Ulcerative colitis can cause debilitating symptoms and complications such as 
colonic strictures, colonic dysplasia, colorectal cancer, and toxic megacolon or 
perforation. Goals of treatment in ulcerative colitis include resolution of 
gastrointestinal symptoms, healing of colonic mucosa, and prevention of disease 
complications. Our treatment armamentarium has expanded dramatically over the 
past 10 years, and we now have multiple biologic agents approved for the 
treatment of moderate-severe disease, in addition to conventional therapies such 
as 5-aminosalicylates, thiopurines, and corticosteroids. In this review, we will 
provide a detailed discussion of the three tumor necrosis factor-alpha (TNF-α) 
inhibitors currently approved for treatment of ulcerative colitis: infliximab, 
adalimumab, and golimumab. All three agents are effective for inducing and 
maintaining clinical response and remission in patients with ulcerative colitis, 
and they have comparable safety profiles. There are no head-to-head trials 
comparing their efficacy, and the choice of agent is most often based on 
insurance coverage, route of administration, and patient preference. Combination 
therapy with an immunomodulator is proven to be more effective than anti-TNF 
monotherapy, and patients who lose response to an anti-TNF agent should undergo 
dose intensification in order to regain clinical response. Despite therapeutic 
optimization, a significant percentage of patients will not achieve clinical 
remission with anti-TNF agents, and so newer therapies are on the horizon.