Stephen Hanauer, MD on Optimizing Early Management of Ulcerative Colitis
In his presentation to the 2025 AIBD Annual Meeting, Stephen B. Hanauer, MD, emphasized the importance of individualized, evidence-based treatment strategies for newly diagnosed ulcerative colitis (UC). He outlined key principles for early intervention, diagnostic clarity, and personalized therapy selection based on disease severity, extent, and patient-specific risk factors.
Stephen B. Hanauer, MD, is the Clifford Joseph Barborka Professor of Medicine at the Feinberg School of Medicine and medical director of the Digestive Health Center at Northwestern University in Chicago, Illinois.
“UC should be suspected in patients with hematochezia, increased stool frequency, or bowel urgency,” Hanauer stated, reinforcing the importance of early diagnosis. Infectious etiologies must be excluded, and colonoscopy with biopsies from both affected and unaffected areas remains essential for confirming the diagnosis and assessing disease extent.
Dr Hanauer emphasized the importance of distinguishing between “disease activity” and “disease severity” when making treatment decisions. Activity is determined by current symptoms, whereas severity includes the inflammatory burden and overall disease impact. The Mayo Endoscopic Score (MES), fecal calprotectin, C-reactive protein (CRP), and patient-reported outcomes—like urgency and normalization of bowel habits—should guide treatment.
First-line therapy for mild to moderate disease includes oral and rectal aminosalicylates. For moderate to severe disease, advanced therapies such as antitumor necrosis factor (TNF) agents, interleukin (IL)-23 blockers, IL-12/23 inhibitors, Janus kinase (JAK) inhibitors, and sphingosine-1-phosphate (S1P) modulators are appropriate, often following corticosteroids and thiopurines.
Hanauer noted that “anti-IL-23 antibodies are effective as first- or second-line agents and are associated with a safer profile than TNFi.” He also addressed black box warnings associated with JAK inhibitors, noting that their practical use should follow failure of at least one advanced agent, while highlighting that “the greatest risk for thromboembolic events is active IBD itself.”
S1P modulators, including ozanimod and etrasimod, were positioned as strong first-line options for moderate disease activity, with minimal cardiovascular side effects. “Despite precautions, the actual heart rate impact is minor—less than one beat per minute,” he explained.
Dr Hanauer concluded by underscoring the practical realities of access. “Time to access is a major determinant of first-line therapy,” he said. Delays in insurance approval, infusion scheduling, or obtaining starter kits may prolong disease activity and the need for corticosteroids, underscoring the need for timely, strategic therapy selection.
Reference
Hanauer S. The patient with newly diagnosed ulcerative colitis. Presented at: 2025 AIBD Annual Meeting. December 8-10, 2025.
