Impact of Adjuvant Medical Therapies on Surgical Outcomes in Idiopathic Subglottic Stenosis. (12th June 2021)

• Record Type: Journal Article
• Authors: Hoffman, Matthew R.; Patro, Ankita; Huang, Li‐Ching; Chen, Sheau‐Chiann; Berry, Lynn D.; Gelbard, Alexander; Francis, David O.
• Other Names: Anderson Catherine investigator.; Amin Milan R. investigator.; Benninger Michael S. investigator.; Blumin Joel H. investigator.; Bock Jonathan M. investigator.; Bryson Paul C. investigator.; Castellanos Paul F. investigator.; Clary Matthew S. investigator.; Cohen Seth M. investigator.; Crawley Brianna K. investigator.; Dailey Seth H. investigator.; Daniero James J. investigator.; de Alarcon Alessandro investigator.; Donovan Donald T. investigator.; Edell Eric S. investigator.; Ekbom Dale C. investigator.; Fink Daniel S. investigator.; Franco Ramon A. investigator.; Garrett C. Gaelyn investigator.; Guardiani Elizabeth A. investigator.; Hillel Alexander T. investigator.; Hoffman Henry T. investigator.; Hogikyan Norman D. investigator.; Howell Rebecca J. investigator.; Johns Michael M. investigator.; Kasperbauer Jan L. investigator.; Khosla Sid M. investigator.; Kinnard Cheryl investigator.; Kupfer Robbi A. investigator.; Langerman Alexander J. investigator.; Lentz Robert J. investigator.; Lorenz Robert R. investigator.; Lott David G. investigator.; Makani Samir S. investigator.; Maldonado Fabien investigator.; Mannion Kyle investigator.; Matrka Laura investigator.; McWhorter Andrew J. investigator.; Merati Albert L. investigator.; Mori Matthew investigator.; Netterville James L. investigator.; O'Dell Karla investigator.; Ongkasuwan Julina investigator.; Postma Gregory N. investigator.; Reder Lindsay S. investigator.; Rohde Sarah L. investigator.; Richardson Brent E. investigator.; Rickman Otis B. investigator.; Rosen Clark A. investigator.; Rutter Michael J. investigator.; Sandhu Guri S. investigator.; Schindler Joshua S. investigator.; Schneider G. Todd T. investigator.; Shah Rupali N. investigator.; Sikora Andrew G. investigator.; Sinard Robert J. investigator.; Smith Marshall E. investigator.; Smith Libby J. investigator.; Soliman Ahmed MS. investigator.; Sveinsdottir Sigríður investigator.; Van Daele Douglas J. investigator.; Veivers David investigator.; Mepi investigator.; Verma Sunil P. investigator.; Weinberger Paul M. investigator.; Weissbrod Philip A. investigator.; Wootten Christopher T. investigator.; Shyr Yu investigator.;
• Is Part Of: Laryngoscope. Volume 131:Number 12(2021)
• Page Start: E2880
• Page End: E2886
• Publication Date: 2021-06-12
• Subjects: Idiopathic subglottic stenosis -- endoscopic dilation -- endoscopic resection with medical therapy -- proton pump inhibitor -- inhaled corticosteroid -- trimethoprim‐sulfamethoxazole -- adjuvant medical treatment; Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.29675
• Languages: English
• ISSNs: 0023-852X

Abstract

Abstract : Objectives/Hypothesis: Adjuvant medications including proton pump inhibitors (PPI), antibiotics (trimethoprim/sulfamethoxazole [TMP‐SMX]), and inhaled corticosteroids (ICS) may be prescribed for patients with idiopathic subglottic stenosis (iSGS). We describe medication use with endoscopic dilation (ED) or endoscopic resection with medical treatment (ERMT) and evaluate impact on outcomes. Study Design: International, prospective, 3‐year multicenter cohort study of 810 patients with untreated, newly diagnosed, or previously treated iSGS. Methods: Post hoc secondary analysis of prospectively collected North American Airway Collaborative data on outcomes linked with adjuvant medication utilization. Primary outcome was time to recurrent operation, evaluated using Kaplan–Meier curves and Cox regression analysis. Secondary outcomes of change in peak expiratory flow (PEF) and clinical chronic obstructive pulmonary disease questionnaire (CCQ) score over 12 months were compared. Results: Sixty‐one of 129 patients undergoing ED received PPI (47%), and 10/143 patients undergoing ED received ICS (7%). TMP‐SMX was used by 87/115 patients (76%) undergoing EMRT. PPI use in the ED group did not affect time to recurrence (hazard ratio [HR] = 1.00, 95% confidence interval [CI]: 0.53–1.88; P = .99) or 12‐month change in PEF (L/min) (median [interquartile range], 12.0 [10.7–12.2] vs. 8.7 [−5.1 to 24.9]; P = .59), but was associated with 12‐month change in CCQ (−0.05 [−0.97 to 0.75] vs. −0.50 [−1.60 to 0.20]; P = .04). ICS did not affect outcome measures. TMP‐SMX use in ERMT did not affect time to recurrence (HR = 0.842, 95% CI: 0.2345–3.023; P = .79), PEF at 12 months (75 [68–89] vs. 81 [68–89]; P = .92), or 12‐month change in CCQ (0.20 [−1.05 to 0.47] vs. −0.30 [−1.00 to 0.10]; P = .45). Conclusion: There is no standard practice for prescribing adjuvant medications. These data do not support that adjuvant medications prolong time to recurrence or increase PEF. Patients with iSGS and gastroesophageal reflux disease may experience some symptom benefit with PPI. Level of Evidence: 3 Laryngoscope, 131:E2880–E2886, 2021