By Dr. Pranab Gyawali — Consultant Gastroenterologist, Dubai
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For more than two decades, I have looked after people with Crohn’s disease and ulcerative colitis as a consultant gastroenterologist. The range of treatment and the way we monitor inflammation have changed considerably during that time.
What caught my attention in this UAE cohort was the speed of the recent change in prescribing. That is why I made this update. The practical question is which patients may benefit from earlier advanced treatment and which patients do not need it.
Does everyone with newly diagnosed IBD now need a biologic?
No. Earlier advanced treatment is most relevant when active inflammation is confirmed objectively and the patient’s overall risk profile suggests that waiting may allow avoidable bowel damage or complications. Symptoms or the diagnosis label alone are insufficient.
The Ahmed and colleagues UAE study found that, among patients who received advanced therapy in a tertiary IBD cohort, the median time from diagnosis to treatment fell from 23 months to 2 months in Crohn’s disease and from 37 months to 3 months in ulcerative colitis. This does not mean that every newly diagnosed patient should start a biologic.
August 2026 update: the UAE registry study followed treatment use from 2015 to 2025 and shows how quickly prescribing changed from 2023.
Watch the August 2026 IBD treatment update
In this August update, I look back at treatment use from 2015 to 2025. I made the video because I was surprised by how quickly prescribing had changed in this UAE cohort. The important question is who may benefit from earlier treatment, not whether everyone with IBD should receive it.
Part 2, published 28 August 2026. Dr Gyawali explains the change in advanced treatment use from 2015 to 2025 and what it means for patient selection.
What did the UAE study find?
The study came from a specialist IBD centre in Abu Dhabi. It included 508 adults with Crohn’s disease or ulcerative colitis who remained under active follow-up. Of these, 380 had received an advanced therapy.
The investigators compared treatment before 2023 with treatment from 2023 onward. Among patients who received advanced therapy, the median time from diagnosis to starting it changed as follows.
| Condition | Before 2023 | From 2023 onward |
|---|---|---|
| Crohn’s disease | 23 months | 2 months |
| Ulcerative colitis | 37 months | 3 months |
The choice of first advanced treatment also changed. In Crohn’s disease, first treatment with an anti-TNF medicine fell from 76% to 42%. IL-23 treatment accounted for 32% of first advanced treatment from 2023 onward.
Who should not wait for advanced IBD treatment?
Doctors first need objective evidence that inflammation is active. Depending on the person, this may come from faecal calprotectin, blood tests, imaging, colonoscopy or a combination of these.
The next question is the person’s overall risk. Disease extent and severity matter, as do Crohn’s disease behaviour, complications, previous treatment, other health conditions, safety considerations and the patient’s priorities. No single symptom or diagnosis label answers the question.
For a patient with confirmed inflammation and a risk profile suggesting that delay may allow bowel damage or complications, earlier advanced treatment can make sense. A patient with genuinely milder disease may follow a different path.
What has not changed?
Not everyone with IBD needs a biologic or another advanced therapy.
Many people with mild to moderate ulcerative colitis do well with properly optimised 5-ASA treatment. If it works and is tolerated, it remains a good medicine.
Crohn’s disease is more variable. Some patients have features that justify early advanced treatment. Others have genuinely milder disease. The UAE study came from a tertiary referral centre, and almost three quarters of its cohort had received advanced therapy. It should not be treated as a rule for every person with IBD in every setting.
Why does earlier treatment still need objective monitoring?
The original December 2025 VLOG explained the move from symptom control alone towards treat-to-target care. That principle remains.
Feeling well matters, but symptoms do not always show whether inflammation is controlled. Follow-up may use faecal calprotectin and blood markers, imaging or colonoscopy, depending on the person and the treatment goal.
Earlier treatment still needs a clear target and a plan for checking whether it is working.
Part 1: IBD biologics and monitoring going into 2026
The earlier update explains treat-to-target care, why symptoms alone may not show whether inflammation is controlled, and how objective monitoring guides treatment.
Questions to ask before starting advanced treatment
- How active and extensive is my disease?
- Which features in my case suggest that waiting may carry a risk?
- What is the treatment target, and how will we measure it?
- Why is this medicine being recommended over the alternatives?
- What safety checks and monitoring will I need?
My clinical view
My priority is to recognise the patients who should not wait. I would still base escalation on objective evidence of active inflammation and the patient’s individual risk profile across several clinical factors, not on symptoms or the diagnosis label alone.
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Frequently asked questions
How do doctors decide who should not wait?
They confirm whether inflammation is active and assess the person’s overall risk of bowel damage or complications. The decision uses several clinical factors. Symptoms or the diagnosis label alone are not enough.
Does every newly diagnosed patient with ulcerative colitis need advanced therapy?
No. Many patients with mild to moderate ulcerative colitis respond well to optimised 5-ASA treatment. Advanced therapy is considered when confirmed inflammation, treatment response and the overall risk profile make it appropriate.
Are IL-23 medicines better than anti-TNF medicines?
The UAE cohort found greater persistence with IL-23 treatment as first advanced therapy for Crohn’s disease. It was an observational study, not a direct randomised trial, and persistence is not the same as effectiveness. The result does not establish that IL-23 treatment is best for every patient.
If I feel well, why do I still need monitoring?
Symptoms and bowel inflammation do not always move together. Monitoring checks whether inflammation is controlled and whether the treatment target is being met.
Related reading
Understanding and choosing IBD treatment
Monitoring treatment and response
This page is for education and does not replace individual medical advice. Do not stop or change prescribed IBD treatment without discussing it with your own specialist team.
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