{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T14:30:58Z","timestamp":1791556258958,"version":"4.3.4"},"reference-count":51,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Subglottic and tracheal stenosis (SGS, TS) are severe manifestations of granulomatosis with polyangiitis (GPA), often\u2010requiring endoscopic airway intervention and systemic immunosuppression. Rituximab (RTX) has shown efficacy for systemic GPA, but its role in SGS and TS remains unclear, with reports of both benefit and relapse. This study evaluated the impact of RTX and cyclophosphamide (CTX) on surgery\u2010free intervals (SFIs) in GPA\u2010associated SGS and TS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A retrospective chart review was conducted on GPA patients with SGS or TS treated at a tertiary center between 1992 and 2023. Therapeutic RTX exposure was defined as 3\u20139\u2009months post\u2010induction or within 1\u2009year of maintenance, and CTX during regular dosing before transitioning to another maintenance regimen. SFIs, calculated as time between endoscopic interventions, were compared with and without RTX and CTX exposure using weighted\n                      <jats:italic>t<\/jats:italic>\n                      \u2010tests.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 55 patients met inclusion; 44 (80%) underwent at least one endoscopic intervention and 34 of those patients (77%) received RTX and\/or CTX. Median follow\u2010up time was 10.2\u2009years (range 0.8\u201329.5\u2009years). Mean SFIs were significantly longer during therapeutic RTX exposure or remission (45\u2009\u00b1\u20098\u2009months) versus non\u2010therapeutic intervals (20\u2009\u00b1\u20096\u2009months) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.046). Prior RTX or CTX use, though not definitionally therapeutic, significantly increased mean SFI from 22 to 25\u2009months compared to no exposure (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.029). CTX alone did not significantly increase SFI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Rituximab may contribute to longer intervals between endoscopic airway intervention and delay relapse in GPA\u2010related airway stenosis, supporting its role in stabilization of airway manifestations. Multidisciplinary management remains essential for this life\u2010threatening GPA manifestation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>3.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.70249","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T10:49:24Z","timestamp":1762166964000},"page":"1858-1865","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Immunosuppression and Surgery\u2010Free Interval in Granulomatosis With Polyangiitis Airway Stenosis"],"prefix":"10.1002","volume":"136","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-4932-6684","authenticated-orcid":false,"given":"Sydney J.","family":"Torres","sequence":"first","affiliation":[{"name":"University of Michigan Medical School  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Neevel","sequence":"additional","affiliation":[{"name":"University of Michigan Department of Otolaryngology\u2010Head and Neck Surgery  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia A.","family":"Ford","sequence":"additional","affiliation":[{"name":"Division of Rheumatology University of Michigan Department of Internal Medicine  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence","family":"Kashat","sequence":"additional","affiliation":[{"name":"MidMichigan Ear, Nose, and Throat East Lansing  East Lansing Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1783-4338","authenticated-orcid":false,"given":"Norman D.","family":"Hogikyan","sequence":"additional","affiliation":[{"name":"University of Michigan Department of Otolaryngology\u2010Head and Neck Surgery  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robbi A.","family":"Kupfer","sequence":"additional","affiliation":[{"name":"University of Michigan Department of Otolaryngology\u2010Head and Neck Surgery  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2313-8542","authenticated-orcid":false,"given":"Robert J.","family":"Morrison","sequence":"additional","affiliation":[{"name":"University of Michigan Department of Otolaryngology\u2010Head and Neck Surgery  Ann Arbor Michigan 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