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Meta-Analysis
. 2020 Sep 29;9(9):CD008294.
doi: 10.1002/14651858.CD008294.pub5.

Pine bark (Pinus spp.) extract for treating chronic disorders

Nina U Robertson  1 , Anel Schoonees  2 , Amanda Brand  2 , Janicke Visser  1
Affiliations
Meta-Analysis

Pine bark (Pinus spp.) extract for treating chronic disorders

Nina U Robertson et al. Cochrane Database Syst Rev. .

Abstract

Background: Pine bark (Pinus spp.) extract is rich in bioflavonoids, predominantly proanthocyanidins, which are antioxidants. Commercially-available extract supplements are marketed for preventing or treating various chronic conditions associated with oxidative stress. This is an update of a previously published review.

Objectives: To assess the efficacy and safety of pine bark extract supplements for treating chronic disorders.

Search methods: We searched three databases and three trial registries; latest search: 30 September 2019. We contacted the manufacturers of pine bark extracts to identify additional studies and hand-searched bibliographies of included studies.

Selection criteria: Randomised controlled trials (RCTs) evaluating pine bark extract supplements in adults or children with any chronic disorder.

Data collection and analysis: Two authors independently assessed trial eligibility, extracted data and assessed risk of bias. Where possible, we pooled data in meta-analyses. We used GRADE to evaluate the certainty of evidence. Primary outcomes were participant- and investigator-reported clinical outcomes directly related to each disorder and all-cause mortality. We also assessed adverse events and biomarkers of oxidative stress.

Main results: This review included 27 RCTs (22 parallel and five cross-over designs; 1641 participants) evaluating pine bark extract supplements across 10 chronic disorders: asthma (two studies; 86 participants); attention deficit hyperactivity disorder (ADHD) (one study; 61 participants), cardiovascular disease (CVD) and risk factors (seven studies; 338 participants), chronic venous insufficiency (CVI) (two studies; 60 participants), diabetes mellitus (DM) (six studies; 339 participants), erectile dysfunction (three studies; 277 participants), female sexual dysfunction (one study; 83 participants), osteoarthritis (three studies; 293 participants), osteopenia (one study; 44 participants) and traumatic brain injury (one study; 60 participants). Two studies exclusively recruited children; the remainder recruited adults. Trials lasted between four weeks and six months. Placebo was the control in 24 studies. Overall risk of bias was low for four, high for one and unclear for 22 studies. In adults with asthma, we do not know whether pine bark extract increases change in forced expiratory volume in one second (FEV1) % predicted/forced vital capacity (FVC) (mean difference (MD) 7.70, 95% confidence interval (CI) 3.19 to 12.21; one study; 44 participants; very low-certainty evidence), increases change in FEV1 % predicted (MD 7.00, 95% CI 0.10 to 13.90; one study; 44 participants; very low-certainty evidence), improves asthma symptoms (risk ratio (RR) 1.85, 95% CI 1.32 to 2.58; one study; 60 participants; very low-certainty evidence) or increases the number of people able to stop using albuterol inhalers (RR 6.00, 95% CI 1.97 to 18.25; one study; 60 participants; very low-certainty evidence). In children with ADHD, we do not know whether pine bark extract decreases inattention and hyperactivity assessed by parent- and teacher-rating scales (narrative synthesis; one study; 57 participants; very low-certainty evidence) or increases the change in visual-motoric coordination and concentration (MD 3.37, 95% CI 2.41 to 4.33; one study; 57 participants; very low-certainty evidence). In participants with CVD, we do not know whether pine bark extract decreases diastolic blood pressure (MD -3.00 mm Hg, 95% CI -4.51 to -1.49; one study; 61 participants; very low-certainty evidence); increases HDL cholesterol (MD 0.05 mmol/L, 95% CI -0.01 to 0.11; one study; 61 participants; very low-certainty evidence) or decreases LDL cholesterol (MD -0.03 mmol/L, 95% CI -0.05 to 0.00; one study; 61 participants; very low-certainty evidence). In participants with CVI, we do not know whether pine bark extract decreases pain scores (MD -0.59, 95% CI -1.02 to -0.16; one study; 40 participants; very low-certainty evidence), increases the disappearance of pain (RR 25.0, 95% CI 1.58 to 395.48; one study; 40 participants; very low-certainty evidence) or increases physician-judged treatment efficacy (RR 4.75, 95% CI 1.97 to 11.48; 1 study; 40 participants; very low-certainty evidence). In type 2 DM, we do not know whether pine bark extract leads to a greater reduction in fasting blood glucose (MD 1.0 mmol/L, 95% CI 0.91 to 1.09; one study; 48 participants;very low-certainty evidence) or decreases HbA1c (MD -0.90 %, 95% CI -1.78 to -0.02; 1 study; 48 participants; very low-certainty evidence). In a mixed group of participants with type 1 and type 2 DM we do not know whether pine bark extract decreases HbA1c (MD -0.20 %, 95% CI -1.83 to 1.43; one study; 67 participants; very low-certainty evidence). In men with erectile dysfunction, we do not know whether pine bark extract supplements increase International Index of Erectile Function-5 scores (not pooled; two studies; 147 participants; very low-certainty evidence). In women with sexual dysfunction, we do not know whether pine bark extract increases satisfaction as measured by the Female Sexual Function Index (MD 5.10, 95% CI 3.49 to 6.71; one study; 75 participants; very low-certainty evidence) or leads to a greater reduction of pain scores (MD 4.30, 95% CI 2.69 to 5.91; one study; 75 participants; very low-certainty evidence). In adults with osteoarthritis of the knee, we do not know whether pine bark extract decreases composite Western Ontario and McMaster Universities Osteoarthritis Index scores (MD -730.00, 95% CI -1011.95 to -448.05; one study; 37 participants; very low-certainty evidence) or the use of non-steroidal anti-inflammatory medication (MD -18.30, 95% CI -25.14 to -11.46; one study; 35 participants; very low-certainty evidence). We do not know whether pine bark extract increases bone alkaline phosphatase in post-menopausal women with osteopenia (MD 1.16 ug/L, 95% CI -2.37 to 4.69; one study; 40 participants; very low-certainty evidence). In individuals with traumatic brain injury, we do not know whether pine bark extract decreases cognitive failure scores (MD -2.24, 95% CI -11.17 to 6.69; one study; 56 participants; very low-certainty evidence) or post-concussion symptoms (MD -0.76, 95% CI -5.39 to 3.87; one study; 56 participants; very low-certainty evidence). For most comparisons, studies did not report outcomes of hospital admissions or serious adverse events.

Authors' conclusions: Small sample sizes, limited numbers of RCTs per condition, variation in outcome measures, and poor reporting of the included RCTs mean no definitive conclusions regarding the efficacy or safety of pine bark extract supplements are possible.

Trial registration: ClinicalTrials.gov NCT01646047.

PubMed Disclaimer

Conflict of interest statement

All authors: none known.

Figures

1
1
Search results.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1: Pine bark extract versus placebo: Asthma, Outcome 1: Decrease in asthma symptoms
1.2
1.2. Analysis
Comparison 1: Pine bark extract versus placebo: Asthma, Outcome 2: Participants off albuterol inhaler
1.3
1.3. Analysis
Comparison 1: Pine bark extract versus placebo: Asthma, Outcome 3: Number of albuterol inhaler puffs per 24 hours
1.4
1.4. Analysis
Comparison 1: Pine bark extract versus placebo: Asthma, Outcome 4: Change in FEV1 % predicted
1.5
1.5. Analysis
Comparison 1: Pine bark extract versus placebo: Asthma, Outcome 5: Change in FEV1 % predicted/FVC
2.1
2.1. Analysis
Comparison 2: Pine bark extract versus placebo: ADHD, Outcome 1: Change in inattention as measured by CAP scores
2.2
2.2. Analysis
Comparison 2: Pine bark extract versus placebo: ADHD, Outcome 2: Change in inattention as measured by CTRS scores
2.3
2.3. Analysis
Comparison 2: Pine bark extract versus placebo: ADHD, Outcome 3: Change in inattention as measured by CPRS scores
2.4
2.4. Analysis
Comparison 2: Pine bark extract versus placebo: ADHD, Outcome 4: Change in hyperactivity as measured by CAP scores
2.5
2.5. Analysis
Comparison 2: Pine bark extract versus placebo: ADHD, Outcome 5: Change in hyperactivity as measured by CTRS scores
2.6
2.6. Analysis
Comparison 2: Pine bark extract versus placebo: ADHD, Outcome 6: Change in hyperactivity as measured by CPRS scores
2.7
2.7. Analysis
Comparison 2: Pine bark extract versus placebo: ADHD, Outcome 7: Change in visual‐motoric coordination and concentration
2.8
2.8. Analysis
Comparison 2: Pine bark extract versus placebo: ADHD, Outcome 8: 8‐oxo‐7,8‐dihydroguanine levels
3.1
3.1. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 1: Reduction of nifedipine dose
3.2
3.2. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 2: Dose reduced to 10 mg nifedipine
3.3
3.3. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 3: Systolic blood pressure (mmHg)
3.4
3.4. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 4: Systolic blood pressure (mmHg): cross‐over trials
3.5
3.5. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 5: Diastolic blood pressure (mmHg)
3.6
3.6. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 6: Diastolic blood pressure (mmHg): cross‐over trials
3.7
3.7. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 7: Fasting blood glucose (mmol/L)
3.8
3.8. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 8: Fasting blood glucose (mmol/L): cross‐over trials
3.9
3.9. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 9: Insulin levels (pmol/L): cross‐over trial
3.10
3.10. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 10: Total cholesterol (mmol/L)
3.11
3.11. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 11: Total cholesterol (mmol/L): cross‐over trials
3.12
3.12. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 12: HDL (mmol/L)
3.13
3.13. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 13: HDL (mmol/L): cross‐over trials
3.14
3.14. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 14: LDL (mmol/L)
3.15
3.15. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 15: LDL (mmol/L): cross‐over trials
3.16
3.16. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 16: Triglycerides (mmol/L): cross‐over trials
3.17
3.17. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 17: CRP (µg/L)
3.18
3.18. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 18: High sensitivity CRP (mg/L): cross‐over trials
3.19
3.19. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 19: Weight (kg): cross‐over trial
3.20
3.20. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 20: BMI (kg/m²): cross‐over trial
3.21
3.21. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 21: Waist circumference (cm): cross‐over trial
3.22
3.22. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 22: Oxidised glutathione (nmol/mL): cross‐over trial
3.23
3.23. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 23: Reduced glutathione (nmol/mL): cross‐over trial
3.24
3.24. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 24: Ratio reduced/oxidised glutathione (nmol/mL): cross‐over trial
3.25
3.25. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 25: Nitrates (microM): cross‐over trial
3.26
3.26. Analysis
Comparison 3: Pine bark extract versus placebo: CVD and risk factors, Outcome 26: Oxidative stress D‐ROM test (carr units)
4.1
4.1. Analysis
Comparison 4: Pine bark extract versus placebo: CVI, Outcome 1: Heaviness scores
4.2
4.2. Analysis
Comparison 4: Pine bark extract versus placebo: CVI, Outcome 2: Swelling scores
4.3
4.3. Analysis
Comparison 4: Pine bark extract versus placebo: CVI, Outcome 3: Pain scores
4.4
4.4. Analysis
Comparison 4: Pine bark extract versus placebo: CVI, Outcome 4: Disappearance of heaviness
4.5
4.5. Analysis
Comparison 4: Pine bark extract versus placebo: CVI, Outcome 5: Disappearance of swelling
4.6
4.6. Analysis
Comparison 4: Pine bark extract versus placebo: CVI, Outcome 6: Disappearance of pain
4.7
4.7. Analysis
Comparison 4: Pine bark extract versus placebo: CVI, Outcome 7: Treatment efficacy as judged by physician
5.1
5.1. Analysis
Comparison 5: Pine bark extract versus control: DM type I, Outcome 1: Microcirculation‐related symptom scores: oral Pycnogenol®
5.2
5.2. Analysis
Comparison 5: Pine bark extract versus control: DM type I, Outcome 2: Microcirculation‐related symptom scores: local Pycnogenol®
5.3
5.3. Analysis
Comparison 5: Pine bark extract versus control: DM type I, Outcome 3: Microcirculation‐related symptom scores: oral and local Pycnogenol®
5.4
5.4. Analysis
Comparison 5: Pine bark extract versus control: DM type I, Outcome 4: Area of ulceration: oral Pycnogenol®
5.5
5.5. Analysis
Comparison 5: Pine bark extract versus control: DM type I, Outcome 5: Area of ulceration: local Pycnogenol®
5.6
5.6. Analysis
Comparison 5: Pine bark extract versus control: DM type I, Outcome 6: Area of ulceration: oral and local Pycnogenol® (mm²)
5.7
5.7. Analysis
Comparison 5: Pine bark extract versus control: DM type I, Outcome 7: Transcutaneous PO2: oral Pycnogenol®
5.8
5.8. Analysis
Comparison 5: Pine bark extract versus control: DM type I, Outcome 8: Transcutaneous PCO2: oral Pycnogenol®
5.9
5.9. Analysis
Comparison 5: Pine bark extract versus control: DM type I, Outcome 9: Transcutaneous PO2: oral and local Pycnogenol®
5.10
5.10. Analysis
Comparison 5: Pine bark extract versus control: DM type I, Outcome 10: Transcutaneous PCO2: oral and local Pycnogenol®
5.11
5.11. Analysis
Comparison 5: Pine bark extract versus control: DM type I, Outcome 11: Skin flux at rest: oral Pycnogenol®
5.12
5.12. Analysis
Comparison 5: Pine bark extract versus control: DM type I, Outcome 12: Skin flux at rest: oral and local Pycnogenol®
6.1
6.1. Analysis
Comparison 6: Pine bark extract versus placebo: DM type II, Outcome 1: Visual acuity
6.2
6.2. Analysis
Comparison 6: Pine bark extract versus placebo: DM type II, Outcome 2: Reduction in fasting blood glucose levels (mmol/L)
6.3
6.3. Analysis
Comparison 6: Pine bark extract versus placebo: DM type II, Outcome 3: HbA1c levels (%)
6.4
6.4. Analysis
Comparison 6: Pine bark extract versus placebo: DM type II, Outcome 4: Reduction in urinary albumin levels (mg/L)
6.5
6.5. Analysis
Comparison 6: Pine bark extract versus placebo: DM type II, Outcome 5: Central macular thickness (μm)
6.6
6.6. Analysis
Comparison 6: Pine bark extract versus placebo: DM type II, Outcome 6: Best corrected visual acuity (logMAR)
6.7
6.7. Analysis
Comparison 6: Pine bark extract versus placebo: DM type II, Outcome 7: Nitrogen monoxide (nmol/L)
6.8
6.8. Analysis
Comparison 6: Pine bark extract versus placebo: DM type II, Outcome 8: Free oxygen radical test (mg/L)
7.1
7.1. Analysis
Comparison 7: Pine bark extract versus placebo: DM types I and II combined, Outcome 1: Diabetic Peripheral Neuropathy Symptom Score: number of participants who showed no change
7.2
7.2. Analysis
Comparison 7: Pine bark extract versus placebo: DM types I and II combined, Outcome 2: Diabetic Peripheral Neuropathy Symptom score: number of participants who showed improvement
7.3
7.3. Analysis
Comparison 7: Pine bark extract versus placebo: DM types I and II combined, Outcome 3: Diabetic Peripheral Neuropathy Symptom Score: number of participants who had worsened symptoms
7.4
7.4. Analysis
Comparison 7: Pine bark extract versus placebo: DM types I and II combined, Outcome 4: Change in HbA1C (%)
7.5
7.5. Analysis
Comparison 7: Pine bark extract versus placebo: DM types I and II combined, Outcome 5: Total cholesterol (mmol/L)
7.6
7.6. Analysis
Comparison 7: Pine bark extract versus placebo: DM types I and II combined, Outcome 6: LDL (mmol/L)
7.7
7.7. Analysis
Comparison 7: Pine bark extract versus placebo: DM types I and II combined, Outcome 7: HDL (mmol/L)
7.8
7.8. Analysis
Comparison 7: Pine bark extract versus placebo: DM types I and II combined, Outcome 8: Triglycerides (mmol/L)
7.9
7.9. Analysis
Comparison 7: Pine bark extract versus placebo: DM types I and II combined, Outcome 9: hsCRP (mg/L)
8.1
8.1. Analysis
Comparison 8: Pine bark extract versus placebo: ED, Outcome 1: IIEF‐5
8.2
8.2. Analysis
Comparison 8: Pine bark extract versus placebo: ED, Outcome 2: IIEF Erectile function domain
8.3
8.3. Analysis
Comparison 8: Pine bark extract versus placebo: ED, Outcome 3: International Prostate Symptom Score
8.4
8.4. Analysis
Comparison 8: Pine bark extract versus placebo: ED, Outcome 4: Total plasma testosterone (nmol/L)
8.5
8.5. Analysis
Comparison 8: Pine bark extract versus placebo: ED, Outcome 5: Systolic blood pressure (mmHg)
8.6
8.6. Analysis
Comparison 8: Pine bark extract versus placebo: ED, Outcome 6: Diastolic blood pressure (mmHg)
8.7
8.7. Analysis
Comparison 8: Pine bark extract versus placebo: ED, Outcome 7: Antioxidant activity (%)
9.1
9.1. Analysis
Comparison 9: Pine bark extract versus control: female sexual dysfunction, Outcome 1: FSFI desire domain
9.2
9.2. Analysis
Comparison 9: Pine bark extract versus control: female sexual dysfunction, Outcome 2: FSFI arousal domain
9.3
9.3. Analysis
Comparison 9: Pine bark extract versus control: female sexual dysfunction, Outcome 3: FSFI lubrication domain
9.4
9.4. Analysis
Comparison 9: Pine bark extract versus control: female sexual dysfunction, Outcome 4: FSFI orgasm domain
9.5
9.5. Analysis
Comparison 9: Pine bark extract versus control: female sexual dysfunction, Outcome 5: FSFI satisfaction domain
9.6
9.6. Analysis
Comparison 9: Pine bark extract versus control: female sexual dysfunction, Outcome 6: FSFI pain domain
10.1
10.1. Analysis
Comparison 10: Pine bark extract versus placebo: osteoarthritis, Outcome 1: Pain scores
10.2
10.2. Analysis
Comparison 10: Pine bark extract versus placebo: osteoarthritis, Outcome 2: Pain score (VAS)
10.3
10.3. Analysis
Comparison 10: Pine bark extract versus placebo: osteoarthritis, Outcome 3: Physical function score
10.4
10.4. Analysis
Comparison 10: Pine bark extract versus placebo: osteoarthritis, Outcome 4: Stiffness scores
10.5
10.5. Analysis
Comparison 10: Pine bark extract versus placebo: osteoarthritis, Outcome 5: Composite WOMAC score
10.6
10.6. Analysis
Comparison 10: Pine bark extract versus placebo: osteoarthritis, Outcome 6: Reduction of NSAIDS
10.7
10.7. Analysis
Comparison 10: Pine bark extract versus placebo: osteoarthritis, Outcome 7: Change in NSAIDs and COX‐2 inhibitor usage (number of pills taken)
10.8
10.8. Analysis
Comparison 10: Pine bark extract versus placebo: osteoarthritis, Outcome 8: Change in number of days in taking NSAIDs and COX‐2 inhibitor
11.1
11.1. Analysis
Comparison 11: Pine bark extract versus placebo: osteopenia, Outcome 1: Bone alkaline phosphatase (ug/L)
11.2
11.2. Analysis
Comparison 11: Pine bark extract versus placebo: osteopenia, Outcome 2: Procollagen type 1 N‐terminal propeptide (ng/mL)
11.3
11.3. Analysis
Comparison 11: Pine bark extract versus placebo: osteopenia, Outcome 3: C‐terminal telopeptide of type I collagen (ng/mL)
11.4
11.4. Analysis
Comparison 11: Pine bark extract versus placebo: osteopenia, Outcome 4: Bone alkaline phosphatase/C‐terminal telopeptide of type I collagen
11.5
11.5. Analysis
Comparison 11: Pine bark extract versus placebo: osteopenia, Outcome 5: Receptor activator of nuclear factor k‐B ligand (ng/mL)
11.6
11.6. Analysis
Comparison 11: Pine bark extract versus placebo: osteopenia, Outcome 6: Osteoprotegerin (ng/mL)
11.7
11.7. Analysis
Comparison 11: Pine bark extract versus placebo: osteopenia, Outcome 7: Parathyroid hormone (pg/mL)
11.8
11.8. Analysis
Comparison 11: Pine bark extract versus placebo: osteopenia, Outcome 8: Serum calcium (mg/dL)
11.9
11.9. Analysis
Comparison 11: Pine bark extract versus placebo: osteopenia, Outcome 9: Serum magnesium (mg/dL)
11.10
11.10. Analysis
Comparison 11: Pine bark extract versus placebo: osteopenia, Outcome 10: Serum phosphorus (mg/dL)
12.1
12.1. Analysis
Comparison 12: Pine bark extract versus placebo: TBI, Outcome 1: Cognitive failure questionnaire
12.2
12.2. Analysis
Comparison 12: Pine bark extract versus placebo: TBI, Outcome 2: Rivermead Post Concussion symptom questionnaire: questions 1 to 3
12.3
12.3. Analysis
Comparison 12: Pine bark extract versus placebo: TBI, Outcome 3: Rivermead Post Concussion symptom questionnaire: questions 1 to 13
12.4
12.4. Analysis
Comparison 12: Pine bark extract versus placebo: TBI, Outcome 4: Hospital Anxiety and Depression scale: anxiety
12.5
12.5. Analysis
Comparison 12: Pine bark extract versus placebo: TBI, Outcome 5: Hospital Anxiety and Depression scale: depression
12.6
12.6. Analysis
Comparison 12: Pine bark extract versus placebo: TBI, Outcome 6: California Verbal Learning Test: short‐delay free recall
12.7
12.7. Analysis
Comparison 12: Pine bark extract versus placebo: TBI, Outcome 7: California Verbal Learning Test: long‐delay free recall
12.8
12.8. Analysis
Comparison 12: Pine bark extract versus placebo: TBI, Outcome 8: California Verbal Learning Test: recognition
12.9
12.9. Analysis
Comparison 12: Pine bark extract versus placebo: TBI, Outcome 9: California Verbal Learning Test: mean total accuracy (%)
12.10
12.10. Analysis
Comparison 12: Pine bark extract versus placebo: TBI, Outcome 10: Wechsler Adult Intelligence scale: digit span
12.11
12.11. Analysis
Comparison 12: Pine bark extract versus placebo: TBI, Outcome 11: Wechsler Adult Intelligence Scale: letter number sequencing
12.12
12.12. Analysis
Comparison 12: Pine bark extract versus placebo: TBI, Outcome 12: Wechsler Adult Intelligence Scale: arithmetic
13.1
13.1. Analysis
Comparison 13: Pine bark extract versus control: serious adverse events, Outcome 1: Withdrawal from study because of pine bark extract supplements
13.2
13.2. Analysis
Comparison 13: Pine bark extract versus control: serious adverse events, Outcome 2: Hospitalisation
13.3
13.3. Analysis
Comparison 13: Pine bark extract versus control: serious adverse events, Outcome 3: Emergency department visits
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References

References to studies included in this review

Arcangeli 2000 {published data only}
    1. Arcangeli P. Pycnogenol® in chronic venous insufficiency. Fitoterapia 2000;71(3):236-44. [PMID: ] - PubMed
Belcaro 2006a {published and unpublished data}
    1. Belcaro G, Cesarone MR, Errichi BM, Ledda A, Di Renzo A, Stuard S. Diabetic ulcers: microcirculatory improvement and faster healing with Pycnogenol. Clinical and Applied Thrombosis/Hemostasis 2006;12(3):318-23. [DOI: 10.1177/1076029606290133] - DOI - PubMed
Belcaro 2008a {published and unpublished data}
    1. Belcaro B, Cesarone MR, Errichi S, Zulli C, Errichi BM, Vinciguerra G, et al. Treatment of osteoarthritis with Pycnogenol®.The SVOS (San Valentino Osteo-arthrosis Study). Evaluation of signs, symptoms, physical performance and vascular aspects. Phytotherapy Research 2008;22(4):518-23. [DOI: 10.1002/ptr.2376] - DOI - PubMed
    1. Belcaro G, Cesarone MR, Errichi S, Zulli C, Errichi BM, Vinciguerra G. Variations in C-reactive protein, plasma free radicals and fibrinogen values in patients with osteoarthritis treated with Pycnogenol®. Redox Report 2008;13(6):27-6. [DOI: 10.1179/135100008X309019] - DOI - PubMed
Bottari 2012 {published data only}
    1. Bottari A, Belcaro G, Ledda A, Cesarone MR, Vinciguerra G, Di Renzo A, et al. Lady Prelox(R) improves sexual function in post-menopausal women. Panminerva Medica 2012;54(1 Suppl 4):3-9. [PMID: ] - PubMed
Cai 2013 {published data only}
    1. Cai T, Morgia G, Carrieri G, Terrone C, Imbimbo C, Verze P, et al. An improvement in sexual function is related to better quality of life, regardless of urinary function improvement: results from the IDIProst® Gold Study. Archivio Italiano di Urologia e Andrologia 2013;85(4):184-9. [DOI: 10.4081/aiua.2013.4.184] - DOI - PubMed
Cesarone 2008 {published data only}
    1. Cesarone MR, Di Renzo A, Errichi S, Schönlau F, Wilmer JL, Blumenfeld J. Improvement in circulation and in cardiovascular risk factors with a proprietary isotonic bioflavonoid formula OPC-3®. Angiology 2008;59(4):404-14. [DOI: 10.1177/0003319708321801] - DOI - PubMed
Chous 2016 {published data only}
    1. Chous AP, Richer SP, Gerson JD, Kowluru RA. The diabetes visual function supplement study (DiVFuSS). British Journal of Ophthalmology 2016;100(2):227-34. [DOI: 10.1136/bjophthalmol-2014-306534] - DOI - PMC - PubMed
Cisár 2008 {published and unpublished data}
    1. Cisár P, Jány R, Waczulíková I, Sumegová K, Muchová J, Vojtaššák J. Effect of pine bark extract (Pycnogenol®) on symptoms of knee osteoarthritis. Phytotherapy Research 2008;22(8):1087-92. [DOI: 10.1002/ptr.2461] - DOI - PubMed
Domanico 2015 {published data only}
    1. Domanico D, Fragiotta S, Cutini A, Carnevale C, Zompatori L, Vingolo EM. Circulating levels of reactive oxygen species in patients with nonproliferative diabetic retinopathy and the influence of antioxidant supplementation: 6-month follow-up. Indian Journal of Ophthalmology 2015;63(1):9-14. [DOI: 10.4103/0301-4738.151455] - DOI - PMC - PubMed
Drieling 2010 {published data only}
    1. Drieling RL, Gardner CD, Ma J, Ahn DK, Stafford RS. No beneficial effects of pine bark extract on cardiovascular disease risk factors. Archives of Internal Medicine 2010;170(17):1541-7. [PMID: ] - PubMed
Duracková 2003 {published and unpublished data}
    1. Ďuračková Z, Trebatický B, Novotný V, Žitňanová I, Breza J. Lipid metabolism and erectile function improvement by Pycnogenol®, extract from the bark of Pinus pinaster in patients suffering from erectile dysfunction - a pilot study. Nutrition Research 2003;23(9):1189-98. [DOI: 10.1016/S0271-5317(03)00126-X] - DOI
Enseleit 2012 {published data only}
    1. Enseleit F, Sudano I, Periat D, Winnik S, Wolfrum M, Flammer AJ, et al. Effects of Pycnogenol on endothelial function in patients with stable coronary artery disease: a double-blind, randomized, placebo-controlled, cross-over study. European Heart Journal 2012;33(13):1589-97. [PMID: ] - PubMed
    1. Enseleit F, Sudano I, Wolfrum M, Periat D, Krasniqi N, Ruschitzka F, et al. Pycnogenol improves endothelial function in patients with coronary artery disease. European Heart Journal 2010;31:690.
Farid 2007 {published data only}
    1. Farid R, Mirfeizi Z, Mirheidari M, Rezaieyazdi Z, Mansouri H, Esmaelli H. Pycnogenol supplementation reduces pain and stiffness and improves physical function in adults with knee osteoarthritis. Nutrition Research 2007;27(11):692-7. [DOI: 10.1016/j.nutres.2007.09.007] - DOI - PubMed
Hosseini 2001a {published data only}
    1. Hosseini S, Pishnamazi S, Sadrzadeh SM, Farid F, Farid R, Watson RR. Pycnogenol® in the management of asthma. Journal of Medicinal Food 2001;4(4):201-9. [EMBASE: 2002026258] [CN-00425484] [CN-00524801] - PubMed
Hosseini 2001b {published and unpublished data}
    1. Hosseini S, Lee J, Sepulveda RT, Rohdewald P, Watson RR. A randomized, double-blind, placebo-controlled, prospective, 16 week crossover study to determine the role of Pycnogenol in modifying blood pressure in mildly hypertensive patients. Nutrition Research 2001;21(9):1251-60. [S0271-5317(01)00342-6]
Lau 2004 {published data only}
    1. Lau BH, Riesen SK, Truong KP, Lau EW, Rohdewald P, Barreta RA. Pycnogenol® as an adjunct in the management of childhood asthma. Journal of Asthma 2004;41(8):825-32. [DOI: 10.1081/JAS-200038433] - DOI - PubMed
Ledda 2010 {published data only}
    1. Ledda A, Belcaro G, Cesarone MR, Dugall M, Schonlau F. Investigation of a complex plant extract for mild to moderate erectile dysfunction in a randomized, double-blind, placebo-controlled, parallel-arm study. BJU International 2010;106(7):1030-3. [PMID: ] - PubMed
    1. Nemr E. Investigation of a complex plant extract for mild to moderate erectile dysfunction in a randomized, double-blind, placebo-controlled, parallel-arm study. BJU International 2010;105(11):1607-8. [DOI: 10.1111/j.1464-410X.2010.09412] - DOI - PubMed
Liu 2004a {published and unpublished data}
    1. Liu X, Wei J, Tan F, Zhou S, Würthwein, Rohdewald P. Antidiabetic effect of Pycnogenol® French maritime pine bark extract in patients with diabetes type II. Life Sciences 2004;75(21):2505-13. [DOI: 10.1016/j.lfs.2003.10.043] - DOI - PubMed
Liu 2004c {published and unpublished data}
    1. Liu X, Wei J, Tan F, Zhou S, Würthwein G, Rohdewald P. Pycnogenol®, French maritime pine bark extract, improves endothelial function of hypertensive patients. Life Sciences 2004;74(7):855-62. [DOI: 10.1016/j.lfs.2003.07.037] - DOI - PubMed
Panahande 2019 {published data only}
    1. Panahande S, Maghbooli Z, Hossein-Nezhad A, Qorbani M, Moeini-Nodeh S, Haghi-Aminjan H, et al. Effects of French maritime pine bark extract (Oligopin®) supplementation on bone remodeling markers in postmenopausal osteopenic women: a randomized clinical trial. Phytotherapy Research 2019;33(4):1233-40. - PubMed
Petrassi 2000 {published data only}
    1. Petrassi C, Mastromarino A, Spartera C. Pycnogenol® in chronic venous insufficiency. Phytomedicine 2000;7(5):383-8. [PMID: ] - PubMed
Reule 2017 {published data only}
    1. Reule CA, Goyvaerts B, Schoen C. Effects of an L-arginine-based multi ingredient product on endothelial function in subjects with mild to moderate hypertension and hyperhomocysteinemia - a randomized, double-blind, placebo-controlled, cross-over trial. BMC Complementary and Alternative Medicine 2017;17(1):92. [DOI: 10.1186/s12906-017-1603-9] - DOI - PMC - PubMed
Steigerwalt 2009 {published and unpublished data}
    1. Steigerwalt R, Belcaro G, Cesarone MR, Di Renzo A, Grossi MG, Ricci A. Pycnogenol® improves microcirculation, retinal edema, and visual acuity in early diabetic retinopathy. Journal of Ocular Pharmacology and Therapeutics 2009;25(6):537-40. [DOI: 10.1089/jop.2009.0023] - DOI - PubMed
Theadom 2013 {published data only}
    1. Theadom A, Mahon S, Barker-Collo S, McPherson K, Rush E, Vandal AC, et al. Enzogenol for cognitive functioning in traumatic brain injury: a pilot placebo-controlled RCT. European Journal of Neurology 2013;20(8):1135-44. [PMID: ] - PubMed
Trebatická 2006 {published and unpublished data}
    1. Chovanová Z, Muchová J, Sivonová M, Dvoráková M, Zitnanová I, Waczulíková I, et al. Effect of polyphenolic extract, Pycnogenol® , on the level of 8-oxoguanine in children suffering from attention deficit/hyperactivity disorder. Free Radical Research 2006;40(9):1003-10. [DOI: 10.1080/10715760600824902] - DOI - PubMed
    1. Dvořáková M, Sivoňová M, Trebatická J, Škodáček I, Waczuliková I, Muchová J, et al. The effect of polyphenolic extract from pine bark, Pycnogenol® on the level of glutathione in children suffering from attention deficit hyperactivity disorder (ADHD). Redox Report 2006;11(4):163-72. [DOI: 10.1179/135100006X116664] - DOI - PubMed
    1. Dvoráková M, Jezová D, Blazícek P, Trebatická J, Skodácek I, Suba J, et al. Urinary catecholamines in children with attention deficit hyperactivity disorder (ADHD): modulation by a polyphenolic extract from pine bark (Pycnogenol®). Nutritional Neuroscience 2007;10(3-4):151-7. [DOI: 10.1080/09513590701565443] - DOI - PubMed
    1. Trebatická J, Kopasová S, Hradečná Z, Činovský K, Škodáček I, Šuba J. Treatment of ADHD with French maritime pine bark extract, Pycnogenol®. European Child & Adolescent Psychiatry 2006;15(6):329-35. [DOI: 10.1007/s00787-006-0538-3] - DOI - PubMed
Valls 2016 {published data only}
    1. Valls RM, Llaurado E, Fernandez-Castillejo S, Puiggros F, Sola R, Arola L, et al. Effects of low molecular weight procyanidin rich extract from french maritime pine bark on cardiovascular disease risk factors in stage-1 hypertensive subjects: Randomized, double-blind, crossover, placebo-controlled intervention trial. Phytomedicine 2016;23(12):1451-61. [DOI: 10.1016/j.phymed.2016.08.007] - DOI - PubMed
Zibadi 2008 {published and unpublished data}
    1. Zibadi S, Rohdewald PJ, Park D, Watson RR. Reduction of cardiovascular risk factors in subjects with type 2 diabetes by Pycnogenol supplementation. Nutrition Research 2008;28(5):315-20. [DOI: 10.1016/j.nutres.2008.03.003] - DOI - PubMed

References to studies excluded from this review

Aoki 2012 {published data only}
    1. Aoki H, Nagao J, Ueda T, Strong JM, Schonlau F, Yu-Jing S, et al. Clinical assessment of a supplement of Pycnogenol(R) and L-arginine in Japanese patients with mild to moderate erectile dysfunction. Phytotherapy Research 2012;26(2):204-7. [PMID: ] - PubMed
Belcaro 2005 {published data only}
    1. Belcaro G, Cesarone MR, Errichi BM, Ledda A, Di Renzo A, Stuard S, et al. Venous ulcers: microcirculatory improvement and faster healing with local use of Pycnogenol. Angiology 2005;56(6):699-705. [PMID: ] - PubMed
Belcaro 2006b {published data only}
    1. Belcaro G, Cesarone MR, Ricci A, Cornelli U, Rodhewald P, Ledda A, et al. Control of edema in hypertensive subjects treated with calcium antagonist (nifedipine) or angiotensin-converting enzyme inhibitors with Pycnogenol. Clinical and Applied Thrombosis/Hemostasis 2006;12(4):440-4. [PMID: ] - PubMed
Belcaro 2008b {published data only}
    1. Belcaro G, Cesarone MR, Genovesi D, Ledda A, Vinciguerra G, Ricci A, et al. Pycnogenol may alleviate adverse effects in oncologic treatment. Panminerva Medica 2008;50(3):227-34. [PMID: ] - PubMed
Belcaro 2010 {published data only}
    1. Belcaro G, Cesarone MR, Dugall M, Hosoi M, Ippolito E, Bavera P, et al. Investigation of Pycnogenol® in combination with coenzyme Q10 in heart failure patients (NYHA II/III). Panminerva Medica 2010;52(2 Suppl 1):21-5. [PMID: ] - PubMed
Belcaro 2011 {published data only}
    1. Belcaro G, Luzzi R, Cesinaro Di Rocco P, Cesarone MR, Dugall M, Feragalli B, et al. Pycnogenol® improvements in asthma management. Panminerva Medica 2011;53(3 Suppl 1):57-64. [PMID: ] - PubMed
Belcaro 2013 {published data only}
    1. Belcaro G, Cornelli U, Luzzi R, Cesarone MR, Dugall M, Feragalli B, et al. Pycnogenol(R) supplementation improves health risk factors in subjects with metabolic syndrome. Phytotherapy Research 2013;27(10):1572-8. [PMID: ] - PubMed
Belcaro 2014 {published data only}
    1. Belcaro G, Luzzi R, Hu S, Cesarone MR, Dugall M, Ippolito E, et al. Improvement in signs and symptoms in psoriasis patients with Pycnogenol(R) supplementation. Panminerva Med 2014;56(1):41-8. [DOI: 10.1111/j.1365-4632.2011.05340] - DOI - PubMed
Bottari 2013 {published data only}
    1. Bottari A, Belcaro G, Ledda A, Luzzi R, Cesarone MR, Dugall M. Lady Prelox(R) improves sexual function in generally healthy women of reproductive age. Minerva Ginecologica 2013;65(4):435-44. [PMID: ] - PubMed
Cesarone 2006a {published data only}
    1. Cesarone MR, Belcaro G, Rohdewald P, Pellegrini L, Ledda A, Vinciguerra G, et al. Comparison of Pycnogenol and Daflon in treating chronic venous insufficiency: a prospective, controlled study. Clinical and Applied Thrombosis/Hemostasis 2006;12(2):205-12. [PMID: ] - PubMed
Cesarone 2006b {published data only}
    1. Cesarone MR, Belcaro G, Rohdewald P, Pellegrini L, Ledda A, Vinciguerra G. Improvement of diabetic microangiopathy with Pycnogenol®: A prospective, controlled study. Angiology 2006;57(4):431-6. [DOI: 10.1177/0003319706290318] - DOI - PubMed
Cesarone 2006c {published data only}
    1. Cesarone MR, Belcaro G, Rohdewald P, Pellegrini L, Ledda A, Vinciguerra G. Rapid relief of signs/symptoms in chronic venous microangiopathy with Pycnogenol®: a prospective, controlled study. Angiology 2006;57(5):569-76. [DOI: 10.1177/0003319706290318] - DOI - PubMed
Cesarone 2010 {published data only}
    1. Cesarone MR, Belcaro G, Rohdewald P, Pellegrini L, Ledda A, Vinciguerra G. Improvement of signs and symptoms of chronic venous insufficiency and microangiopathy with Pycnogenol®: a prospective, controlled study. Phytomedicine 2010;17:835-9. [DOI: 10.1016/j.phymed.2010.04.009] - DOI - PubMed
Furumura 2012 {published data only}
    1. Furumura M, Sato N, Kusaba N, Takagaki K, Nakayama J. Oral administration of French maritime pine bark extract (Flavangenol((R))) improves clinical symptoms in photoaged facial skin. Clinical Interventions in Aging 2012;7:275-86. [PMID: ] - PMC - PubMed
Hosoi 2018 {published data only}
    1. Hosoi M, Belcaro G, Saggino A, Luzzi R, Dugall M, Feragalli B. Pycnogenol® supplementation in minimal cognitive dysfunction. Journal of Neurosurgical Sciences 2018;62(3):279-84. - PubMed
Hu 2015 {published data only}
    1. Hu S, Belcaro G, Cornelli U, Luzzi, R, Cesarone M, Dugall M, et al. Effects of Pycnogenol(R) on endothelial dysfunction in borderline hypertensive, hyperlipidemic, and hyperglycemic individuals: the borderline study. International Angiology 2015;34(1):43-52. - PubMed
Khurana 2013 {published data only}
    1. Khurana H, Pandey RK, Saksena AK, Kumar A. An evaluation of Vitamin E and Pycnogenol in children suffering from oral mucositis during cancer chemotherapy. Oral Diseases 2013;19(5):456-64. [PMID: ] - PubMed
Kobori 2015 {published data only}
    1. Kobori Y, Suzuki K, Iwahata T, Shin T, Sadaoka Y, Sato, R, et al. Improvement of seminal quality and sexual function of men with oligoasthenoteratozoospermia syndrome following supplementation with L-arginine and Pycnogenol(R). Archivio Italiano di Urologia e Andrologia (Archives of Italian Urology and Andrology) 2015;87(3):190-3. [DOI: 10.4081/aiua.2015.3.190] - DOI - PubMed
Koch 2002 {published data only}
    1. Koch R. Comparative study of Venostasin® and Pycnogenol® in chronic venous insufficiency. Phytotherapy Research 2002;16(Suppl 1):S1-5. [DOI: 10.1002/ptr.1010] - DOI - PubMed
Kohama 2004 {published data only}
    1. Kohama T, Suzuki N, Ohno S, Inoue M. Analgesic efficacy of French maritime pine bark extract in dysmenorrhea: An open clinical trial. Journal of Reproductive Medicine for the Obstetrician and Gynecologist 2004;49(10):828-32. [PMID: 15568408 ] - PubMed
Kohama 2007 {published data only}
    1. Kohama T, Herai K, Inoue M. Effect of French maritime pine bark extract on endometriosis as compared to leuprorelin acetate. The Journal of Reproductive Medicine 2007;52(8):703-8. [PMID: ] - PubMed
Kohama 2013 {published data only}
    1. Kohama T, Negami M. Effect of low‐dose French maritime pine bark extract on climacteric syndrome in 170 perimenopausal women. The Journal of Reproductive Medicine 2013;58:39-46. - PubMed
Ledda 2018 {published data only}
    1. Ledda A, Belcaro G, Feragalli B, Cornelli U, Dugall M, Corsi M, Ceraone M. Benign prostatic hypertrophy: Pycnogenol® supplementation improves prostate symptoms and residual bladder volume. Minerva Medica 2018;109(4):280-4. - PubMed
Liu 2004b {published data only}
    1. Liu X, Zhou H-J, Rohdewald P. French maritime pine bark extract Pycnogenol dose-dependently lowers glucose in type 2 diabetic patients. Diabetes Care 2004;27(3):839. [PMID: 14988316 ] - PubMed
Luzzi 2014 {published data only}
    1. Luzzi R, Belcaro G, Hu S, Dugall M, Hosoi M, Cacchio M, et al. Improvement in symptoms and cochlear flow with pycnogenol in patients with Meniere's disease and tinnitus. Minerva Medica 2014;105(3):245-54. - PubMed
Luzzi 2016 {published data only}
    1. Luzzi R, Belcaro G, Ippolito E. Carotid plaque stabilization induced by the supplement association Pycnogenol(R) and centella asiatica (Centellicum(R)). Minerva Cardioangiologica 2016;64(6):603-9. - PubMed
Luzzi 2017 {published data only}
    1. Luzzi R, Belcaro G, Hosoi M, Feragalli B, Cornelli U, Dugall M, Ledda A. Normalization of cardiovascular risk factors in perimenopausal women with Pycnogenol®. Minerva Ginecologica 20017;69(1):29-34. [DOI: 10.23736/S0026‐4784.16.03913‐7] - DOI - PubMed
Maia 2013 {published data only}
    1. Maia H Jr, Haddad C, Casoy J. Combining oral contraceptives with a natural nuclear factor-kappa B inhibitor for the treatment of endometriosis-related pain. International Journal of Women's Health 2013;6:35-9. [PMID: ] - PMC - PubMed
NCT03777683 {published data only}
    1. NCT03777683. Evaluation the effects of Pycnogenol supplementation on the clinical status in traumatic brain injury patients. ClinicalTrials.gov (first posted 17 December 2018).
Nemr 2010 {published data only}
    1. Nemr EG. Investigation of a complex plant extract for mild to moderate erectile dysfunction in a randomized, double-blind, placebo-controlled, parallel-arm study. BJU International 2010;105(11):1607-8. - PubMed
Ni 2002 {published data only}
    1. Ni Z, Mu Y, Gulati O. Treatment of melasma with Pycnogenol®. Phytotherapy Research 2002;16(6):567-71. [DOI: 10.1002/ptr.1085] - DOI - PubMed
Nikolova 2007 {published data only}
    1. Nikolova V, Stanislavov R, Vatev I, Nalbanski B, Punevska M. Sperm parameters in male idiopathic infertility after treatment with prelox. Akusherstvo i Ginekologiia 2007;46(5):7-12. [PMID: ] - PubMed
Nishioka 2007 {published data only}
    1. Nishioka K, Hidaka T, Nakamura S, Umemura T, Jitsuiki D, Soga J, et al. Pycnogenol®, French maritime pine bark extract, augments endothelium‐dependent vasodilation in humans. Hypertension Research 2007;30(9):775-80. [DOI: 10.1291/hypres.30.775] - DOI - PubMed
Nuzum 2011 {published data only}
    1. Nuzum DS, Gebru TT, Kouzi SA. Pycnogenol for chronic venous insufficiency. American Journal of Health-System Pharmacy 2011;68(17):1589-90, 1599-1601. [DOI: 10.2146/ajhp100676] [PMID: ] - DOI - PubMed
Riccioni 2004 {published data only}
    1. Riccioni C, Sarcinella R, Izzo A, Palermo G, Liguori M. Effectiveness of Troxerutin in association with Pycnogenol in the pharmacological treatment of venous insufficiency [Efficacia della Troxerutina associata al Pycnogenol nel trattamento farmacologico dell'insufficienza venosa]. Minerva Cardioangiologica 2004;52(1):43-8. [PMID: ] - PubMed
Ryan 2008 {published data only}
    1. Ryan J, Croft K, Mori T, Wesnes K, Spong J, Downey L, et al. An examination of the effects of the antioxidant Pycnogenol® on cognitive performance, serum lipid profile, endocrinological and oxidative stress biomarkers in an elderly population. Journal of Psychopharmacology 2008;22(5):553-62. [DOI: 10.1177/ 0269881108091584] - PubMed
Sedighiyan 2018 {published data only}
    1. IRCT2016062628637N1. The effects of pine bark extract supplementation and weight loss diet on resting energy expenditure, body composition and metabolic syndrome criteria in obese women. apps.who.int/trialsearch/Trial2.aspx?TrialID=IRCT2016062628637N1 (first registered 07 July 2016).
    1. Sedighiyan M, Abdolahi M, Taheri E, Qorbani M, Omidian P, Hosseini S. The French maritime pine bark extract reduce metabolic syndrome risk and improve body composition in obesity: a new clinical approach. Acta Medica Iranica 2018;56(3):196-203.
Smetanka 2019 {published data only}
    1. Smetanka A, Stara V, Farsky I, Tonhajzerova I, Ondrejka I. Pycnogenol® supplementation as an adjunct treatment for antidepressant-induced sexual dysfunction. Physiology International 2019;106(1):59-69. [DOI: 10.1556/2060.106.2019.02] - DOI - PubMed
Spadea 2001 {published data only}
    1. Spadea L, Balestrazzi E. Treatment of vascular retinopathies with Pycnogenol®. Phytotherapy Research 2001;15(3):219-23. [DOI: 10.1002/ptr.853] - DOI - PubMed
Stanislavov 2008 {published data only}
    1. Stanislavov R, Nikolova V, Rohdewald P. Improvement of erectile function with Prelox: a randomized, double-blind, placebo-controlled, crossover trial. International Journal of Impotence Research 2008;20(2):173-80. [PMID: ] - PubMed
    1. Stanislavov R, Nikolova V, Rohdewald P. Improvement of seminal parameters with Prelox: a randomized, double-blind, placebo-controlled, cross-over trial. Phytotherapy Research 2009;23(3):297-302. [PMID: ] - PubMed
    1. Stanislavov R, Nikolova V. The aging process and erectile dysfunction: Clinical trial for overcome hyperproduction of endogenous methylarginines. Journal of Sexual Medicine 2010;7:427. [DOI: 10.1111/j.1743-6109.2010.02103-3.x] - DOI
Stanislavov 2014 {published data only (unpublished sought but not used)}
    1. Stanislavov R, Rohdewald P. Improvement of erectile function by a combination of French maritime pine bark and roburins with aminoacids. Minerva Urologica e Nefrologica [Italian Journal of Urology and Nephrology] 2015;67(1):27-32. - PubMed
    1. Stanislavov R, Rohdewald P. Sperm quality in men is improved by supplementation with a combination of L-arginine, L-citrullin, roburins and Pycnogenol(R). Minerva Urologica e Nefrologica [Italian Journal of Urology and Nephrology] 2014;66(4):217-23. [PMID: ] - PubMed
Stefanescu 2001 {published data only}
    1. Stefanescu M, Matache C, Onu A, Tanaseanu S, Dragomir C, Constantinescu I. Pycnogenol® efficacy in the treatment of systemic lupus erythematosus patients. Phytotherapy Research 2001;15(8):698-704. [DOI: 10.1002/ptr.915] - DOI - PubMed
Suzuki 2008 {published data only}
    1. Suzuki N, Uebaba K, Kohama T, Moniwa N, Kanayama N, Koike K. French maritime pine bark extract significantly lowers the requirement for analgesic medication in dysmenorrhea: A multicenter, randomized, double-blind, placebo-controlled study. Journal of Reproductive Medicine for the Obstetrician and Gynecologist 2008;53(5):338-46. [PMID: ] - PubMed
Tenenbaum 2002 {published data only}
    1. Tenenbaum S, Paull JC, Sparrow EP, Dodd DK, Green L. An experimental comparison of Pycnogenol and methylphenidate in adults with Attention-Deficit/Hyperactivity Disorder (ADHD). Journal of Attention Disorders 2002;6(2):49-60. [PMID: ] - PubMed
Thom 2005 {published data only}
    1. Thom E. A randomized, double-blind, placebo-controlled study on the clinical efficacy of oral treatment with DermaVite on ageing symptoms of the skin. The Journal of International Medical Research 2005;33(3):267-72. [PMID: ] - PubMed
Vinciguerra 2006 {published data only}
    1. Vinciguerra G, Belcaro G, Cesarone MR, Rohdewald P, Stuard S, Ricci A, et al. Cramps and muscular pain: prevention with pycnogenol in normal subjects, venous patients, athletes, claudicants and in diabetic microangiopathy. Angiology 2006;57(3):331-9. [PMID: ] - PubMed
Walter 2017 {published data only}
    1. Walter A, Finelli K, Bai X, Arnett P, Bream T, Seidenberg P, et al. Effect of Enzogenol(R) supplementation on cognitive, executive, and vestibular/balance functioning in chronic phase of concussion. Developmental Neuropsychology 2017;42(2):93-103. [DOI: 10.1080/87565641.2016.1256404] - DOI - PubMed
Wilson 2010 {published data only}
    1. Ross SM. Allergic rhinitis: a proprietary extract of Pinus pinaster Aiton (Pycnogenol) is found to improve the symptoms associated with allergic rhinitis. Holistic Nursing Practice 2016;30(5):301-4. [DOI: 10.1097/HNP.0000000000000170] - DOI - PubMed
    1. Wilson D, Evans M, Guthrie N, Sharma P, Baisley J, Schonlau F, et al. A randomized, double-blind, placebo-controlled exploratory study to evaluate the potential of pycnogenol for improving allergic rhinitis symptoms. Phytotherapy Research 2010;24(8):1115-9. [DOI: 10.1002/ptr.3232] - DOI - PubMed
Yang 2007 {published data only}
    1. Yang H-M, Liao M-F, Zhu S-Y, Liao M-N, Rohdewald P. A randomised, double-blind, placebo-controlled trial on the effect of Pycnogenol® on the climacteric syndrome in peri-menopausal women. Acta Obstetricia et Gynecologica 2007;86(8):978-85. [DOI: 10.1080/00016340701446108] - DOI - PubMed

References to studies awaiting assessment

Muchova 2014 {published data only}
    1. Muchová J, Országhová Z, Žitnanová I, Trebatický B, Breza J, Duracková Z. The effect of natural polyphenols on the oxidative stress markers in patients with diabetic nephropathy. Free Radical Biology & Medicine 2014;75 Suppl 1:S42. [DOI: 10.1016/j.freeradbiomed.2014.10.795] - DOI - PubMed

References to ongoing studies

ACTRN12615000233527 {published data only}
    1. ACTRN12615000233527. An investigative study on the safety and efficacy of French Maritime Pine Bark Extract, Papain and Aloe Vera in pre-diabetic participants. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368098 (first registered 13 March 2015).
IRCT20100408003664N21 {published data only}
    1. IRCT20100408003664N21. Effect of pine bark extract on the treatment of patients with type 2 diabetes with microalbuminuria. apps.who.int/trialsearch/Trial2.aspx?TrialID=IRCT20100408003664N21 (first registered 26 April 2018).
IRCT20140406017139N3 {published data only}
    1. IRCT20140406017139N3. The effects of oligopin supplementation on inflammatory and metabolic parameters in women with polycystic ovary syndrome. apps.who.int/trialsearch/Trial2.aspx?TrialID=IRCT20140406017139N3 (first registered 22 December 2018).
IRCT2017060334308N1 {published data only}
    1. IRCT2017060334308N1. Evaluating the effects of oligopin supplementation on the turnover of bone formation and antioxidant changes in postmenopausal osteopenic women: a randomized double-blind clinical trial with placebo-concurrent controls. apps.who.int/trialsearch/Trial2.aspx?TrialID=IRCT2017060334308N1 (first registered 20 August 2017). [IRANIAN REGISTRY OF CLINICAL TRIALS: 26242]
IRCT20180718040512N1 {published data only}
    1. IRCT20180718040512N1. The effect of French maritime pine bark extract (Oligopin® ) on FBS, LDL,HDL and systolic blood pressure in women with type II diabetic. apps.who.int/trialsearch/Trial2.aspx?TrialID=IRCT20180718040512N1 (first registered 04 August 2018). [IRANIAN REGISTRY OF CLINICAL TRIALS: 32711]
ISRCTN22412590 {published data only}
    1. ISRCTN22412590. Pilot study for the treatment of heart failure with Pycnogneol. www.isrctn.com/search?q=ISRCTN22412590 (first registered 06 December 2007). [DOI: 10.1186/ISRCTN22412590] - DOI
ISRCTN44961472 {published data only}
    1. ISRCTN44961472. Pycnogenol® to reduce use of commercial anti-hypertensive medications: a randomised, double-blind, placebo-controlled, prospective, 15-week study. www.isrctn.com/ISRCTN44961472 (first registered 31 October 2007). [DOI: 10.1186/ISRCTN44961472] - DOI
NCT00064857 {published data only}
    1. NCT00064857. Pycnogenol for the treatment of lymphedema of the arm in breast cancer survivors [Pycnogenol for the treatment of lymphedema of the arm in breast cancer survivors]. clinicaltrials.gov/ct2/show/NCT00064857 (first posted 16 July 2003).
NCT00214032 {published data only}
    1. NCT00214032. Pycnogenol for the treatment of lymphedema [Treatment of arm lymphedema in breast cancer survivors: a double-blind, randomized study of Pycnogenol vs. placebo]. clinicaltrials.gov/ct2/show/NCT00214032 (first posted 21 September 2005).
NCT00952627 {published data only}
    1. NCT00952627. Effects of Pycnogenol on cardiac fibrosis and diastolic dysfunction in aged hypertensive subjects [Mechanism of the anti-remodeling activity of the over-the-counter dietary supplement, Pycnogenol, on age-dependent process of cardiac fibrosis in aged hypertensive subjects with echocardiographic evidence of grade I/II diastolic dysfunction]. clinicaltrials.gov/ct2/show/NCT00952627 (first posted 06 August 2009).
NCT01321281 {published data only}
    1. NCT01321281. A study to determine if Aquamin modulates inflammatory biomarkers in the blood of osteoarthritis and healthy subjects [Randomised, placebo controlled study to determine if Aquamin (as AquaCal and AquaPT) modulates Inflammatory biomarkers in the blood of osteoarthritis and healthy subjects]. clinicaltrials.gov/ct2/show/NCT01321281 (first posted 23 March 2011).
NCT02909686 {published data only}
    1. NCT02909686. Effects of botanical microglia modulators in Gulf War illness [Effects of botanical microglia modulators in Gulf War Illness]. clinicaltrials.gov/ct2/show/NCT02909686 (first posted 21 September 2016).
NCT03106584 {published data only}
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    1. NCT03368690. Therapeutic effects of pine bark extracts in attention deficit hyperactivity disorder [Effects of polyphenolic extract from pine bark on the inattention and hyperactivity in patients with attention deficit hyperactivity disorder based on the antioxidative status]. clinicaltrials.gov/ct2/show/NCT03368690 (first posted 11 December 2017).
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    1. NCT03704454. The use of Pycnogenol® to alleviate menopausal symptoms induced or increased by breast and gynecological cancer treatments [The use of Pycnogenol® to alleviate menopausal symptoms induced or increased by breast and gynecological cancer treatments]. clinicaltrials.gov/ct2/show/NCT03704454 (first posted 12 October 2018).
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    1. Verlaet AA, Ceulemans B, Verhelst H, Van West D, De Bruyne T, Pieters L, et al. Effect of Pycnogenol(R) on attention-deficit hyperactivity disorder (ADHD): study protocol for a randomised controlled trial. Trials 2017;18(1):145. [DOI: 10.1186/s13063-017-1879-6] - DOI - PMC - PubMed

Additional references

American Botanical Council 2010
    1. American Botanical Council. Press release: ABC publishes monograph on scientific and clinical research of Pycnogenol. cms.herbalgram.org/press/2010/PycnogenolMonograph.html (accessed 19 August 2010).
Ammar 2009
    1. Ammar RB, Bhouri W, Sghaier MB, Boubaker J, Skandrani I, Neffati A, et al. Antioxidant and free radical-scavenging properties of three flavonoids isolated from the leaves of Rhamnus alaternus L. (Rhamnaceae): a structure-activity relationship study. Food Chemistry 2009;116(1):258-64.
Bartlett 2008
    1. Bartlett HE, Eperjesi F. Nutritional supplementation for type 2 diabetes: a systematic review. Ophthalmic and Physiological Optics 2008;28:503-23. - PubMed
Bellamy 2001
    1. Bellamy N. WOMAC osteoarthritis index. www.womac.org/index.htm (accessed 23 September 2010).
Benzie 2014
    1. Benzie I, Choi S. Antioxidants in food: content, measurement, significance, action, cautions, caveats, and research needs. Advances in Food and Nutrition Research 2014;71:1-53. [DOI: 10.1016/B978-0-12-800270-4.00001-8 ] - PubMed
Bernell 2016
    1. Bernell S, Howard SW. Use your words carefully: what is a chronic disease? Frontiers in Public Health 2016;4:159. - PMC - PubMed
Bjelakovic 2007
    1. Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. Journal of the American Medical Association 2007;297(8):842-57. - PubMed
Bjorklund 2017
    1. Bjorklund G, Chirumbolo S. Role of oxidative stress and antioxidants in daily nutrition and human health. Journal of Nutrition 2017;33:311-21. [DOI: 10.1016/j.nut.2016.07.018] - DOI - PubMed
CDC 2017
    1. National Center for Chronic Disease Prevention and Health Promotion. Chronic disease overview. www.cdc.gov/chronicdisease/overview/index.htm (accessed 20 July 2017).
Chovanová 2006
    1. Chovanová Z, Muchová J, Sivoňvá M, Dvořáková M, Žitňanová I, Waczulíková I. Effect of polyphenolic extract, Pycnogenol®, on the level of 8-oxoguaninein children suffering from attention deficit/hyperactivity disorder. Free Radical Research 2006;40(9):1003-10. [DOI: 10.1080/10715760600824902] - DOI - PubMed
Clark 2010
    1. Clark CE, Arnold E, Lasserson TJ, Wu T. Herbal interventions for chronic asthma in adults and children: a systematic review and meta-analysis. Primary Care Respiratory Journal 2010;19(4):307-14. [DOI: 10.4104/pcrj.2010.00041] - DOI - PMC - PubMed
Clarke 2007
    1. Clarke M. Standardising outcomes for clinical trials and systematic reviews. Trials 2007;8:39-41. - PMC - PubMed
COMET Initiative
    1. COMET Initiative. www.comet-initiative.org/ (accessed 22 June 2020).
Cos 2004
    1. Cos P, Bruyne T, Hermans N, Apers S, Vanden Berghe D, Vlietnick AJ. Proanthocyanidins in health care: current and new trends. Current Medicinal Chemistry 2004;11(10):1345-59. - PubMed
Covidence [Computer program]
    1. Covidence. Melbourne, Australia: Veritas Health Innovation, accessed 10 February 2019. Available at www.covidence.org.
Donma 2005
    1. Donma MM, Donma O. Phytonutrients and children: the other side of the medallion. Food Research International 2005;38(6):681-92.
Drum 2014
    1. Drum CE. The dynamics of disability and chronic conditions. Disibility and Health 2014;7:2-5. - PubMed
Dvoráková 2006
    1. Dvořáková M, Sivoňvá M, Trebatická J, Škodáček I, Waczulíková I, Muchová J. The effect of polyphenolic extract from pine bark, Pycnogenol®, on the level of glutathione in children suffering from attention deficit hyperactivity disorder (ADHD). Redox Report 2006;11(4):163-72. [DOI: 10.1179/135100006X116664] - DOI - PubMed
Dvoráková 2007
    1. Dvořáková M, Ježová D, Blažíček P, Trebatická J, Škodáček I, Šuba J. Urinary catecholamines in children with attention deficit hyperactivity disorder (ADHD): modulation by a polyphenolic extract from pine bark (Pycnogenol®). Nutritional Neuroscience 2007;10(3/4):151-7. [DOI: 10.1080/09513590701565443] - DOI - PubMed
GRADEPro GDT 2015 [Computer program]
    1. GRADEpro GDT. Version accessed prior to 14 July 2020. Hamilton (ON): McMaster University (developed by Evidence Prime), 2015. Available from gradepro.org.
Hadi 2019
    1. Hadi A, Pourmasoumi M, Mohammadi H, Javaheri A, Rouhani MH. The impact of Pycnogenol® supplementation on plasma lipids in humans: a systematic review and meta‐analysis of clinical trials. Phytotherapy Research 2019;33:276–87. [DOI: 10.1002/ptr.6234] - DOI - PubMed
Hald 2005
    1. Hald A, Lotharius J. Oxidative stress and inflammation in Parkinson's disease: is there a causal link? Experimental Neurology 2005;193(2):279-90. - PubMed
Henrotin 2011
    1. Henrotin Y, Lambert C, Couchourel D, Ripoll C, Chiotelli E. Nutraceuticals: do they represent a new era in the management of osteoarthritis? - a narrative review from the lessons taken with five products. Osteoarthritis and Cartilage 2011;19:1-21. - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327(7414):557-60. - PMC - PubMed
Higgins 2011
    1. Higgins JP, Altman DG (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JP, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011).The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
Higgins 2019
    1. Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Cochrane, 2019. Available from www.training.cochrane.org/handbook.
Keqin 2014
    1. Keqin O, Liwei G. Absorption and metabolism of proanthocyanidins. Journal of Functional Foods 2014;7:43-53.
Kruger 2014
    1. Kruger MJ, Davies N, Myburgh KH, Lecour S. Proanthocyanidins, anthocyanins and cardiovascular diseases. Food Research International 2014;59:41-52.
Leydhecker 1986
    1. Leydhecker W. Drug treatment for diabetic retinopathy [Zur medicamentösen Behandlung der diabetischen retinopathie]. The Opthalmology Department of the University Clinic of Wurzburg, Germany 1986.
Li 2015
    1. Li Y, Feng J, Zhang X, Cui Y. Pine bark extracts: nutraceutical, pharmacological, and toxicological evaluation. Journal of Pharmacology and Experimental Therapeutics 2015;353:9-16. - PubMed
Lichtenstein 2005
    1. Lichtenstein AH, Russell SG. Essential nutrients: foods or supplements: where should the emphasis be? JAMA 2005;294(3):351-8. - PubMed
Litchford 2008
    1. Litchford MD. Assessment: laboratory data. In: Mahan LM, Escott-Stump S, editors(s). Krause's food & nutrition therapy. 12th edition. Missouri: Saunders Elsevier, 2008:426-7.
Lobo 2010
    1. Lobo V, Patil A, Phatak A, Chandra N. Free radicals, antioxidants and functional foods: Impact on human health. Pharmacognosy Reviews 2010;4(8):118-26. [DOI: 10.4103/0973-7847.70902] - DOI - PMC - PubMed
Martin 2007
    1. Martin CM. Chronic disease and illness care. Canadian Family Physician 2007;53:2086-91. - PMC - PubMed
Moore 1998
    1. Moore RA, Gavaghanb D, Tramèr MR, Collinsa SL, McQuaya HJ. Size is everything – large amounts of information are needed to overcome random effects in estimating direction and magnitude of treatment effects. Pain 1998;78:209-16. - PubMed
Nijveldt 2001
    1. Nijveldt RJ, Nood E, Hoorn DE, Boelens PG, Norren K, Leeuwen PA. Flavonoids: a review of probable mechanisms of action and potential applications. American Journal of Clinical Nutrition 2001;74(4):418-25. - PubMed
Oliff 2010
    1. Oliff H. Scientific and clinical monograph for Pycnogenol. abc.herbalgram.org/site/PageServer?pagename=Pycnogenol (accessed 19 Aug 2010).
Pizzino 2017
    1. Pizzino G, Irrera N, Cucinotta M, Pallio G, Mannino F, Arcoraci V, et al. Oxidative stress: harms and benefits for human health. Oxidative Medicine and Cell Longevity 2017;2017:8416763. [DOI: 10.1155/2017/8416763] - DOI - PMC - PubMed
Preiser 2012
    1. Preiser J. Oxidative Stress. Journal of Parenteral and Enteral Nutrition 2012;36(2):147-54. - PubMed
Rauf 2019
    1. Rauf A, Imran M, Abu-Izneid T, Ul-Haq I, Patel S, Pan X, et al. Proanthocyanidins: a comprehensive review. Biomedicine and Pharmacotherapy 2019 May 27 [Epub ahead of print]. [DOI: 10.1016/j.biopha.2019.108999] - DOI - PubMed
Review Manager 2020 [Computer program]
    1. Review Manager. Version 5.4. The Cochrane Collaboration, 2020.
Sackett 1993
    1. Sackett DL, Cook DJ. Can we learn anything from small trials? Annals of the New York Academy of Sciences 1993;703:25-31. - PubMed
Salganik 2001
    1. Salganik RI. The benefits and hazards of antioxidants: controlling apoptosis and other protective mechanisms in cancer patients and the human population. Journal of the American College of Nutrition 2001;20(5 Suppl):464-7. - PubMed
Schulz 2011
    1. Schulz KF, Altman DG, Moher D, for the CONSORT Group. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. International Journal of Surgery 2011;9(8):672-7. [DOI: 10.1016/j.ijsu.2011.09.004] - DOI - PubMed
Shea 2007
    1. Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Medical Research Methodology 2007;7:10-6. - PMC - PubMed
Sies 2017
    1. Sies H, Berndt C, Jones DP. Oxadative stress. Annual Review of Biochemistry 2017;86:715-48. - PubMed
Tonks 2007
    1. Tonks A. Antioxidant supplements may damage your health. BMJ 2007;334(7592):501.
Walker 2001
    1. Walker C. Recognising the changing boundaries of illness in defining terms of chronic illness: a prelude to understanding the changing needs of people with chronic illness. Australian Health Review 2001;24(2):207-14. - PubMed
Watson 2006
    1. Watson T. The science of anti-oxidants and exercise performance. In: Burke L, Deakin V, editors(s). Clinical Sports Nutrition. 3rd edition. Sydney: McGraw-Hill, 2006:345.
Whitney 2002
    1. Whitney EN, Rolfes SR. Antioxidant nutrients and phytochemicals in disease prevention. In: Understanding Nutrition. 9th edition. Stamford: Wadsworth, 2002:377-83.
Wiegel 2005
    1. Wiegel M, Meston C, Rosen R. The Female Sexual Function Index (FSFI):Cross-Validation and Development of Clinical Cutoff Scores. Journal of Sex & Marital Therapy 2005;31(1):1-21. [DOI: 10.1080/00926230590475206] - DOI - PubMed
Yudoh 2005
    1. Yudoh K, Trieu N, Nakamura H, Hongo-Masuko K, Kato T, Nishioka K. Potential involvement of oxidative stress in cartilage senescence and development of osteoarthritis: oxidative stress induce chondrocyte telomere instability and downregulation of chondrocyte function. Arthritis Research and Therapy 2005;7(2):R380-91. - PMC - PubMed
Zhang 2018
    1. Zhang Z, Tong X, Wei YL, Zhao L, Xu JY, Qin LQ. Effect of Pycnogenol supplementation on blood pressure: a systematic review and meta-analysis. Iranian Journal Public Health 2018;47(6):779-87. - PMC - PubMed
Zwar 2006
    1. Zwar N, Harris M, Griffiths R, Roland M, Dennis S, Powell Davies G, et al. A systematic review of chronic disease management. openresearch-repository.anu.edu.au/bitstream/1885/119226/3/final_25_zwar... (accessed 20 July 2017).

References to other published versions of this review

Schoonees 2010
    1. Schoonees A, Visser J, Volmink J. Proanthocyanidin supplements for the treatment of chronic disorders. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No: CD008294. [DOI: 10.1002/14651858.CD008294] - DOI
Schoonees 2011
    1. Schoonees A, Visser J, Musekiwa A, Volmink J. Pyconogenol® for the treatment of chronic disorders. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No: CD008294. [DOI: 10.1002/14651858.CD008294.pub2] - DOI - PubMed
Schoonees 2012a
    1. Schoonees A, Visser J, Musekiwa A, Volmink J. Pyconogenol® for the treatment of chronic disorders. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No: CD008294. [DOI: 10.1002/14651858.CD008294.pub3] - DOI - PubMed
Schoonees 2012b
    1. Schoonees A, Visser J, Musekiwa A, Volmink J. Pycnogenol® (extract of French maritime pine bark) for the treatment of chronic disorders. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No: CD008294. [DOI: 10.1002/14651858.CD008294.pub4] - DOI - PubMed

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