Introduction:
Subglottic stenosis (SGS) is a congenital or acquired fibrotic disorder causing airway narrowing below the glottis and above the first two tracheal rings. SGS may be iatrogenic, traumatic, autoimmune, or idiopathic. Treatment often involves repeated laryngeal dilations and/or surgical resection, along with adjuvant medications. Only a few studies have examined methotrexate as a potential treatment. This project aimed to evaluate its efficacy as an adjunct treatment.

Methods:
This study was a retrospective chart review of patients who presented to a quaternary care center with SGS between January 2010 to April 2024. Patients with SGS who received methotrexate treatment were compared to those with SGS who did not. Only subjects with sufficient data were included. The endpoint data of time between interventions and other baseline statistics were collected in REDCap. SPSS was used for data analysis.

Results:
31 patients with SGS who met the inclusion criteria were identified. Patients who had ≤ 1 intervention were excluded from the t-test analysis but reported descriptively. The difference in the mean number of days between interventions was not statistically significant, with 168.9 days for the control group (CG) and 197.8 days for the experimental group (EG) (P = .63, 95% CI [-151, 93]). For those in the EG (n=6), the difference in the mean number of days between interventions before and after starting methotrexate treatment was not statistically significant, with 158.2 days before and 132 days after (P = .74, 95% CI [-206, 259]). In the EG, 2 of 6 patients did not undergo any further interventions after starting methotrexate, indicating a potential clinical benefit. In the CG (n=25), 7 of 25 patients had ≤ 1 intervention.

Conclusion:
Methotrexate treatment for SGS does not appear to change the interval between laryngeal dilation and/or surgeries. Further studies of larger sample sizes are needed to confirm these findings.