Effects of Ginkgo Biloba

JAMA Abstracts - October 22, 1997

ERROR MSGA Placebo-Controlled, Double-blind, Randomized Trial of an Extract of Ginkgo Biloba for Dementia

Pierre L. Le Bars, MD, PhD; Martin M. Katz, PhD; Nancy Berman, PhD; Turan M. Itil, MD; Alfred M. Freedman, MD; Alan F. Schatzberg, MD; for the North American EGb Study Group

Context.EGb 761 is a particular extract of Ginkgo biloba used in Europe to alleviate symptoms associated with numerous cognitive disorders. Its use in dementias is based on positive results from only a few controlled clinical trials, most of which did not include standard assessments of cognition and behavior.

Objective.To assess the efficacy and safety of EGb in Alzheimer disease and multi-infarct dementia.

Design.A 52-week, randomized double-blind, placebo-controlled, parallel-group, multicenter study.

Patients.Mildly to severely demented outpatients with Alzheimer disease or multi-infarct dementia, without other significant medical conditions.

Intervention.Patients assigned randomly to treatment with EGb (120 mg/d) or placebo. Safety, compliance, and drug dispensation were monitored every 3 months with complete outcome evaluation at 12, 26, and 52 weeks.

ERROR MSGPrimary Outcome Measures.Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog), Geriatric Evaluation by Relative's Rating Instrument (GERRI), and Clinical Global Impression of Change (CGIC).

Results.From 309 patients included in an intent-to-treat analysis, 202 provided evaluable data for the 52-week end point analysis. In the intent-to-treat analysis, the EGb group had an ADAS-Cog score 1.4 points better than the placebo group (P=.04) and a GERRI score 0.14 points better than the placebo group (P=.004). The same patterns were observed with the evaluable data set in which 27% of patients treated with EGb achieved at least a 4-point improvement on the ADAS-Cog, compared with 14% taking placebo (P=.005); on the GERRI, 37% were considered improved with EGb, compared with 23% taking placebo (P=.003). No difference was seen in the CGIC. Regarding the safety profile of EGb, no significant differences compared with placebo were observed in the number of patients reporting adverse events or in the incidence and severity of these events.

Conclusions.EGb was safe and appears capable of stabilizing and, in a substantial number of cases, improving the cognitive performance and the social functioning of demented patients for 6 months to 1 year. Although modest, the changes induced by EGb were objectively measured by the ADAS-Cog and were of sufficient magnitude to be recognized by the caregivers in the GERRI.

JAMA. 1997;278:1327-1332

From the New York Institute for Medical Research, Tarrytown (Dr Le Bars); Department of Psychiatry, Albert Einstein College of Medicine-Montefiore Medical Center, New York, NY (Dr Katz); Harbor-UCLA Medical Center, Torrance, Calif (Dr Berman); Department of Psychiatry, New York Medical College, Valhalla (Drs Itil and Freedman); and Harvard Medical Center, Boston, Mass (Dr Schatzberg).

EDITOR'S NOTE.Few treatments for Alzheimer disease (AD) have been found to be both effective and acceptable to patients and their caregivers. "Natural" substances have been an increasingly popular treatment for a variety of conditions. Their effectiveness, however, often has not been tested in a controlled trial, and the substances can vary in contents and active ingredients in the United States since they are not regulated as drugs. In this study, a well-defined plant extract of gingko biloba called EGb761 used in Germany for the treatment of dementia was evaluated in a randomized controlled trial. While the effect size was modest, EGb761 reduced patients' cognitive decline and manifestations of dementia rated by the caregiver as compared with placebo, particularly for patients with a diagnosis of AD. The mechanism of action is unclear but is postulated to be related to the agent's antioxidant properties. Only a single dose was studied, drop-out rates were high, and longer-term follow-up will be important; but this agent is an intriguing addition to the drugs thought to be helpful for patients with AD.

Margaret A. Winker, MD, Senior Editor