Over the last decade, several new classes of biologic and targeted small molecule therapy have been licensed for Crohn’s disease and ulcerative colitis. In addition, the introduction of biosimilars has reduced drug acquisition costs, allowing earlier and more prolonged use of these drugs. However, despite these advances in the management of inflammatory bowel diseases (IBD), a considerable proportion of patients remain refractory to all conventional and currently licenced biologic and small molecule therapies. This chapter summarizes the immunological pathways that drive intestinal inflammation in Crohn’s disease (CD) and ulcerative colitis (UC) and then reviews emerging drugs targeting different components of these pathways. These include biological agents, small molecules, and oligonucleotides that target key inflammatory cytokines, lymphocyte differentiation, and leukocyte trafficking pathways.