IL-23p19 inhibitors such as guselkumab and risankizumab are effective in the treatment of moderate to severe ulcerative colitis. A meta-analysis of six randomized trials with 3,640 patients showed that these drugs significantly increased the likelihood of clinical remission (RR = 2.45) and clinical response (RR = 2.03) compared with placebo. Endoscopic improvement was also significantly higher in the IL-23 inhibitor group (RR = 2.49). Efficacy was also observed in patients naïve to prior biologic therapy and in those refractory to other therapies. The overall incidence of adverse events was similar to placebo (RR = 0.91), with no increased risk of serious infections. Thus, IL-23p19 inhibitors are an effective and well-tolerated treatment option for ulcerative colitis.