The utility of infliximab as a therapy for complicated inflammatory bowel disease (Crohn’s disease, ulcerative colitis) has been established through large prospective trials in the last decade. With approval of adalimumab physicians and patients now have the choice between two different anti-TNF agents. In addition to control of inflammation, the avoidance of chronic exposure to glucocorticoids has become a primary reason to use anti-TNF therapy. Early use of anti-TNF therapy in the course of disease is a potential new indication. The increasingly critical appreciation of side effects promotes mono-therapy with anti-TNF agents.