Efficacy and safety of serial intralesional corticosteroids for subglottic stenosis: systematic review & meta-analysis.

OBJECTIVE

We conducted this systematic review and meta-analysis to investigate the efficacy and safety of the use of serial intralesional steroid injection (SILSI) in patients with subglottic stenosis (SGS).

DATA SOURCES: PubMed, Web of Science, and Scopus databases, from inception until December 2024.

REVIEW

METHODS

Database search used the following keywords: "Subglottic stenosis" AND "Intralesional." The meta-analysis pooled the mean difference (MD) and standardized mean difference (SMD) for outcomes measured on different scales, based on pre-operative and post-operative values, with 95% confidence interval (CI). For categorical variables, we used Open MetaAnalyst software to calculate the rate of different outcomes and the effect estimates. Heterogeneity was assessed using the I2 statistic.

RESULTS

The use of SILSI in SGS patients increases the surgery-free survival duration with a MD = 395.27 days (95% CI: 166.14, 624.39, p = 0.0007), I2 = 81%, p = 0.0003. Additionally, the use of SILSI was associated with an increase in peak expiratory flow (PEF: MD = 30.6; 95% CI: 16.1, 45.1; p < 0.0001), I2 = 100%, p < 0.00001. The effect estimates for categorical outcomes were success rate (0.92; 95% CI: 0.872, 0.969), adverse events (0.257; 95% CI: -0.043, 0.556), and recurrence rate (0.451; 95% CI: -0.058, 0.960).

CONCLUSION

SILSI has shown a high success rate, extended surgery-free survival, and improved PEF, with a relatively low recurrence rate and minimal risk of adverse events. Given this high efficacy and favorable safety profile, SILSI is recommended for use in SGS.