Testing the Role of Anti-fungal Therapy in Improving the Response to Therapies for Crohn's Disease

NCT ID: NCT06274554

Last Updated: 2025-10-01

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: PHASE3
• Total Enrollment: 120 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2024-10-04
• Study Completion Date: 2029-12-31

Brief Summary

The goal of this clinical trial is to learn about the effects of fluconazole in patients who plan to start or are currently undergoing standard of care treatment and plan to dose-escalate an IL-23 therapy for their Crohn's disease.

The main question it aims to assess is whether or not patient response to IL-23 therapies improve when simultaneously treated with fluconazole.

Detailed Description

The purpose of this study is to examine the efficacy and safety of fluconazole in combination with IL-23 therapy versus IL-23 therapy alone for the treatment of Crohn's disease (CD). IL-23 therapy may include ustekinumab (anti-interleukin-12/23), risankizumab (anti-interleukin-23), or guselkumab (anti-interleukin-23).

Subjects will be stratified into two groups based on standard of care treatment: IL-23 therapy initiation or IL-23 therapy dose escalation. Subjects in each group will then be randomized to one of two treatment arms:

1. IL-23 Therapy with Fluconazole (200 mg on Day 0 and 100 mg on Days 1-13)

2. IL-23 Therapy with Placebo (200 mg on Day 0 and 100 mg on Days 1-13)

Subjects will blindly receive the fluconazole treatment only if they meet all inclusion and exclusion criteria. Subjects will return for standard of care clinic visits 2 weeks post-treatment initiation and 12 weeks post-treatment initiation. Disease activity will be assessed at standard of care visits. Stool, blood, and oral swab samples will collected for research from subjects at Day 0 (pre-treatment initiation), Week 2 post-treatment initiation, Week 8 post-treatment initiation, and Week 12 post-treatment initiation. If subjects consent to biopsies, biopsies will also be collected for research at endoscopic procedures (colonoscopies and/or flexible sigmoidoscopies). Subjects will return at Week 24 and 1 year post-treatment initiation for standard of care visits, where blood, stool, and oral swabs will also be collected for research.

Conditions

Crohn's Disease; Inflammatory Bowel Diseases

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: DOUBLE

Study Groups

IL-23 Therapy with Fluconazole

Fluconazole will be blindly administered as capsules for oral consumption. On the first day, 200 mg will be given. Subjects will then take 100 mg once daily for thirteen days.

Group Type: EXPERIMENTAL

Fluconazole

Intervention Type: DRUG

Oral fluconazole capsules.

IL-23 Therapy

Intervention Type: BIOLOGICAL

Risankizumab (IL-23), Guselkumab (IL-23), or Ustekinumab (IL-12/23) as standard of care treatment.

IL-23 Therapy with Placebo

Placebo will be blindly administered as capsules for oral consumption. On the first day, 200 mg will be given. Subjects will then take 100 mg once daily for thirteen days.

Group Type: PLACEBO_COMPARATOR

Placebo

Intervention Type: DRUG

Oral placebo capsules will be used as a comparator.

IL-23 Therapy

Intervention Type: BIOLOGICAL

Risankizumab (IL-23), Guselkumab (IL-23), or Ustekinumab (IL-12/23) as standard of care treatment.

Interventions

Fluconazole

Oral fluconazole capsules.

Intervention Type: DRUG

Placebo

Oral placebo capsules will be used as a comparator.

Intervention Type: DRUG

IL-23 Therapy

Risankizumab (IL-23), Guselkumab (IL-23), or Ustekinumab (IL-12/23) as standard of care treatment.

Intervention Type: BIOLOGICAL

Other Intervention Names

Diflucan; Risankizumab; Ustekinumab; Guselkumab

Eligibility Criteria

Inclusion Criteria

1. Patients at least 18 years old

2. Patients with mild to moderate Crohn's disease as defined by CDAI score of 150-450

Exclusion Criteria

1. Antifungal usage within one month prior to initiation of blinded fluconazole usage

2. Known allergy to fluconazole

3. Patients with known hepatic disease, cirrhosis, or with elevated liver biochemistries (e.g., transaminase(s) >3X upper limit of normal (ULN), and/or bilirubin levels >1.5X ULN (with exception of confirmed Gilbert's disease) at baseline

4. Patients taking any medications judged by clinical provider to interact with fluconazole and are known contraindications (refer to section 2.2) and cause serious adverse events, including but not limited to death, cardiac events, serious cardiac dysrhythmias, and prolongation of QTc

5. Pregnant or lactating women

6. Severe Crohn's disease defined by a PRO-2 score ≥ 34 or imminent need for surgery, or deemed not medically fit by physician

7. Patient with symptomatic stricturing

8. Patient with pouchitis or an ostomy

9. Patients with known, active fungal infection(s) since these patients would require particular, standard-of-care monitoring and treatment, which may include intravenous and/or prolonged courses of fluconazole or other therapies.

10. Patients with hypokalemia, or advanced cardiac failure

11. Patients with renal insufficiency

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

The Leona M. and Harry B. Helmsley Charitable Trust

OTHER

Sponsor Role: collaborator

Weill Medical College of Cornell University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Randy Longman, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Weill Medical College of Cornell University

Locations

Weill Cornell Medicine

New York, New York, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

Caroline Ericsson, BS

Role: CONTACT

cae4007@med.cornell.edu

646-697-0985

Aurelia Li, BS

Role: CONTACT

aul4004@med.cornell.edu

646-697-0985

Facility Contacts

Caroline Ericsson, BS

Role: primary

cae4007@med.cornell.edu

646-697-0985

Aurelia Li

Role: backup

aul4004@med.cornell.edu

Other Identifiers

23-11026746

Identifier Type: -

Identifier Source: org_study_id