Clinical trial activity continues to evolve as scientific ambition, operational complexity, and competitive pressure intensify across biopharma development. According to the IQVIA Institute Global R&D Trends 2026 Report: Advancing Innovation in a Changing Landscape, therapeutic clinical trial trends in 2025 reflect both resilience and transition, with growth concentrated in specific disease areas, shifting sponsor profiles, and increasing reliance on novel therapeutic modalities supported by both strong biological rationale and operational feasibility to manage risk.
Taken together, the latest trends highlight how sponsors are recalibrating trial strategies to balance innovation with feasibility in an increasingly demanding development environment.
Oncology continues to anchor global clinical development. The IQVIA Institute reports that oncology accounted for the largest share of trial starts in 2025, representing 38 percent of all Phase I to Phase III industry sponsored trials. This reflects persistent clinical unmet needs, rapid scientific discovery, and sustained investment despite rising development complexity.
Importantly, oncology trials are no longer defined primarily by traditional small molecules. One third of oncology trials starting in 2025 involved novel therapeutic modalities such as antibody drug conjugates (ADCs), radiopharmaceuticals (RPTs), cell and gene therapies (CAGT), and multi-specific antibodies. This represents a threefold increase compared with a decade earlier and underscores a fundamental shift in how cancer therapies are being prioritized and developed.
While oncology enrollment durations improved modestly in 2025, they remain significantly longer than those observed in other therapeutic areas, reinforcing the underlying operational challenges associated with oncology trials.
Beyond oncology, several other therapeutic areas continue to expand their clinical trial footprints. The Global R&D Trends 2026 Report highlights obesity as one of the fastest growing areas in clinical development, driven by the success of incretin-based therapies and intense competition to develop next generation treatments.
Trial starts in obesity have increased more than five-fold over the past decade, with growth observed across all phases of development. This expansion is increasingly shifting toward mid- and late-stage programs, signaling maturation of the pipeline rather than early experimentation.
Immunology and neurology also remain high growth areas. In immunology, while Janus kinase inhibitors continue to represent a large share of activity, newer mechanisms such as CD19, TSLP, and TNF like ligand 1a are contributing to diversification. In neurology, trial activity continues to increase despite longstanding development challenges, particularly in Alzheimer’s disease, depression, and Parkinson’s disease.
The increasing use of novel modalities is reshaping not only pipelines but also trial design and execution. The IQVIA Institute notes that trials involving complex modalities such as cell and gene therapies, ADCs, and RPTs introduce higher requirements around site readiness, manufacturing coordination, and protocol optimization including novel trial design.
In oncology alone, novel modalities accounted for one third of trial starts in 2025, compared with just 11 percent in 2016. These therapies often require specialized sites and patient populations, contributing to longer enrollment timelines and increased operational risk.
As a result, sponsors are placing greater emphasis on thoughtful trial design, targeted site selection, and early planning to mitigate downstream delays.
One of the most notable structural trends in clinical development is the central role of EBP companies. According to the IQVIA Institute, EBP sponsors accounted for 68 percent of all clinical trial starts in 2025, up from 56 percent in 2019.
This shift is evident across nearly all therapeutic areas and is especially pronounced in early phase development. Emerging biopharma companies lead most Phase I trials globally, reflecting both the innovation engine of smaller organizations and the outsourcing of discovery risk by larger pharmaceutical companies.
At the same time, large pharmaceutical companies remain more prominent in later stage trials, particularly Phase III, where scale, capital, and regulatory experience are critical, linking “de-risked” developing programs with future-looking commercial feasibility.
Trial location patterns are also shifting. The report shows that the United States and China together accounted for roughly one third of global trial country use in 2025, with China leading in Phase I activity and the United States maintaining leadership in Phase II and Phase III.
China’s growth has been driven largely by domestic, single country trials sponsored by both EBP companies as well as investigator-initiated trials, while Europe has seen a relative decline in trial starts over the past several years. These geographic shifts have implications for patient access, regulatory strategy, and operational execution.
Despite innovation and growth in several therapeutic areas, trial efficiency remains a concern. The IQVIA Institute reports that median enrollment duration increased to more than 16 months in 2025, driven largely by oncology trial volume.
While trial complexity declined slightly in 2025 due to fewer eligibility criteria and modest reductions in participant numbers, longer enrollment and extended inter trial intervals contributed to an overall increase in development timelines from Phase I to approval.
These trends reinforce the importance of efficiency focused strategies, including use of real-world evidence, novel trial designs, and improved site and patient engagement.
The clinical trial landscape in 2026 is defined by concentration rather than uniform growth. A small number of therapeutic areas, led by oncology and obesity, account for a disproportionate share of activity. Emerging biopharma companies continue to drive early innovation, while trial complexity and operational execution are becoming key differentiators.
Sponsors that succeed in this environment are those that align therapeutic strategy with realistic execution planning, leverage data to improve trial design, and adapt to evolving geographic and modality driven requirements.
The Global R&D Trends 2026 Report makes clear that clinical trial activity remains robust, but increasingly selective. Growth is focused on where scientific promises, commercial opportunity, and operational feasibility intersect.
As therapeutic pipelines continue to evolve, clinical trial strategies will play a defining role in determining which innovations reach patients and how quickly they do so.
This blog is based on insights from The IQVIA Institute’s Global R&D Trends 2026 Report: Advancing Innovation in a Changing Landscape. For more report information, please visit https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/global-r-and-d-trends-2026.
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