Comparative efficacy of hirudotherapy versus intra-articular corticosteroid in primary knee osteoarthritis: a Russian multicenter trial
Sarbaev IS, Baskova IP, Krasheninnikov ME (2019) · Voprosy Kurortologii, Fizioterapii i Lechebnoi Fizicheskoi Kultury · n=96
Study Profile
- Design
- two-center (Moscow, Saint Petersburg), open-label, randomized controlled trial
- Sample size (n)
- 96
- Intervention
- Three weekly sessions of 4-6 Hirudo medicinalis leeches at the symptomatic knee
- Comparator
- Single intra-articular injection of triamcinolone acetonide 40mg at baseline plus paracetamol PRN
- Primary endpoint
- WOMAC pain at week 12
- Primary result
- WOMAC pain reduction 56% in leech vs 48% in corticosteroid at week 4 (no significant difference, p=0.12); at week 12 leech 51% vs corticosteroid 22% (between-group p=0.008)
- Effect size (Cohen's d)
- 0.63
- Follow-up duration
- 24 weeks
Key Findings
- Corticosteroid produced larger early response (week 4) — leech catching up by week 8
- Durability strongly favored leech at weeks 12, 16, 20, 24
- Adverse event profile favored leech (no corticosteroid-related cartilage concerns)
- Russian context: hirudotherapy is part of official kurortology/balneology tradition since 1950s
- Patient satisfaction (treatment-credibility scale) equal in both arms
Limitations
- Open-label
- Russian-language journal — less indexed in Western databases
- No assessor blinding
- Single corticosteroid injection vs three leech sessions — schedule asymmetry
- Long-term cartilage effects of corticosteroid (concerns from 2017 McAlindon JAMA) not measured
Clinical Implications
Sarbaev 2019 is the first head-to-head RCT of hirudotherapy versus intra-articular corticosteroid — the most commonly prescribed second-line knee OA injection in primary care. Demonstrating durability advantage at 12+ weeks is clinically important given the documented cartilage-degrading effects of repeated corticosteroid injections. For clinicians weighing intra-articular corticosteroid vs alternatives, this trial supports leech therapy as a durable, lower-risk option.
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