Romy Lauche

Importance to Hirudotherapy

Romy Lauche transformed hirudotherapy from a discipline supported by individually-impressive trials into a discipline supported by formal meta-analytic evidence — a transformation that changed how Cochrane, NICE, and German Joint Federal Committee (G-BA) committees viewed leech therapy. Before Lauche, the literature contained perhaps five high-quality RCTs (Michalsen 2003, Andereya 2006/2008, Stange 2012 carpal tunnel, Müller 2013 lateral epicondylitis) plus a long tail of case series. Reading them individually, the impression was 'multiple positive small trials.' Reading them through Lauche's formal pooled meta-analytic framework, the impression became 'consistent moderate-to-large effect size across heterogeneous indications and populations, with low risk of publication bias and robust sensitivity analyses.' Lauche's 2014 Pain Medicine paper was the first formal meta-analysis of leech therapy in any indication. Pooling 5 RCTs and 207 patients across knee OA, thumb OA, lateral epicondylitis, and tenosynovitis, she calculated a standardized mean difference of -1.49 (95% CI -2.31 to -0.67) for short-term pain reduction versus active controls — an effect size larger than any single oral or topical NSAID has demonstrated in head-to-head comparison. Her 2016 BMC CAM follow-up focused specifically on osteoarthritis, again confirming the effect with tighter inclusion criteria. The 2019 individual-patient-data meta-analysis (the gold standard of meta-analytic evidence) extended the analytic horizon to 12 months and confirmed persistent benefit. Lauche's methodological care — explicit acknowledgment of the small literature, lack of placebo controls in many trials, risk-of-bias gradings transparently mapped to each pooled estimate — has made her work difficult to dismiss even by skeptics of complementary medicine. The 2018 German S3-level guideline for naturopathic therapy of osteoarthritis cites her meta-analyses as the primary evidence source for the 'should-be-considered' recommendation for leech therapy in knee and thumb OA. ASH considers her the most important contemporary methodologist of hirudotherapy evidence synthesis.