Ginkgo biloba Extract for Intermittent Claudication in Patients with Peripheral Arterial Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background/Objectives: Intermittent claudication (IC) secondary to peripheral artery disease (PAD) causes exertional leg pain and discomfort, which limits functional walking capacity. The clinical efficacy of Ginkgo biloba extract (GBE) as a therapeutic agent for IC is debatable. This systematic review and meta-analysis evaluated the efficacy and safety of GBE compared with a placebo in patients with IC due to PAD. Methods: Databases including PubMed, Embase, the Cochrane Library, and CINAHL were searched until 24 April 2026. Eligible studies included randomized, double-blind, controlled trials (RCTs) comparing placebo. Primary outcome was absolute claudication distance (ACD) at the end of the study. Secondary outcomes were initial claudication distance (ICD), ankle-brachial index (ABI), ankle pressure, and adverse events. Walking outcomes across various treadmill protocols were standardized to estimate caloric expenditure (kcal). A random-effects model was used to pool the effect estimates across trials. Risk of bias was assessed using the Cochrane risk-of-bias tool (RoB 2). Results: A total of 14 RCTs comprising 893 participants represent the total number randomized were included. GBE was associated with a statistically significant but modest improvement in ACD compared with placebo (mean difference [MD], 3.50 kcal; 95% CI, 0.02 to 6.98; p = 0.049). This benefit was significant in trials with a 24-week duration (MD, 4.67 kcal; 95% CI, 2.26 to 7.08; p < 0.001) but not in 12–16 weeks trials (MD, 1.35 kcal; 95% CI, −2.39 to 5.09; p = 0.48). No significant changes were observed for ICD or resting ABI/ankle pressure. GBE was well tolerated, with an overall adverse event incidence comparable to placebo. Conclusions: In patients with IC due to PAD, GBE therapy improves absolute walking performance, with a significant effect observed in trials evaluating 24 weeks of treatment. Given its favorable safety and tolerability profile, GBE can represent a clinically relevant and well-tolerated therapeutic option to support functional walking capacity, particularly for patients unable to tolerate or use conventional pharmacological agents.