Impact of Adjuvant Medical Therapies on Surgical Outcomes in Idiopathic Subglottic Stenosis

North American Airway Collaborative

doi:10.1002/lary.29675

Impact of Adjuvant Medical Therapies on Surgical Outcomes in Idiopathic Subglottic Stenosis

North American Airway Collaborative

Otolaryngology

Research output: Contribution to journal › Article › peer-review

32 Scopus citations

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.

Original language	English (US)
Pages (from-to)	E2880-E2886
Journal	Laryngoscope
Volume	131
Issue number	12
DOIs	https://doi.org/10.1002/lary.29675
State	Published - Dec 1 2021

Funding

This work was funded by grant 1409‐22214 from the Patient Centered Outcomes Research Institute. Dr Gelbard is also supported by grant R01HL146401‐01 from the NIH National Heart, Lung, and Blood Institute. Dr Francis is also supported by grant R01CA251566‐01 from the National Cancer Institute, NIH and R21016724‐01 from the National Institute for Deafness and Communication Disorders, NIH.

Funders	Funder number
Author National Institutes of Health National Institutes of Health National Institutes of Health National Institutes of Health The Bev Hartig Huntington's Disease Foundation National Institutes of Health	R21016724‐01
National Institute of Health National Heart, Lung, and Blood Institute	R01HL146401, R01CA251566‐01
National Institute of Health-National Cancer Institute
National Institute on Deafness and Other Communication Disorders R01DC012546 Xue Zhong Liu National Institute on Deafness and Other Communication Disorders R01DC012115 Xue Zhong Liu National Institute on Deafness and Other Communication Disorders R01DC014427 Ulrich Müller Peter G Barr-Gillespie National Institute on Deafnessand Other Communication Disorders R01DC005965 Ulrich Müller National Institute on Deafness and Other Communication Disorders

Keywords

Idiopathic subglottic stenosis
adjuvant medical treatment
endoscopic dilation
endoscopic resection with medical therapy
inhaled corticosteroid
proton pump inhibitor
trimethoprim-sulfamethoxazole

ASJC Scopus subject areas

Otorhinolaryngology

Access to Document

10.1002/lary.29675

Cite this

@article{6108d324311a422a8c67f4d4cd60e96e,

title = "Impact of Adjuvant Medical Therapies on Surgical Outcomes in Idiopathic Subglottic Stenosis",

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.",

keywords = "Idiopathic subglottic stenosis, adjuvant medical treatment, endoscopic dilation, endoscopic resection with medical therapy, inhaled corticosteroid, proton pump inhibitor, trimethoprim-sulfamethoxazole",

author = "\{North American Airway Collaborative\} and Hoffman, \{Matthew R.\} and Ankita Patro and Huang, \{Li Ching\} and Chen, \{Sheau Chiann\} and Berry, \{Lynn D.\} and Alexander Gelbard and Francis, \{David O.\} and Catherine Anderson and Amin, \{Milan R.\} and Benninger, \{Michael S.\} and Blumin, \{Joel H.\} and Bock, \{Jonathan M.\} and Bryson, \{Paul C.\} and Castellanos, \{Paul F.\} and Clary, \{Matthew S.\} and Cohen, \{Seth M.\} and Crawley, \{Brianna K.\} and Dailey, \{Seth H.\} and Daniero, \{James J.\} and \{de Alarcon\}, Alessandro and Donovan, \{Donald T.\} and Edell, \{Eric S.\} and Ekbom, \{Dale C.\} and Fink, \{Daniel S.\} and Franco, \{Ramon A.\} and Garrett, \{C. Gaelyn\} and Guardiani, \{Elizabeth A.\} and Hillel, \{Alexander T.\} and Hoffman, \{Henry T.\} and Hogikyan, \{Norman D.\} and Howell, \{Rebecca J.\} and Johns, \{Michael M.\} and Kasperbauer, \{Jan L.\} and Khosla, \{Sid M.\} and Cheryl Kinnard and Kupfer, \{Robbi A.\} and Langerman, \{Alexander J.\} and Lentz, \{Robert J.\} and Lorenz, \{Robert R.\} and Lott, \{David G.\} and Makani, \{Samir S.\} and Fabien Maldonado and Kyle Mannion and Laura Matrka and McWhorter, \{Andrew J.\} and Merati, \{Albert L.\} and Matthew Mori and Netterville, \{James L.\} and Karla O'Dell and Schindler, \{Joshua S.\}",

note = "Publisher Copyright: {\textcopyright} 2021 The American Laryngological, Rhinological and Otological Society, Inc.",

year = "2021",

month = dec,

day = "1",

doi = "10.1002/lary.29675",

language = "English (US)",

volume = "131",

pages = "E2880--E2886",

journal = "Laryngoscope",

issn = "0023-852X",

publisher = "Wiley-Blackwell",

number = "12",

}

TY - JOUR

T1 - Impact of Adjuvant Medical Therapies on Surgical Outcomes in Idiopathic Subglottic Stenosis

AU - North American Airway Collaborative

AU - Hoffman, Matthew R.

AU - Patro, Ankita

AU - Huang, Li Ching

AU - Chen, Sheau Chiann

AU - Berry, Lynn D.

AU - Gelbard, Alexander

AU - Francis, David O.

AU - Anderson, Catherine

AU - Amin, Milan R.

AU - Benninger, Michael S.

AU - Blumin, Joel H.

AU - Bock, Jonathan M.

AU - Bryson, Paul C.

AU - Castellanos, Paul F.

AU - Clary, Matthew S.

AU - Cohen, Seth M.

AU - Crawley, Brianna K.

AU - Dailey, Seth H.

AU - Daniero, James J.

AU - de Alarcon, Alessandro

AU - Donovan, Donald T.

AU - Edell, Eric S.

AU - Ekbom, Dale C.

AU - Fink, Daniel S.

AU - Franco, Ramon A.

AU - Garrett, C. Gaelyn

AU - Guardiani, Elizabeth A.

AU - Hillel, Alexander T.

AU - Hoffman, Henry T.

AU - Hogikyan, Norman D.

AU - Howell, Rebecca J.

AU - Johns, Michael M.

AU - Kasperbauer, Jan L.

AU - Khosla, Sid M.

AU - Kinnard, Cheryl

AU - Kupfer, Robbi A.

AU - Langerman, Alexander J.

AU - Lentz, Robert J.

AU - Lorenz, Robert R.

AU - Lott, David G.

AU - Makani, Samir S.

AU - Maldonado, Fabien

AU - Mannion, Kyle

AU - Matrka, Laura

AU - McWhorter, Andrew J.

AU - Merati, Albert L.

AU - Mori, Matthew

AU - Netterville, James L.

AU - O'Dell, Karla

AU - Schindler, Joshua S.

PY - 2021/12/1

Y1 - 2021/12/1

N2 - 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.

AB - 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.

KW - Idiopathic subglottic stenosis

KW - adjuvant medical treatment

KW - endoscopic dilation

KW - endoscopic resection with medical therapy

KW - inhaled corticosteroid

KW - proton pump inhibitor

KW - trimethoprim-sulfamethoxazole

UR - https://www.scopus.com/pages/publications/85107780215

UR - https://www.scopus.com/pages/publications/85107780215#tab=citedBy

U2 - 10.1002/lary.29675

DO - 10.1002/lary.29675

M3 - Article

C2 - 34117778

AN - SCOPUS:85107780215

SN - 0023-852X

VL - 131

SP - E2880-E2886

JO - Laryngoscope

JF - Laryngoscope

IS - 12

ER -

Impact of Adjuvant Medical Therapies on Surgical Outcomes in Idiopathic Subglottic Stenosis

Abstract

Funding

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this