According to the findings of a post-hoc analysis, fecal lactoferrin is a valuable prognostic biomarker offering valuable insights into both long-term therapeutic outcomes and the potential risk of colectomy among individuals grappling with ulcerative colitis. Investigators aimed to ascertain whether fecal lactoferrin could serve as an early predictor of long-term outcomes in cases of ulcerative colitis.

The study encompassed individuals who were administered biologics and for whom data regarding fecal lactoferrin concentration at the fourth week were accessible from both the UNIFI and PURSUIT trials (n = 1063). The assessment encompassed treatment outcomes such as histological improvement and remission, endoscopic improvement and remission, and clinical remission, all of which were measured upon completion of the maintenance therapy period. Within the PURSUIT trial subset (n = 667), tracking of the occurrence of colectomy was done from week 0 up to a maximum of week 228.

Utilizing multivariate logistic and Cox proportional-hazard regression analyses, the links between fecal lactoferrin levels and treatment outcomes as well as the likelihood of colectomy were examined. An elevated fecal lactoferrin level in the fourth week demonstrated an association with unfavorable long-term histologic, endoscopic, and clinical results. Fecal lactoferrin levels exceeding 84.5 μg/mL indicated a reduced probability of achieving histological (odds ratio [OR]: 0.27), endoscopic (OR: 0.40), and clinical (OR: 0.43) remission.

Notably, the fecal lactoferrin measurement at week 4 offered additional predictive insight alongside fecal calprotectin, as well as endoscopic and clinical scores, concerning the eventual therapeutic outcomes. Regarding the risk of colectomy, subjects with week-4 fecal lactoferrin levels equal to or exceeding 20.1 μg/mL and those below 20.1 μg/mL exhibited corresponding incidence rates of 6.39% and 1.10%, respectively. Remarkably, individuals with fecal lactoferrin levels ≥20.1 μg/mL faced a notably amplified colectomy risk, marking a 995% increase (hazard ratio: 10.95).

Hence, fecal lactoferrin has the potential to serve as a valuable predictive biomarker for both long-term therapeutic outcomes and the likelihood of colectomy in ulcerative colitis-affected people.