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00925njm 22002777a 4500 dc Gómez Labrador, Celia author Ricart, Elena author Iborra, Marisa author Iglesias, Eva author Martín Arranz, María Dolores author De Castro, Luisa author De Francisco, Ruth author García Alonso, Francisco Javier author Sanahuja, Ana author Gargallo Puyuelo, Carla J. author Mesonero, Francisco author Casanova, María José author Mañosa, Míriam author Rivero, Montserrat author Calvo, Marta author Sierra Ausin, Mónica author González Muñoza, Carlos author Calvet, Xavier author García López, Santiago author Guardiola, Jordi author Arias García, Lara author Márquez Mosquera, Lucía author Gutiérrez, Ana author Zabana, Yamile author Navarro Llavat, Mercè author Lorente Poyatos, Rufo author Piqueras, Marta author Torrealba, Leyanira author Bermejo, Fernando author Ponferrada Díaz, Ángel author Pérez Calle, José L. author Barreiro de Acosta, Manuel author Tejido, Coral author Cabriada, José Luis author Marín Jiménez, Ignacio author Roncero, Óscar author Ber, Yolanda author Fernández Salazar, Luis Ignacio author Camps Aler, Blau author Lucendo, Alfredo J. author Llaó, Jordina author Bujanda, Luis author Muñoz Villafranca author Domènech, Eugeni author Chaparro, María author Gisbert, Javier P. author 2024 Markers that allow for the selection of tailored treatments for individual patients with inflammatory bowel diseases (IBD) are yet to be identified. Our aim was to describe trends in real-life treatment usage. For this purpose, patients from the ENEIDA registry who received their first targeted IBD treatment (biologics or tofacitinib) between 2015 and 2021 were included. A subsequent analysis with Machine Learning models was performed. The study included 10,009 patients [71% with Crohn’s disease (CD) and 29% with ulcerative colitis (UC)]. In CD, anti-TNF (predominantly adalimumab) were the main agents in the 1st line of treatment (LoT), although their use declined over time. In UC, anti-TNF (mainly infliximab) use was predominant in 1st LoT, remaining stable over time. Ustekinumab and vedolizumab were the most prescribed drugs in 2nd and 3rd LoT in CD and UC, respectively. Overall, the use of biosimilars increased over time. Machine Learning failed to identify a model capable of predicting treatment patterns. In conclusion, drug positioning is different in CD and UC. Anti-TNF were the most used drugs in IBD 1st LoT, being adalimumab predominant in CD and infliximab in UC. Ustekinumab and vedolizumab have gained importance in CD and UC, respectively. The approval of biosimilars had a significant impact on treatment. Pharmaceutics, 2024, Vol. 16, Nº. 5, 629 1999-4923 https://uvadoc.uva.es/handle/10324/68141 10.3390/pharmaceutics16050629 629 5 Pharmaceutics 16 1999-4923 Biologicals Productos biológicos Drugs Medicamentos Drug development Biopharmaceutics Pharmaceutical biotechnology Biotecnologia farmacèutica Inflammatory bowel diseases Enfermedad inflamatoria intestinal Crohn's disease Crohn, Enfermedad de Intestines - Diseases Intestinos - Enfermedades Ulcerative colitis Colitis ulcerosa Pharmacology Gastroenterology Trends in targeted therapy usage in inflammatory bowel disease: TRENDY study of ENEIDA