Table 2

Systematic reviews of clinical trials of hypericum and garlic preparations

Features

Author

Indication

Intervention

Comparisons

Studies

1/2/3/

Results

Author's Conclusion

Year

4/5


St John's wort (Hypericum perforatum)

Gaster

depression

hypericum

placebo and

8 RCT

p/y/p/

4 placebo-controlled trials with

Data suggest that hypericum is

2000 [20]

antidepressants

y/n

positive results, in 4 trials

superior to placebo, insuffcient

standard antidepr. tended to be

evidence re equivalence with

slightly better

antidepressants

Williams

depression

hypericum

placebo and

14 RCT

y/y/n/

Treatment response: RR 1.9

Data suggest that hypericum is

2000 &

(and other

antidepressants

y/y

(95%C11.2–2.8) vs. placebo and

superior to placebo, insuffcient

Mulrow 98

drugs)

1.2 (1.0–1.4) vs. antidepressants

evidence re equivalence with

[21,22]

antidepressants

Kim 99 [23]

depression

hypericum

placebo and

6 RCT

p/y/y/

Treatment response: RR 1.48

Hypericum more effective than

antidepressants

y/y

(95%C11.03–1.92) vs. placebo

placebo and similarly effective as

and 0.98 (0.67–1.28) vs.

low dose antidepressants; quality

antidepressants

problems

Stevinson

depression

hypericum

placebo and

6 RCT

y/y/y/

Only trials published after Linde

Data confirm findings of earlier

99 [24]

antidepressants

y/n

96; trials show effects better

trials, but still insuff. evidence to

than placebo/similar to

assess equivalence with

antidepressants

antidepressants

Linde 98 &

depression

hypericum

placebo and

27 RCT

y/y/y/

Treatment response: RR 2.47

Hypericum more effective than

96 [25,26]

antidepressants

y/y

(95%C11.69–3.61) vs. placebo

placebo. Inadequate evidence to

and 1.01 (0.87–1.16) vs.

assess equivalence with

antidepressants

antidepressants

Volz 97

depression

hypericum

placebo and

15

p/p/n/

Most placebo-controlled trials

A therapy with hypericum of mild

[27]

antidepressants

RCT/CCT

n/n

positive; similarly effective as

and moderate depression can be

(not adequately dosed)

attempted. Further studies needed

antidepressants

Ernst 95

depression

hypericum

placebo and

11 RCT

y/y/y/

Most of 8 placebo-controlled

Hypericum is superior to placebo

[28]

antidepressants

y/n

trials positive. 3 trials against

and seems equally effective as

standard medication with similar

standard medication

effects

Volz 2000

mild to

hypericum

fluoxetine

17+9

n/y/n/

No direct comparison of

Response rates are similar;

[29]

mod.

CCT

y/n

hypericum and fluoxetine

findings difficult to interpret

depression

available. Mean depression

because of the indirect comparison

score (HAMD) reduction in

hypericum trials 53%, in

fluoxetine trials 55%

Friede 98

anxiety in

hypericum

placebo,

8 RCT

?/y/y/

Trials collectively show reduction

Hypericum is effective for

[30]

depressed

amitriptyline

y/n

of anxiety symptoms over

depressed patients with anxiety

p.

placebo. Only 1 trial vs

amitriptyline

Garlic (Allium sativum)

Lawrence

cardiovasc.

garlic

mainly placebo;

45 RCT

y/y/y/

37 trials consistently show small

Insufficient data to draw conclusion

2000 [31]

risk factors

no & other

y/y

short-term effects over placebo

regarding clinical cardiovascular

treatment

for cholesterol reduction. No

outcomes. Garlic preparations may

consistent effects on blood

have small, positive, short-term

pressure, promising effects re

effects on lipids

platelet aggregation and

fibrionolytic activity

Stevinson

hyperchol-

garlic

placebo

13 RCT

y/y/y/

Pooled total cholesterol

Available data suggest that garlic is

2000 [32]

esterolemia

y/y

reduction over placebo 0.41

superior to placebo. The size of the

(95% Cl -0.66 to -0.15) mmol/l;

effect is modest. The use of garlic

when analysis restricted to high

for hyperchol. is therefore of

quality trials 0.11 (-0.30 to 0.08)

questionable value

Silagy 94 &

cholesterol

garlic

placebo

16 RCT

y/p/y/

Pooled cholesterol reduction

Meta-analysis suggests positive

Neil 96

lowering

y/y

over placebo 0.65 (95% Cl 0.53–

effects but reviewers are sceptic

[33,34]

0.76) mmol/l

(low quality; own replication

negative)

Warshafsky

cholesterol

garlic

placebo

5 RCT

p/y/y/

Pooled cholesterol reduction

Available evidence supports the

93 [35]

lowering

y/y

over placebo 0.59 (95%Cl 0.44–

use of garlic as one modality to

0.74) mmol/l

decrease cholesterol levels

Silagy 94

lowering

dried garlic

placebo, other

8 RCT

y/p/y/

Pooled reduction over placebo:

Garlic maybe of some clinical use

[36]

blood

(Kwai)

treatment

y/y

SBP 7.7 (95% Cl 4.3–11.0), DBP

in subjects with mild hypertension.

press.

5.0 (2.9–7.1) mm Hg

Further research needed

Kleijnen 91

cardiovasc.

garlic

placebo

18

p/p/y/

Most studies with shortcomings.

No clear conclusion drawn

[37]

risk factors

supplements

RCT/CCT

y/n

The majority of trials with pos.

results but inconsistent effect

sizes

Kleijnen 89

cardiovasc.

garlic &

unclear

10 RCT,

y/p/n/

All trials with severe

Inadequate evidence to justify

[38]

risk factors

onions

8 CCT

y/n

shortcomings. Fresh garlic with

supplementation, further research

beneficial effcts, onions and

needed

commercially available

supplements yielded

contradictory results

Jepson 97

lower limb

garlic

placebo

1 RCT

y/y/y/

Walking distance not

Insufficient evidence

[39]

atheroscler.

y/-

significantly different between

groups


legend see table 1

Linde et al. BMC Complementary and Alternative Medicine 2001 1:5   doi:10.1186/1472-6882-1-5

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