GLP‐1 Receptor Agonist Effect on Disease Severity in Idiopathic Subglottic Stenosis

Objective Glucagon‐like peptide 1 receptor agonists (GLP‐1RAs) have been associated with systemic anti‐inflammatory effects in addition to weight loss. Their effect on idiopathic subglottic stenosis (iSGS) has not been evaluated. This study aimed to characterize the effect of GLP‐1RAs on surgery‐free interval (SFI) in iSGS. Study Design Retrospective cohort study. Setting Single‐institution academic center. Methods Two hundred and twenty‐three iSGS patients were reviewed for GLP‐1RA usage. SFI, and secondary measures of weight loss, body mass index (BMI), and Cotton‐Myer grade before and after starting GLP‐1RAs were analyzed. Patients were excluded if GLP‐1RAs were begun prior to establishing SFI, or if serial intralesional steroid injection or endoscopic or open cricotracheal resection were performed. Statistical comparisons for SFI and weight loss were performed with paired t tests, univariate, and multiple linear regression, and a generalized linear mixed‐effects model was used to compare Cotton‐Myer grades, with a threshold for significance of α = .05. Results Thirty‐two patients (14%) were taking GLP‐1RAs, with 14 meeting the inclusion criteria. SFI increased by a mean of 10.7 months, or 68.5% ( P = .001). Patients lost 39 pounds on average, with a mean BMI decrement of 6.8 points ( P < .001). There was no appreciable correlation between weight loss, initial BMI, and SFI on multiple linear regression ( P = .92, adjusted R 2 = −0.16) or univariate linear regression between SFI and weight loss ( P = .98, R 2 < 0.001) or BMI ( P = .72, R 2 = 0.01). There was no difference in Cotton‐Myer grade at the time of surgery between patients before and after starting therapy ( P = .44). Conclusion GLP‐1RA therapy increases SFI in iSGS independent of initial BMI or weight loss. Level of Evidence IV.