The care for a patient with moderate to severe ulcerative colitis remains challenging in spite of the fact that morbidity and mortality rates have been considerably reduced during the last 30 years. 5-ASA, thiopurines and infliximab are well established treatment regimens for the maintenance of remission. 5-ASA is considered the standard treatment in mild to moderate UC. Corticosteroids remain the first line therapy for inducing remission in refractory patients and in severe disease cases. Morbidity and mortality can be clearly reduced with the administration of cyclosporin and infliximab as rescue therapies in severe refractory cases. Although the drugs and treatment strategies discussed above have been reasonably effective, there are still patients who do not respond to them and which require a colectomy. With new biologic agents, new treatment options for UC continue to evolve, in the hope that in the near future, other agents may further the clinical experience with these biological agents in achieving better therapeutic results and there will be a more effective and safer treatment.