Until recently development of new medical therapies for the treatment of patients who have ulcerative colitis (UC) has been somewhat stagnant. In 2005, results of two prospective, randomized, placebo-controlled clinical trials demonstrated that infliximab, a chimeric monoclonal antibody directed against tumor necrosis factor alpha (TNF-alpha) tested initially in patients who had Crohn's disease and now a standard agent in the treatment of these patients, is efficacious for treatment of UC. This article provides information about the evolution of anti-TNF therapy for the treatment of UC.