Immunosuppressive treatment is an important tool in the therapy of patients with inflammatory bowel disease. Treatment goal is a long lasting remission. Candidates for immunosuppressive treatment are patients with steroid-refractory active disease, steroid-dependency, chronic active disease or frequent relapses. Conventional immunosuppressives (azathioprine/6-mercaptopurine, methotrexate, the calcineurin inhibitors cyclosporine A and tacrolimus), and anti-TNF antibodies (infliximab, adalimumab) are available. Current guidelines set the frame for the rational use of these drugs.