Those managing ulcerative colitis (UC) must be aware of new treatments. Mesalamine (5-ASA) is the first treatment for mild UC. Steroids have been the first therapy for patients with more severe UC but these are not effective or safe long term. This means that other medicines are needed. Newer advanced therapies are now frequently used. There are several types of advanced therapies. These are the anti-TNF, anti-integrin and anti-IL12/23 agents as well as the JAK inhibitors and sphingosine1-phosphate receptor modulators. All of these are effective in treating UC. Choosing among treatments is complicated. There are multiple factors to think about when choosing a treatment for UC. Without research studies that directly compare the different treatments, the use of any one treatment should be based on effectiveness and safety. Other considerations include specific disease features, patient factors and the preference of patients.