Celecoxib plus topical flurbiprofen patch versus celecoxib alone for symptomatic knee osteoarthritis: a randomized controlled trial

Abstract Objectives Rapid symptom control may facilitate earlier mobility and self-management in symptomatic knee osteoarthritis (KOA), but evidence for combining oral and topical non-steroidal anti-inflammatory drugs (NSAIDs) remains limited. This study aimed to determine whether adding a topical flurbiprofen patch to oral celecoxib provides greater short-term improvements in pain, physical function, quality of life, and patient global assessment than oral celecoxib alone in patients with symptomatic KOA. Methods In this open-label randomized controlled trial conducted at a tertiary academic hospital from January 2024 to March 2025, 90 patients with chronic inflammatory symptomatic KOA were randomized 1:1 to receive either oral celecoxib 200 mg once daily or celecoxib plus topical flurbiprofen patch twice daily. Outcomes were assessed at baseline and on days 3, 7, and 14. Primary outcomes were pain severity by visual analog scale (VAS) and functional impairment by WOMAC. Secondary outcomes included quality of life by SF-36 and patient global assessment (PGA). Results Eighty-nine patients completed the study (45 celecoxib; 44 combination therapy). Baseline characteristics were comparable between groups. Compared with celecoxib alone, combination therapy produced greater early pain relief, with larger VAS reductions on day 3 (3.4 ± 0.9 vs. 2.0 ± 0.8, p < 0.01) and day 7 (3.9 ± 1.0 vs. 3.3 ± 1.0, p = 0.02), but not day 14. WOMAC improvement was greater in the combination group on days 3, 7, and 14 (all p < 0.01). At day 14, SF-36 health domain scores and PGA ratings were also higher with combination therapy. Conclusions Adding topical flurbiprofen patch to oral celecoxib provided faster early improvement in pain and function and better short-term patient-reported outcomes in symptomatic KOA. Trial registration Chinese Clinical Trial Registry: ChiCTR1800014584