Background: Inflammatory bowel diseases, encompassing Crohn’s disease (CD) and ulcerative colitis (UC), are chronic diseases that compromise the gastrointestinal tract due to constant activation of the immune system in response to environmental, genetic, and dietary factors in a genetically susceptible individual. Treatment goals have evolved from simple remission of symptoms to complete mucosal and transmural healing, leading to a change in the choice of treatment strategy from a conventional “step-up” approach to earlier intervention, a rapid step-up approach or even a “top-down” strategy. Aim: To compare biologic therapy indications and types as well as loss of response rates in patients with UC vs CD.Methods: We conducted a cross-sectional, observational, open population study by reviewing electronic medical records in a specialized private clinic in Canoas, a city located in Rio Grande do Sul, the southernmost state of Brazil. The sample included all patients aged 18 years or over on follow-up at the clinic since 2016 who agreed to participate in the study by signing an informed consent form. Statistical analysis was performed using Pearson’s chi-square test or Fisher’s exact test. The Z-test was used for multiple comparisons, with Bonferroni correction to compare proportions. Data were analyzed in SPSS, version 25.0. The significance level was set at P<0.05 for all analyses. Results: A total of 157 patients were investigated, 89 with CD and 68 with UC. Most patients were female, and 68.2% were within the young age range of 20 to 40 years. Regarding CD location, 48% of patients had perianal involvement and 52% had luminal involvement only. Regarding UC extent, 35% had ulcerative proctitis, 41% distal UC, and 24% had extensive UC or pancolitis. Regarding biologic therapy, 72.6% of patients used at least one immunobiologic agent, mostly anti-tumor necrosis factors (80%). In patients using immunobiologics, 62% used only one; 15%, two; 6%, three; and 3%, four. Combination therapy (immunobiologic agent combined with an immunomodulator) was used in 70% of patients. The therapeutic target (endoscopic remission) was achieved in 62.3% of cases, and this rate was significantly higher in patients with CD (72%) than in those with UC (28%). In UC, endoscopic healing was most commonly associated with proctitis (50%), followed by distal UC (36%) and extensive UC (14%). Time to response was <6 months in approximately 58% of patients. Endoscopic healing at 6 months was observed in 70.7% of patients with perianal CD. There were no statistically significant differences in healing rates between patients with perianal and luminal CD. Loss of response was observed in approximately 30% of patients, occurring 12 months after therapy initiation in most cases. Optimization of biologic therapy was required in almost half of patients (49.1%). Approximately 10% of patients required at least one surgical procedure (luminal or perianal). Conclusion: Early personalized therapy proved essential for favorable outcomes, minimizing loss of response, change of treatment strategy, and surgeries. Endoscopic remission was superior in CD, suggesting a slower response in UC.