Testing the Role of Anti-fungal Therapy in Improving the Response to Therapies for Crohn's Disease (FUN-CD)
A Prospective, Randomized, Placebo-controlled Trial of Fluconazole in Combination With IL-23 Therapy Versus IL-23 Therapy Alone for the Treatment of Crohn's Disease
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.
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
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:
- IL-23 Therapy with Fluconazole (200 mg on Day 0 and 100 mg on Days 1-13)
- 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. They will have an ancillary visit at Weill Cornell or a local laboratory of their choosing 2 weeks post-treatment initiation. Subjects will also return for a standard of care clinic visit 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) and Week 12 post-treatment initiation. Subjects may also opt in to provide these samples at Week 2 post-treatment initiation and Week 8 post-treatment initiation. If subjects consent to biopsies, biopsies will also be collected for research at endoscopic procedures (colonoscopies and/or flexible sigmoidoscopies). Subjects may opt in to return at Week 24 and 1 year post-treatment initiation for standard of care visits, where blood, stool, and oral swabs would also be collected for research.
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Phase 3
Contacts and Locations
Study Contact
Study Contact
- Name: Emely Fernandez, BS
- Phone Number: 646-697-0985
- Email: emf4006@med.cornell.edu
Study Contact Backup
- Name: Emilia Vignogna, BS
- Phone Number: 646-697-0985
- Email: etv4001@med.cornell.edu
Study Locations
-
-
New York
-
New York, New York, United States, 10065
- Recruiting
- Weill Cornell Medicine
-
Sub-Investigator:
- Dana Lukin, MD, PhD
-
Principal Investigator:
- Randy Longman, MD, PhD
-
Sub-Investigator:
- Ellen Scherl, MD
-
Principal Investigator:
- Iliyan Iliev, PhD
-
Contact:
- Aurelia Li
- Email: aul4004@med.cornell.edu
-
Contact:
- Emely Fernandez, BS
- Phone Number: 646-697-0985
- Email: emf4006@med.cornell.edu
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patients at least 18 years old
- Patients with mild to moderate Crohn's disease as defined by CDAI score of 150-450
Exclusion Criteria:
- Antifungal usage within one month prior to initiation of blinded fluconazole usage
- Known allergy to fluconazole
- 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
- 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
- Pregnant or lactating women
- Severe Crohn's disease defined by a PRO-2 score ≥ 34 or imminent need for surgery, or deemed not medically fit by physician
- Patient with symptomatic stricturing
- Patient with pouchitis or an ostomy
- 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.
- Patients with hypokalemia, or advanced cardiac failure
- Patients with renal insufficiency
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: 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.
|
Oral fluconazole capsules.
Other Names:
Risankizumab (IL-23), Guselkumab (IL-23), or Ustekinumab (IL-12/23) as standard of care treatment.
Other Names:
|
|
Placebo Comparator: 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.
|
Oral placebo capsules will be used as a comparator.
Risankizumab (IL-23), Guselkumab (IL-23), or Ustekinumab (IL-12/23) as standard of care treatment.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Proportion of subjects achieving clinical response
Time Frame: Week 12 post-Fluconazole Initiation
|
Participants with clinical response are those participants with a reduction of the Crohn's Disease Activity Index (CDAI) by 100 or more points from baseline at week 12 post-Fluconazole initiation.
|
Week 12 post-Fluconazole Initiation
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Proportion of subjects achieving clinical remission
Time Frame: Week 12 post-Fluconazole Initiation
|
Participants achieving clinical remission are those participants with a Crohn's Disease Activity Index (CDAI) score of no greater than 150 points at week 12 post-Fluconazole initiation.
|
Week 12 post-Fluconazole Initiation
|
|
Proportion of patients achieving endoscopic response or remission
Time Frame: Up to 1 Year post-Fluconazole Initiation
|
Participants achieving endoscopic response are those participants with a reduction in the Simple Endoscopic Score for Crohn's Disease (SES-CD) of at least 50% from baseline.
Participants achieving endoscopic remission are those participants with an SES-CD score less than or equal to 2
|
Up to 1 Year post-Fluconazole Initiation
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Randy Longman, MD, PhD, Weill Medical College of Cornell University
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Intestinal Diseases
- Digestive System Diseases
- Gastrointestinal Diseases
- Gastroenteritis
- Crohn Disease
- Inflammatory Bowel Diseases
- Amino Acids, Peptides, and Proteins
- Proteins
- Heterocyclic Compounds, 1-Ring
- Heterocyclic Compounds
- Azoles
- Antibodies, Monoclonal, Humanized
- Antibodies, Monoclonal
- Antibodies
- Immunoglobulins
- Immunoproteins
- Blood Proteins
- Serum Globulins
- Globulins
- Triazoles
- Ustekinumab
- Fluconazole
- guselkumab
- risankizumab
Other Study ID Numbers
Other Study ID Numbers
- 23-11026746
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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