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

This systematic review assessed randomized and crossover trials of pine bark extract in adults and children with chronic disorders across asthma, ADHD, cardiovascular disease and risk factors, diabetes, erectile dysfunction, osteoarthritis, osteopenia, and traumatic brain injury. The evidence base was small and clinically diverse, with one or a few trials per condition.

Trials evaluated oral pine bark extract in branded formulations such as Pycnogenol, Oligopin, and Enzogenol, usually at 100 to 200 mg/day or weight-based doses for 4 weeks to 6 months. Several studies compared the supplement with placebo or usual care; a few active regimens also included co-formulated ingredients such as L-arginine.

Pine bark extract showed several favorable signals in small individual trials, but the review could not establish definitive efficacy or safety and does not support routine use. In asthma, FEV1 % predicted improved by 7.00% and symptoms improved in 30/30 versus 16/30 participants (RR 1.85, 95% CI 1.32 to 2.58); the ADHD trial found lower inattention scores (CAP MD -1.92, 95% CI -3.33 to -0.51). Other reported benefits included lower systolic and diastolic blood pressure (MD -4.00 and -3.00 mm Hg), HbA1c (MD -0.90%), erectile function (IIEF-5 MD 8.10), and WOMAC total score (MD -730.00). Certainty was very low across outcomes, and harms were sparsely reported, although one participant receiving Pycnogenol was hospitalized for acute decompensated heart failure.

The evidence was limited by very small sample sizes, few randomized trials per condition, and marked heterogeneity in populations, doses, formulations, and outcome measures. Reporting was poor, follow-up was generally short, and safety data were sparse, leaving overall certainty very low and limiting generalizability.