OBJECTIVES: To identify patient demographics and treatment use patterns in patients with Ulcerative Colitis (UC) who initiated biologic treatment with infliximab in a managed care setting. METHODS: Patients with UC (ICD-9 code 556.X) who initiated infliximab between January 2007 and December 2008 were identified from the US IMPACT health insurance claims database. Two cohorts were identified based on whether they received UC related surgery (UCSURG) or did not receive a UC related surgery (UCNon-SURG) within a 24 month follow-up. All patients were continuously enrolled for both medical and pharmacy benefits during the 6 months prior to their first infliximab claim (index claim) and 24 months post index claim. RESULTS: A total of 264 individuals with UC were followed over 24-months, of which 84% did not receive surgery (UCNon-SURG) and 16% underwent surgery (UCSURG). In both cohorts, mean age was 42 years and 45% were women. The majority of patients (80%) were 18 to 54 years old with a higher proportion of UCSURG patients in the 35-44 year group range. During the 6-month baseline period, UCSURG patients had higher hospitalization rates (40%) and incurred more healthcare expenditures ($17,217) than UCNon-SURG (22%; $11,774). In the 24 month follow-up, 60% of patients within UCSURG underwent surgery during the first year following their index claim.  Seventy percent of UCNon-SURG patients continued biologics with 34% remaining on “biologic only” compared to UCSURG, where 70% had no treatment. CONCLUSIONS: Most UC patients (84%) initiated on infliximab did not require surgery and continued biologic treatment (70%) over 24 months. Additional research is needed to further understand reasons for discontinuation of biologic treatment. Although 16% of UC patients underwent surgery, they incurred high direct and indirect costs even prior to surgery. There is an unmet need of effective UC treatment options that may delay or prevent disease progression.