Yaobitong plus celecoxib for low back pain: a Chinese multicenter cohort and network pharmacology study.

Background: Yaobitong capsule is frequently co-administered with celecoxib for low back pain in China, but its incremental effectiveness and safety in routine clinical practice remain uncertain. We compared Yaobitong plus celecoxib with celecoxib alone and explored potential biological mechanisms. Methods: This multicenter retrospective cohort study included Chinese outpatients with low back pain treated at 3 hospitals. After 1:1 propensity score matching, 150 patients receiving Yaobitong plus celecoxib were compared with 150 receiving celecoxib alone. The primary outcome was the change in the Oswestry Disability Index (ODI) at 1 month. Secondary outcomes included pain, lumbar function, clinically meaningful response, rescue analgesic use, treatment escalation, and adverse events. Network pharmacology was conducted as an exploratory analysis. Results: After matching, measured baseline characteristics were balanced. At 1 month, the mean ODI reduction was 20.8 points with combination therapy and 14.6 points with celecoxib alone (between-group difference, -6.2 points; 95% CI, -8.36 to -4.04). Combination therapy was also associated with greater reductions in low back and leg pain and greater improvement in JOA score. Clinically meaningful ODI improvement occurred in 80.7% versus 64.0% of patients. Rescue analgesic use and treatment escalation were less frequent with combination therapy. Adverse events occurred in 19.3% and 16.0% of patients, respectively; no serious adverse events were documented. Exploratory network analyses highlighted cytokine- and inflammation-related targets and pathways. Conclusions: Adding Yaobitong to celecoxib may be associated with greater short-term improvement in disability, pain, and lumbar function, with no clear between-group difference in adverse events. Randomized trials with longer follow-up are warranted.