By Dr. Pranab Gyawali — Consultant Gastroenterologist, Dubai
I decided to make this VLOG because I’m asked this question quite often: how do doctors actually decide which biologic to use for Crohn’s disease or ulcerative colitis?
I’ve been looking after patients with inflammatory bowel disease (IBD) for over 25 years. Over that time, treatment options have expanded dramatically. That’s been a major step forward for patients, but it has also made the decision-making process more complex for both doctors and patients.
This page is designed to explain the structured way I approach biologic decisions in practice, and to help you understand the discussions your own IBD team has with you.
Watch the video
The three steps I use when choosing a biologic
1) Your disease pattern
The first thing we consider is how your disease is behaving and how urgently we need to control inflammation. Someone who is very unwell (for example, severe symptoms, significant weight loss, bleeding, or repeated steroid use) may need treatment that can bring inflammation under control quickly and reliably.
In Crohn’s disease, complications also matter. If a patient has fistulas (especially perianal fistulas), that can influence which biologic class is most appropriate, because some treatments have stronger evidence in fistulising disease.
By contrast, if someone is relatively stable but still has ongoing inflammation on tests, we may focus more on a long-term strategy where durability and tolerability are prioritised.
2) What you’ve tried before
The second step is your treatment history. Some patients respond well to the first biologic, while others do not respond at all. Some patients improve at first but later lose response over time.
If a biologic hasn’t worked, or has stopped working, specialists often switch to a different class (a different mechanism of action) rather than repeating a very similar approach. This is a normal part of modern IBD care and is guided by careful clinical assessment.
3) You as a person
The third step is looking at you as an individual, not just your bowel. We consider lifestyle and treatment preferences (for example, home injections versus supervised infusions), and we take a careful history of infections because this can influence which options are safer for an individual patient.
Pregnancy planning is also important. Some biologics have more established experience around pregnancy, while some advanced therapies are generally avoided if pregnancy is planned. These decisions should always be made with your own specialist team who knows you and your medical history.
Finally, we consider symptoms outside the gut (such as joint, skin, or eye inflammation) because this can also influence the most appropriate biologic choice.
Learn more about biologic options
This VLOG focuses on how decisions are made, rather than listing or comparing drugs. If you would like a detailed overview of biologic classes and how they are used in IBD, please see:
Learn about Biologicals used in UC and Crohn’s in Dubai
If you wish to discuss this further or would like to make an appointment, please use the booking form on this page. A member of our team will contact you within 12 business hours.
Recommended Guides
- Inflammatory Bowel Disease (IBD) in Dubai
- Ulcerative Colitis in Dubai
- Crohn’s Disease in Dubai
- IBD Treatment Update 2026: What’s Changing for Crohn’s & Colitis Patients in Dubai
- How 5-ASA Works in Ulcerative Colitis (Salofalk, Pentasa, Asacol)
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