The Effect of Antifungal Therapy on Disease Activity in Patients with Inflammatory Bowel Disease: A Retrospective Matched Analysis.

INTRODUCTION: The purpose of our study was to report indications for fluconazole use in IBD and examine whether fluconazole was associated with IBD activity. Our hypothesis was fluconazole did not increase rate of relapse in IBD. METHODS: We performed a retrospective review on IBD patients at our institution who received oral fluconazole between January 2012 and December 2023. These patients were matched 1:2 to controls who did not take fluconazole. Patients were matched based on age, sex, disease phenotype (ulcerative colitis or Crohn's disease), and baseline disease activity (remission or active). Time-to-relapse/remission was compared between the fluconazole and control groups using Cox regression. RESULTS: Seventy-seven patients took fluconazole, and 152 patients did not. Among the fluconazole group, 57 were in remission (Cohort A) and 20 had active disease at baseline (Cohort B). The most common indication for fluconazole was vaginal candidiasis (51.9%). Among patients in remission (Cohort A), there was no significant difference in time-to-relapse between groups, even when adjusting for biologic exposure, (HR = 0.85, 95% CI: 0.27- 2.6, p=0.78). Among patients with active disease (Cohort B), there was no significant difference in time-to-remission between groups (HR = 0.68, 95% CI: 0.33-1.4, p=0.29). In an exploratory sub-group analysis, patients who received a long course of fluconazole (>2 weeks) achieved remission faster compared to patients who received a short course (1-3 days), P< 0.05. DISCUSSION: Fluconazole administration did not increase relapse rate; similarly, patients who had active disease at time of fluconazole were just as likely to achieve remission.