Pharmacological Research - Modern Chinese Medicine (Jun 2023)
Comparative efficacy and safety of ginkgo biloba related agents in patients with acute ischemic stroke: A Bayesian network meta-analysis of randomized controlled trials
Abstract
Background: Acute Ischemic stroke (AIS) has been a leading cause of long-term disability and even death, accounting for significant economic costs and leading to heavy care and financial burdens for patients and their families. Ginkgo biloba extract is highly valued for its efficacy and broad implementation into clinical practice. Therefore, a Bayesian network meta-analysis (BNMA) was conducted to determine the differences in efficacy and safety among various ginkgo biloba-related agents and to prescribe the optimal medication for decision-making. Methods: Inclusion and exclusion eligibility criteria were determined in advance. From the inception of the literature until December 2022, a systematic literature search was conducted in seven electronic databases. An assessment of the methodological quality of the included studies was carried out according to the Cochrane Collaborations tool. A previous registration (PROSPERO CRD42022319301) of this review protocol was undertaken. Results: There were 94 eligible studies included in the NMA involving 10,071 patients, with the experimental control group of 5,063 and the control group of 5,008, involving five ginkgo biloba-related agents included in the NMA. Findings of the studies revealed that supplementation with ginkgo biloba-related agents significantly improved the clinical effective rate, functional independence, neurological function impairments and activities of daily living function compared with the conventional western medicine (WM) group in a relatively safe manner. Comprehensive therapeutic efficacy analysis of neurological function impairments and activities of daily living function showed that GI+WM and GDLM+WM manifest at the first grade among these five therapeutic strategies. Conclusion: This Bayesian network meta-analysis results showed that the combination of ginkgo biloba-related agents and WM was more effective for AIS patients than WM alone. GI+WM and GDLM+WM stand out for the comprehensive therapeutic efficacy of patients with stroke through comparisons among various therapeutic approaches. Moreover, SXN+WM, GK+WM and GDLM+WM might be among the most effective in improving the functional efficacy outcome, while GI+WM might be among the least effective. GI+WM, GDLM+WM, SXN+WM and GK+WM might be among the most effective in improving neurofunctional deficits, while GNT+WM might be among the least effective. In terms of improving activities of daily living function, five ginkgo biloba-related agents might be among the most effective. However, well-designed researches with standardized functional outcome measures for AIS, further adequately powered, blinding and suitable comparators are still required to contribute to the current clinical practice.
