Factors Affecting Dilation Interval in Patients With Granulomatosis With Polyangiitis‐Associated Subglottic and Glottic Stenosis

Chen, Lena; Lina, Ioan; Motz, Kevin; Berges, Alexandra J.; Ospino, Rafael; Seo, Philip; Hillel, Alexander T.

doi:10.1177/01945998211004264

Cited by 7 publications

(7 citation statements)

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“…Most of the patients within the rheumatologic group had ANCA‐positive granulomatosis polyangiitis (GPA). The mainstay of treatment for GPA is systemic treatment with immunosuppressive medication, though airway manifestations can develop despite immunosuppression and can persist even in disease remission 24 . We had eight total patients with GPA in our series which represents largest reported cohort of SISI outcomes for this population.…”

Section: Discussionmentioning

confidence: 99%

“…The mainstay of treatment for GPA is systemic treatment with immunosuppressive medication, though airway manifestations can develop despite immunosuppression and can persist even in disease remission. 24 We had eight total patients with GPA in our series which represents largest reported cohort of SISI outcomes for this population. Patients within this group required an average of 1.7 injections per year and no patients required additional surgery within 3 years of the initial SISI series.…”

Section: Sisi Outcomes Based On Etiologymentioning

confidence: 99%

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Serial In‐Office Steroid Injections for Airway Stenosis: Long‐Term Benefit and Cost Analysis

et al. 2023

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ObjectivesTo evaluate the long‐term benefit of serial in‐office steroid injections (SISI) in the treatment of subglottic and proximal tracheal stenosis (SG/PTS). Evaluate cost of SISI compared to endoscopic dilation (ED).Study DesignRetrospective study and cost analysis.MethodsAll patients with SGS/PTS with at least two consecutive in‐office steroid injections between 2013 and 2021 were evaluated. Patients with less than 2 years of follow‐up data after the initial SISI series were excluded. Demographics, etiology of stenosis, total injections performed, time between steroid series, surgery‐free interval (SFI) and adverse events were collected. For patients with known surgical history before SISI, pre‐SISI SFI was compared. Institutional billing records and the national CMS average reimbursement were evaluated. Total charges for three treatment strategies (ED alone, ED with post‐operative SISI and primary intervention with SISI) were also compared.ResultsForty‐nine patients were included; 29 (59%) idiopathic, 11 (22%) traumatic and 9 (18%) rheumatologic. Mean (SD) follow‐up time after the first SISI was 3.41 years (1.5), range (2.08–7.25 years). 79% (39/49) did not require additional surgery during the entire follow‐up period. The SFI improved from a mean 13.5 months (SD 12.6; range 2–42 months) pre‐SISI to a mean (SD) of 42 months (SD 20.2; range 10–87 months) (p < 0.0001) after SISI. Annual average charges for ED alone in our cohort was $15,383.28, compared to $7,070.04 for SISI.ConclusionsSISI are an effective treatment for patients with SG/PTS. In‐office steroid injections could offer cost savings for the patient.Level of Evidence4 Laryngoscope, 133:2673–2679, 2023

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Section: Discussionmentioning

confidence: 99%

Section: Sisi Outcomes Based On Etiologymentioning

confidence: 99%

Serial In‐Office Steroid Injections for Airway Stenosis: Long‐Term Benefit and Cost Analysis

et al. 2023

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“…The study by Chen et al studied differences in dilatation intervals for patients treated with different systemic immunosuppressive therapies compared to the patients not treated with that therapy [43]. Median dilatation interval in leflunomide-(n = 4) versus nonleflunomide-treated patients was 484 versus 155 days (p = 0.033).…”

Section: Treatment Of Subglottic Manifestationsmentioning

confidence: 99%

Systemic and Local Medical or Surgical Therapies for Ear, Nose and/or Throat Manifestations in ANCA-Associated Vasculitis: A Systematic Literature Review

Krol

Remmelts

Klaasen

et al. 2023

JCM

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Background: Ear, nose and throat (ENT) manifestations are common in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), yet how to treat these manifestations remains controversial. Therefore, we systematically reviewed the literature on the efficacy of therapies on ENT manifestations in AAV. Methods: A systematic review was conducted in accordance with the PRISMA guidelines, searching Medline, Embase and Cochrane libraries, including clinical studies between January 2005 and January 2022, in adults with AAV and ENT involvement, reporting on the effects of local and systemic therapy. The critical appraisal was performed using tools provided by the Cochrane Library and the level of evidence (LoE) was scored according to the Oxford Centre for Evidence-based Medicine. Results: After screening 5609 identified studies, 136 full-text articles were assessed. Finally, 31 articles were included for critical appraisal and data-extraction. Nearly all studies (n = 29) were retrospective and scored low on LoE. The included studies evaluated local interventions (n = 11), glucocorticoids combined with conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) (n = 8), rituximab (n = 6), or mepolizumab (n = 6). Due to heterogeneity across studies meta-analysis was not performed. Four studies on mepolizumab for sinonasal symptoms (n = 92) showed response in 33–100% and relapse in 35%. Local therapy for subglottic stenosis was effective in 80–100% of patients in 11 studies (n = 157), but relapses were common (up to 83%). In five studies, hearing improvement was observed in 56–100%, with better outcomes when glucocorticoids were combined with csDMARDs compared to glucocorticoids only. Conclusion: Response rates of ENT manifestations varied widely in studies and relapses were observed frequently. Heterogeneity among studies impaired comparison.

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“…Methotrexate has demonstrated success in improving breathing symptoms while on therapy 15 and in extending the time between dilations 16 . Leflunomide, an antirheumatic agent, has also shown success in extending the SFI in patients with granulomatosis with polyangiitis‐associated SGS 17 …”

Section: Introductionmentioning

confidence: 99%

“…16 Leflunomide, an antirheumatic agent, has also shown success in extending the SFI in patients with granulomatosis with polyangiitis-associated SGS. 17 Alternatively, in-office procedures, including serial subglottic intralesional steroid injections (SILSI), 5,18 are becoming more prominent in the treatment of SGS. Due to its favorable cost and less invasive nature as an inoffice procedure, SILSI as an adjuvant treatment to ED is becoming more favorable and prominent in the management of stenotic regions of the airway.…”

Section: Introductionmentioning

confidence: 99%

Cost‐Effectiveness of Steroids for Prolonging the Surgery‐Free Interval in Subglottic Stenosis

2023

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ObjectivesRepeat endoscopic dilation (ED) in the operating room for subglottic stenosis (SGS) remains an economic burden to patients. The cost‐effectiveness (CE) of adjuvant serial intralesional steroid injections (SILSI) to prolong the surgery‐free interval (SFI) in SGS patients requiring ED has yet to be studied.MethodsDetails of the cost of SILSI and ED were received from our tertiary academic center. SFI, cost of intervention, and the effect of SILSI on prolonging SFI were collected from a systematic review by Luke et al. SGS etiologies in the review included idiopathic, iatrogenic, or autoimmune. A break‐even analysis, comparing the cost of SILSI alone with the cost of repeat ED, was performed to determine if SILSI injections were cost‐effective in prolonging the SFI.ResultsAverage extension of the SFI with SILSI was an additional 219.3 days compared to ED alone based on a systematic review of the literature. 41/55 (74.5%) cases did not require further ED once in‐office SILSI management began. SILSI administered in a 4‐dose series in 3‐to‐7‐week intervals (~$7,564.00) is CE if the reported recurrence rate of SGS requiring ED (~$39,429.00) has an absolute risk reduction (ARR) of at least 19.18% with the use of SILSI. Based on the literature, SILSI prevents ~3 out of every 4 cases of SGS at sufficient follow‐up from undergoing repeat ED, resulting in an ARR of ~75%.ConclusionsSILSI is economically reasonable if it prolongs the SFI of at least one case of recurrence out of 5. SILSI, therefore, can be CE in extending the interval for surgical ED.Level of EvidenceN/A Laryngoscope, 2023

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Factors Affecting Dilation Interval in Patients With Granulomatosis With Polyangiitis‐Associated Subglottic and Glottic Stenosis

Cited by 7 publications

References 57 publications

Serial In‐Office Steroid Injections for Airway Stenosis: Long‐Term Benefit and Cost Analysis

Serial In‐Office Steroid Injections for Airway Stenosis: Long‐Term Benefit and Cost Analysis

Systemic and Local Medical or Surgical Therapies for Ear, Nose and/or Throat Manifestations in ANCA-Associated Vasculitis: A Systematic Literature Review

Cost‐Effectiveness of Steroids for Prolonging the Surgery‐Free Interval in Subglottic Stenosis

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