Advances in Pharmacological Therapy of Benign Tracheal Stenosis: A Meta-Analysis of Preclinical Studies.

Abstract

Background: Benign tracheal stenosis, characterized by granulation hyperplasia, is a rare and serious disease threatening human health. Interventional bronchoscopy demonstrates limited therapeutic efficacy and poses a risk of re-injury to the airway. The objective of this meta-analysis is to evaluate the efficacy of pharmacological therapy in preclinical models of tracheal stenosis.

Method: We conducted an extensive literature search across PubMed, EMBASE, Web of Science, and Cochrane Library from inception to January 31, 2024. Studies evaluated the efficacy of various pharmacological agents in treating tracheal stenosis. The SYRCLE bias risk tool was utilized to evaluate potential bias, and the GRADE approach was used to assess the quality of evidence for each outcome. Primary outcomes included the stenosis index (SI) and the degree of tracheal stenosis (SD). Secondary outcomes comprised additional indicators relevant to evaluation of tracheal stenosis, such as the fibrosis indexes, the ratio of the lamina propria thickness to the cartilage (LCR), and the severity of inflammation. Meta-analysis was conducted via Cochrane Collaboration Review Manager (version 5.4).

Results: A total of 7554 studies related to pharmacological therapies for benign airway stenosis were reviewed, of which 34 articles met inclusion criteria for this meta-analysis following study selection. Of these, five studies evaluated SI, 17 studies evaluated SD, and six studies evaluated the fibrosis indexes. Compared to the control group, pharmacological therapy was associated with a significant reduction in SI (weighted mean difference (WMD) -0.21, 95% CI: -0.33 to -0.10, p < 0.001, I ² = 82%), SD (WMD = -0.26; 95% CI: -0.34 to -0.18; p < 0.001, I ² = 93%), and the fibrosis indexes (WMD = -3.15; 95% CI: -4.4 to -1.9; p < 0.001, I ² = 82%).

Conclusion: Various pharmacological agents exhibited different efficacies in alleviating tracheal stenosis symptoms. These findings provide valuable insights into prospective therapeutic strategies.