies (out of 11). Studies were comparable with regard to diagnoses, inclusion and exclusion criteria and methodology.	Elderly patients (21–63 to 55–80 year); with cerebral insufficiency; in- and exclusion criteria comparable.	No information
Cerebral insufficiency	Kleijnen and Knipschild (24)	EGb 761 (24% gingko-flavone glycosides, 6% terpenoids); LI 1370 (25% ginkgo-flavone glycosides, 6% terpenoids). There may be differences in composition of preparations depending on manufacturing process used.	Systematic review eight randomized double-blind, placebo-controlled human studies (out of 40), investigating the utility of Ginkgo Biloba for ‘cerebral insufficiency.’	Patients aged 50+ with mild to moderate symptoms of cerebral insufficiency (indication and duration of symptoms specified if known).	No information
		In most trials, 120–160 mg/day, divided in three doses, was used; 6 weeks to 12 months.
Memory improvement: studies in healthy volunteers
Cognitive function in healthy subjects	Canter and Ernst (87)	Standardized Ginkgo biloba extracts: EGb761 (24% flavonoid glyco, 6% terpene lactones) GK501 (24% flavo, 6% terpene) LI1370 (27% flavo, 7% terpene) Ginkgo biloba forte (24% flavo, 6% terpene)	Review: of placebo-controlled double-blind trials: 9 trials, mainly short term (1–30 days). (literature search to Nov 2001)	Healthy subjects with no diagnosed relevant medical condition, mean age <60 year, EXCLUDING subjects with age-related memory impairment or ‘cerebral insufficiency.’	No information
		At different dose
Memory improvement: patient studies
Cognitive decline/dementia	Birks et al. (28) (updated in 2007 and 2009 (30, 32)	All but one study * used a Ginkgo preparation based on the standard extract (=24 mg flavone glycosides, 6 mg ginkgolides/100 mg); daily dose: 80–600 mg/day (usually < 200).	Meta-analysis 33 included studies: unconfounded, randomized, double-blind controlled; duration 3–52 weeks (majority 12 weeks) update 2009: 36 included trials	People with acquired cognitive impairment, including dementia, of any degree of severity. Excl: other serious illnesses, other mental illnesses, illness that can cause the memory problems; many excluded people with a history of abuse of alcohol, drugs, or medication. Most, but not all studies excluded patients on vasoactive drugs, antipsychotics, neuroleptics, cholinergic, antidepressants.	No information
Alzheimer disease	Oken et al. (98)	EGb761 and Tanakan daily dose: 120–240 mg	Meta-analysis of 4 studies inclusion criteria: sufficiently characterized patients with diagnosis of Alzheimer disease; clearly stated study exclusion criteria for depression, other neurologic disease, central nervous system-active medications; use of standardized ginkgo extract; randomized placebo-controlled, double-blind study design; at least one objective assessment of cognitive function as outcome measure; sufficient statistical information	Patients with a diagnosis of Alzheimer disease, by criteria; N=424 (212 ginkgo group, 212 placebo group)	Use of central nervous system-active medications excluded
		Study duration: 12–24–26 weeks