With a rising prevalence of inflammatory bowel disease (IBD) in Saudi Arabia, understanding national trends in biologic utilization is essential for optimizing clinical care and healthcare resource allocation. However, available data from the region remain very limited, and no prior comprehensive synthesis has been conducted to evaluate utilization patterns, outcomes, or cost implications. A comprehensive literature search was performed across PubMed, Cochrane Library, Google Scholar, and local Saudi medical journals up to April 2025. Studies reporting on biologic utilization, cost, effectiveness, or outcomes in Saudi IBD populations were included. Data were synthesized narratively due to heterogeneity in study designs. Seven studies encompassing nearly 1000 patients were analysed. Infliximab and adalimumab were the most prescribed biologics, with higher use in Crohn's disease (CD) than ulcerative colitis (UC). UC patients and those receiving adalimumab had higher odds of treatment failure. Ustekinumab and vedolizumab demonstrated efficacy in anti-tumor necrosis factor (anti-TNF)-refractory cases, including paediatric cohorts. Health-related quality of life (HRQoL) improved in 99% of patients on biologics. Annual treatment costs ranged from $5,572 (Ustekinumab) to $18,424 (vedolizumab). Biosimilars were reported as effective and potentially cost-saving, although detailed outcome data remain limited. The use of biologic therapy in Saudi Arabia is increasing, with emerging trends favouring personalized treatment approaches and the adoption of newer agents. Wider adoption of biosimilars and dose optimization strategies may offer cost-saving opportunities while maintaining therapeutic efficacy. There is a pressing need for high-quality, longitudinal data supported by a national IBD registry to guide clinical decision-making, monitor outcomes, and inform future healthcare policy.