Clinical Trial Tracker 2Q26: Trial Starts Signal Stronger CRO Demand

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Clinical Trial Tracker 2Q26: Trial Starts Signal Stronger CRO Demand

by an avg "decay" to

get more accurate comparisons, resulting in a 2Q26 total starts estimate of 1,367, up ~11% YoY and

~8% sequentially (see Exhibit 2). Notably, the -8.6% current average decay (see important, updated

Appendix discussion) reflects an updated average. That improves from our prior analysis of a ~9.6%

average decay, using data from 2Q23–2Q25. Beyond YoY growth, we think this improvement (in

lay terms...a reduction in abandoned or deferred trials) is a proxy for stronger sponsor conviction

behind R&D agendas.

CRO Revenue Still Lagging Trial Start Recovery. Clinical CRO organic growth has historically

tracked TTM Phase 2+3 trial starts (Exhibit 6), reflecting the importance of larger Phase IIb/III

studies to CRO revenue. Through 2025, the relationship largely held as organic clinical growth

improved alongside trial activity. More recently, however, the relationship has diverged. TTM Phase

2+3 trial starts accelerated from +10% in 4Q25 to +11% in 1Q26 and +14% in 2Q26, while CRO

organic clinical revenue growth slowed from +8% in 4Q25 to +5% in 1Q26 (2Q still to be reported).

Notably, this divergence comes despite Phase 3 active trials reaching their highest level since 2022

and Phase 1/2 enrollment reaching record levels (Exhibit 8 & 10). We believe the growing adoption

of FSP models may be contributing to the disconnect, as revenue tied to dedicated personnel and

long-term resource commitments may be less directly linked to individual trial starts than traditional

full-service outsourcing. Changing lags may also be at play.

Biotech Funding, Trial Starts Point to Improving CRO Demand. Funding has historically led trial