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Due to the trend of continuous pharmaceutical manufacturing, twin screw wet granulation (TSWG), a continuous process, has gained increased research interest as a potential substitution of traditional batch granulation processes. Despite the complex nature of TSWG, its mechanisms have been gradually unveiled with the aid of innovative research strategies. This review synthesizes these recent findings to provide a comprehensive and mechanistic understanding of TSWG. We explain the impact of screw profiles (i.e. conveying, kneading, turbine