A retrospective study comparing oral celecoxib combined with flurbiprofen hydrogel patch versus oral celecoxib therapy for lateral epicondylitis: real-world analysis of the anti-inflammatory and analgesic efficacy and safety.

Objective: The study is aimed to retrospectively compare the efficacy, safety, and impact on serum inflammatory markers between oral celecoxib combined with flurbiprofen hydrogel patch and oral celecoxib alone in the treatment of lateral epicondylitis. Methods: A retrospective cohort analysis was conducted on 64 patients diagnosed with lateral epicondylitis between January 2022 and December 2024. Patients were divided into two groups: the combined therapy group (oral celecoxib + topical flurbiprofen hydrogel patch, n = 32) and the single therapy group (oral celecoxib alone, n = 32). The primary outcome measures were Visual Analog Scale (VAS) scores and Patient-Rated Tennis Elbow Evaluation (PRTEE) scores measured at pre-treatment, 2 weeks, and 4 weeks of treatment. Secondary outcome measures included overall efficacy rate, effecting time, and 3-month recurrence rate. Serum inflammatory markers (tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and C-reactive protein (CRP)) were measured and compared between the two groups at pre-treatment, 2 weeks, and 4 weeks. Adverse events were evaluated between two groups. Results: Pre-treatment characteristics were comparable between the two groups. Regarding clinical efficacy, at both 2 and 4 weeks post-treatment, the combined therapy group showed significantly lower VAS scores (2 weeks post-treatment: 3.9 ± 1.4 vs. 5.0 ± 1.5, P = 0.003; 4 weeks post-treatment: 2.2 ± 1.1 vs. 3.6 ± 1.3, P < 0.001) and PRTEE scores (2 weeks post-treatment: 37.8 ± 10.5 vs. 46.3 ± 12.1, P = 0.004; 4 weeks post-treatment: 21.0 ± 9.8 vs. 31.4 ± 10.9, P < 0.001) compared to the single therapy group. The combined therapy group also demonstrated a higher overall efficacy rate (81.3% vs. 59.4%, P = 0.049) and a faster effecting time (median: 4.0 days vs. 7.0 days, P = 0.003). Regarding inflammatory markers, at both 2 and 4 weeks post-treatment, serum levels of TNF-α, IL-6, and CRP in the combined therapy group were significantly reduced from pre-treatment. Specifically, at 4 weeks post-treatment, TNF-α levels were significantly lower in the combined therapy group (12.3 ± 3.5 pg/mL vs. 16.8 ± 4.1 pg/mL, P < 0.001), as were IL-6 levels (8.1 ± 2.9 pg/mL vs. 11.7 ± 3.3 pg/mL, P < 0.001) and CRP levels (5.2 ± 2.1 mg/L vs. 8.0 ± 2.8 mg/L, P < 0.001). In terms of safety, there was no significant difference in the overall incidence of adverse events (21.9% vs. 12.5%, P = 0.327) and the 3-month recurrence rate (15.6% vs. 34.4%, P = 0.085) between two groups. Conclusion: For lateral epicondylitis, the combination of oral celecoxib and topical flurbiprofen hydrogel patch is superior to oral celecoxib alone in alleviating pain, improving function, and reducing systemic inflammation. The combined therapy also increases the overall efficacy rate, reduces the effecting time, without increasing systemic adverse events. The combined regimen represents an effective and safe treatment option to offer benefits for clinical application.