Medical Maintenance Therapy Following Laser Excision in Patients With Granulomatosis With Polyangiitis (GPA)‐Associated Subglottic Stenosis

• Published in: Otolaryngology-head and neck surgery 2024-07, Vol.171 (1), p.180-187
• Main Authors: Aden, Aisha A., Awadallah, Andrew S., Xie, Katherine Z., Wallerius, Katherine P., O'Byrne, Thomas J., Bowen, Andrew J., Edell, Eric S., Bayan, Semirra L., Ekbom, Dale C., Koster, Matthew J.
• Format: Article
• Language: English
• Subjects: Adult; CO2 laser excision; Female; GPA; GPA SGS; Granulomatosis with Polyangiitis - complications; Granulomatosis with Polyangiitis - drug therapy; Humans; Immunosuppressive Agents - therapeutic use; Laryngoscopy; Laryngostenosis - etiology; Laryngostenosis - surgery; Laser Therapy - methods; Maintenance Chemotherapy; Male; Middle Aged; Retrospective Studies; rituximab; Rituximab - therapeutic use; subglottic stenosis; Treatment Outcome; Young Adult
• ISSN: 0194-5998; 1097-6817; 1097-6817
• DOI: 10.1002/ohn.694

Objective To report on a series of patients with cANCA/PR3‐positive, granulomatosis with polyangiitis (GPA)‐associated subglottic stenosis (SGS) and evaluate response to medical maintenance therapy with rituximab versus other immunosuppressants following initial endoscopic laser excision. Study Design Retrospective chart review. Setting Tertiary academic center. Methods A retrospective chart review of patients with SGS and cANCA/PR3‐positive GPA who received immunosuppressive maintenance therapy following endoscopic laser excision at our institution from June 1989 to March 2020 was performed. Data pertaining to patient demographics, clinical features, medications, and endoscopic laser procedures were collected. Results A total of 27 patients (15 women) with mean age (range) of 40 (19‐59) years and mean (range) follow‐up of 12.6 years (1.5‐28.6) were identified. Sixteen patients (60%) had limited GPA. Six patients (24%) had previously received local intervention with open surgery (n = 1, 4%) or endoscopic techniques (n = 5, 20%). All patients experienced symptom improvement following initial CO2 laser excision at our institution without any procedural complications or adverse events. Following initial laser excision, 15 patients (60%) were treated with rituximab and 10 patients (40%) were treated with nonrituximab immunosuppressive agents. Patients treated with rituximab were less likely to recur (P = 0.040). Limited GPA was associated with an increased incidence of recurrence (P = 0.031). Median time (years) to recurrence (range) was 3.2 (0.3‐19.3) and was not significantly associated with treatment or GPA subtype. Conclusion Endoscopic CO2 laser excision is a safe and effective local intervention for GPA‐associated SGS. Medical maintenance therapy with rituximab reduces risk of recurrence following initial laser excision relative to treatment with non‐rituximab agents.