Trajectory of Fecal Lactoferrin for Predicting Prognosis in Ulcerative Colitis

Objectives: To investigate the characteristics and prognostic value of fecal lactoferrin trajectories in ulcerative colitis (UC).

Methods: This study used data from the UNIFI trial (ClinicalTrials.gov, NCT02407236) and included patients who received ustekinumab during induction for trajectory modeling ( = 637). Patients who received ustekinumab during maintenance therapy were used for 1-year outcome analyses ( = 403). The levels of fecal lactoferrin, fecal calprotectin, and serum C-reactive protein were measured at weeks 0, 2, 4, and 8. The trajectories of these biomarkers were developed using a latent class growth mixed model.

Results: The trajectories of fecal lactoferrin, fecal calprotectin, and serum C-reactive protein were distinct, but all were associated with prior exposure to anti-tumor necrosis factor agents and vedolizumab. Furthermore, the fecal lactoferrin trajectory was the most valuable predictor of endoscopic, clinical, and histological remission. Compared to the high/moderate-rapid decrease trajectory group, the moderate-slow decrease, high-slow decrease, and high-stable groups had adjusted odds ratios (95% confidence interval) of 0.38 (0.18, 0.78; = 0.010), 0.47 (0.23, 0.93; = 0.032), and 0.33 (0.17, 0.63;  = 0.001), respectively, of 1-year endoscopic remission. Patients with high/moderate-rapid decrease trajectories also had the highest likelihood of achieving clinical and histological remission. Finally, we developed a patient-stratification scheme based on fecal lactoferrin trajectories and concentrations. Patients with good, moderate, and poor prognoses in the scheme had a distinct probability of achieving 1-year endoscopic remission (52.7%, 30.9%, and 12.8%, respectively).

Conclusions: The trajectory of fecal lactoferrin is a valuable prognostic factor for 1-year remission in UC.