How Severe UC Is Treated Today: From Biologics to Rescue Therapies

Written by Stephanie Booth
Medically Reviewed by Melinda Ratini, MS, DO on February 17, 2026

Ulcerative colitis (UC) is a lifelong condition. That means you may try a lot of different treatments — and know how frustrating it can be when they don’t help.

The nature of UC is “flare and remission,” says Ashkan Farhadi, MD, a board-certified gastroenterologist at MemorialCare Orange Coast Medical Center in Fountain Valley, California. “Our goal is, if you’re in flare, to bring you into remission. If you are in remission, our goal is to keep you [there].”

More treatments are available than ever before. But a medication that prevents flares for someone else may not do the same for you; it may even cause side effects that you don’t want. Some treatments can also stop working well over time.

Even if you’ve been living with UC for a while, this step-by-step guide will help you better understand your treatment options so you can talk about them with your doctor.

“Medication for UC is tiered. Doctors usually start with one category of medication, then go to the next if you don’t start to improve,” Farhadi says. 

Anti-inflammatory medicines

These include:

Aminosalicylates (5-ASAs)

When you have UC, doctors usually prescribe this treatment first. 5-ASAs lower inflammation in your intestines. You take them long-term to try to prevent flares.

5-ASAs are considered safe and usually well-tolerated, meaning any side effects, such as headaches, will likely be mild.

Your doctor could prescribe:

The type of 5-ASA you get can depend on which part of your colon is inflamed.

Corticosteroids

This type of medication can help control a moderate-to-severe UC flare by “turning down” your immune system. Steroids are powerful treatments, so your doctor will be careful as to when and how long you take them. 

Steroids raise your risk of infections. Over time, they can also cause side effects such as high blood pressure, high blood sugar, cataracts, weak bones, and mood swings.

Corticosteroids that are used to treat UC include:

Immunomodulators

Your doctor can prescribe an immunomodulator to bring you into remission or when other types of UC treatments don’t work well. 

Immunomodulators lower inflammation in your colon by changing how your immune system works. You might not see a difference for three to six months, so your doctor may prescribe a faster-acting treatment, like a steroid or biologic, at the same time.

Your options include:

Biologics

These antibodies block cells and proteins made by your immune system, which play a key role in inflammation. Biologic medicines can be a good choice when you have severe UC. They can be used as induction therapy (to induce, or bring about, a remission). They can also help keep you in remission.

Sometimes, biologics are combined with immunomodulators.

Biologics for UC include:

Anti-tumor necrosis factor (anti-TNF) agents

  • Adalimumab (Humira)
  • Adalimumab-aaty (Yuflyma)
  • Adalimumab-accf (Idacio)
  • Adalimumab-adaz (Hyrimoz)
  • Adalimumab-adbm (Cyltezo)
  • Adalimumab-afzb (Abrilada)
  • Adalimumab-aqvh (Yusimry)
  • Adalimumab-atto (Amjevita)
  • Adalimumab-bwwd (Hadlima)
  • Adalimumab-dyyb (Inflectra)
  • Adalimumab-fkjp (Hulio)
  • Adalimumab-qbtx (IXIFI)
  • Adalimumab-ryvk (Simlandi)
  • Golimumab (Simponi)
  • Infliximab (Remicade)
  • Infliximab-abda (Renflexis)
  • Infliximab-axxq (Avsola)
  • Inflilximab-dyyb (Inflectra, Zymfentra)
  • Unbranded infliximab (infliximab)

Interleukin-12 and -23 antagonists

  • Mirikizumab (Omvoh)
  • Risankizumab (Skyrizi)
  • Ustekinumab (Stelara)
  • Usteikinumab-aauz (Otulfi)
  • Ustekinumab-aekn (Selarsdi)
  • Ustekinumab-auub (Wezlana)
  • Ustekinumab-fkce (Yesintek) 
  • Ustekinumab-hmny (Starjemza)
  • Ustekinumab-srlf (Imodulsa)
  • Ustekinumab-stba (Steqeyma)
  • Ustekinumab-ttwe (Pyzchiva)

Interleukin-23 antagonists

Integrin receptor agonists

Even if one biologic treatment works well for you, you’ll probably need to switch to a different medication over time.

“Most biologics are protein-based, and the body has a tendency to react to them by making antibodies and neutralizing them,” Farhadi says. “It’s not uncommon that a medication works great, and after six months, you see it start losing its function.”

Small molecules

These treatments target parts of your immune system that are involved with the inflammation process. You take them by mouth and they get absorbed into your blood stream.

Janus kinase (JAK) inhibitors block JAK enzymes that are found in your cells. This helps “turn down” your immune system. Your doctor could prescribe:

  • Tofacitinib (Xeljanz)
  • Upadacitinib (RINVOQ)

Sphingosine 1-phosphate (S1P) receptor modulators stop immune cells that cause inflammation from moving out of your lymph nodes and into your gut. They include:

  • Etrasimod (Velsipity)
  • Ozanimod (Zeposia)

More research needs to be done comparing small molecule drugs to biologics. So far, upadacitinib appears to achieve the best results. But your doctor will factor a lot of things into which type they prescribe including the cost, inflammatory markers in your blood and stool, and other health issues you live with.

Up to 25% of people who live with UC have acute severe ulcerative colitis (ASUC). This can be a medical emergency. Your doctor will need to manage your symptoms quickly to try to prevent serious and sometimes life-threatening complications. 

Rescue therapies for ASUC include:

Corticosteroids, which you’ll get by IV in a hospital for several days. Steroids are the first line of treatment for ASUC, but 30% to 40% of people need more medication.

Infliximab (Remicade) is a biologic that blocks TNF, a substance in your body that adds to inflammation. One study found that early treatment may result in a shorter hospital stay.

Cyclosporine can slow down your immune system and lower inflammation. In the 1970s, it was known as an organ transplant drug. It can help get ASUC under control, but it’s not safe as a long-term treatment.

Some JAK inhibitors, such as tofacitinib or upadacitinib, can treat ASUC, although more research needs to be done. You may be given these treatments along with steroids.

Because so many UC medicines are now available, surgery to treat UC is less common than it used to be. But it may be an option if:

  • Your treatments stop helping.
  • You have severe side effects from other treatments.
  • You have UC complications, such as a ruptured colon.

Surgeries for UC include:

  • Colectomy, which removes part or all of your colon
  • Protectomy, which removes part or all of your rectum
  • Proctocolectomy, which takes out both your colon and rectum

If you have one of these surgeries, your surgeon may need to create a new way for solid waste to leave your body, such as:

  • An ostomy pouch that you wear outside your belly
  • An internal pouch, called a J-pouch, which connects to your anus

Like all surgeries, these procedures come with risks. Afterward, you’ll need time to get used to the new changes in your body. But they can do more than improve both your symptoms and your quality of life. They are a critical treatment for UC complications that can be life-threatening.

After you start treatment, your doctor will keep track of how your symptoms change and be on the lookout for any treatment side effects. Going to follow-up appointments, even if you feel good, is important. 

Your doctor will regularly test your blood and stool to look for signs of inflammation and organ function. You could also have imaging tests, like a colonoscopy, which lets your doctor see your entire colon.

“Our goal is no longer clinical remission,” says Farhadi. “Our goal is deep mucosal remission.”

That means that your doctor wants not only to improve your UC symptoms but also to heal your gut and prevent your symptoms from coming back.

Let your doctor know right away if you have: 

  • A fever above 100.3 F
  • Vomiting
  • Increased rectal bleeding or blood in your stool
  • Severe and/or constant pain

Early treatment is key to getting UC under control. So is a good relationship with your doctor.

Some questions you can ask them:

Which treatment do you recommend for me and why?

Your doctor considers many factors when choosing a treatment for you. Just because you’ve seen a lot of ads for a certain treatment doesn’t mean it’s right for you, and the treatment with the highest cost isn’t always “the best.” “Typically, that’s not the case,” Farhadi says. “Sometimes I even revert the most expensive medication to the cheapest one, and we achieve [our] goal.”

How much will this medicine cost me?

Some UC treatments are “out-of-this-world expensive,” says Farhadi. If you don’t have health insurance, you may pay $20,000 or $30,000 each year out of your own pocket. Hence, cost needs to be part of the conversation.

“If we are not considering that in the decision-making, we are making a mistake,” says Farhadi.

How long could I stay on this medicine?

UC is a lifelong condition, and your doctor will also take that into account. “We have to be careful in selecting things that may not be able to accommodate a lifelong continuity,” Farhadi says.

What else can I do to help manage my UC?

For instance, make sure to talk to your doctor about:

  • Stress management
  • Sleep hygiene
  • The foods you eat

“A lot of factors besides medication are very crucial in this disease,” says Farhadi.

UC Treatment

What They’re Used For

How They Work

ASA-5s

To bring on and maintain remission

Lower inflammation in your colon

Corticosteroids

Short-term treatment for a UC flare or as rescue therapy

Quickly relieve symptoms by “turning down” your immune system

Immunomodulators

To bring on and maintain remission when ASA-5s don’t help 

Slowly change how your immune system works

Biologics

Long-term treatment (some can also be used for rescue therapy)

Block cells or proteins that cause inflammation

Small molecules

Long-term treatment to prevent flares (some kinds may be used for rescue therapy)

Interfere with how your immune system works

Rescue therapies

Treating acute severe UC, when you’re at risk of severe or life-threatening complications

Rapidly manage symptoms and decrease inflammation

Surgery

When medications don’t help or you have serious complications

Removes part or all of your colon 

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