Top 10 CROs to watch in 2025

Contract research organisations – also called clinical research organisations (CROs) – are essential to the pharma, biotech, and medtech industries, supporting their efforts to test, refine and market their latest drugs and devices. According to MarketsandMarkets, reports show the global CRO market was estimated to be worth up to $82 billion in 2024, and is expected to reach USD 139.42 billion by 2029. Over the years, the growth of Contract Research Organisations (CROs) has been driven by increased investment in research and development, a rise in clinical trials and the patent expirations of blockbuster drugs.

M&A in the CRO marketplace

A few years ago, mergers and acquisitions (M&As) surged as CROs focused on post-pandemic recovery, but 2023 saw a slowdown due to macroeconomic challenges. A new trend then emerged, and continued into 2024, with M&As centred on emerging markets, digital capabilities, and digital integration. Over the past five years, the CRO sector has seen major M&As, including:

• Syneos Health: Acquired by a private investment consortium for US$7 billion in September 2023

• Fortrea: Divested from Labcorp in 2023, returning to its Covance roots, alongside the further divestment of Endpoints

• PPD: Acquired by Thermo Fisher for US$17.4 billion in 2021, and further consolidated with the addition of CorEvitas, LLC, a leading provider of regulatory-grade, real-world evidence

• Parexel: Acquired by EQT and Goldman Sachs in 2021

The CRO market in 2025

Whilst during the height of the Covid-19 years, we saw record numbers of hires across the industry, by 2023 it became apparent that the pandemic-driven acceleration has slowed, and the last few years have been marked by challenges leading to consolidation, reorganisations and cautious hiring. The dramatic shift in the market was driven not only by a lack of funding and investment, rising interest rates and global recession concerns, but also by a slowdown in R&D in certain areas like vaccines and the ongoing impact of geopolitical changes, which continue to reshape the dynamics of global markets.

Reflecting efforts to leverage more cost-effective clinical trial sites, there has also been increasing interest in partnerships and acquisitions in Asia, LATAM and Eastern Europe, as well as access to diverse patient populations. Additionally, Decentralised Clinical Trials (DCT) and AI-driven platforms have gained traction, with more CROs acquiring companies with DCT capabilities or developing their own in-house solutions.

With expansions, partnerships and innovations continuing throughout the CRO industry, 2025 is set to be another dynamic year. The top ten CROs to watch in 2025 are listed below, in no particular order, and include both industry leaders by market share and revenue, as well as up-and-comers steadily increasing their presence through strategic collaboration and innovative service offerings.

The top 10 CROs in 2025

1. IQVIA

In 2016, Quintiles and IMS Health merged and rebranded as IQVIA, becoming the largest CRO in the world. As a leading global provider of advanced analytics, technology solutions and clinical research services to the life sciences industry, IQVIA has solidified its position at the forefront of the CRO world through a series of strategic acquisitions, including the recent purchase of MCRA, a renowned provider of regulatory and reimbursement services.

In 2024, IQVIA generated revenues of US$15,405 million, reflecting a 2.8% growth compared to the previous year. The company’s Research & Development Solutions revenue not only met but surpassed expectations, with bookings exceeding forecasts despite a turbulent CRO market. Meanwhile, Technology & Analytics Solutions performed strongly, maintaining momentum and positioning the company for continued success into 2025. At the end of 2024, IQVIA announced the rebrand of Q2 to IQVIA Laboratories, underlining its ongoing commitment to innovation and strengthening its ability to provide comprehensive services for the biopharma industry. As a global leader in healthcare intelligence, IQVIA is well-positioned to continue shaping the CRO landscape.

2. ICON

In 2021, ICON bought PRA and 2024 saw them further solidify and harmonise their joined teams. Operating from 40+ countries across the world, the top-tier CRO, ICON, offers a full range of consulting, clinical development and commercialisation services.

In recent years, ICON has worked to advance the speed and efficiency of clinical development, which has supported a growing number of customer partnerships. In 2024, ICON generated full-year revenues of $8,282 million, a year-on-year increase of 2.0%.

In 2024, ICON embarked on a series of strategic acquisitions to expand its capabilities and market presence. In February, ICON acquired Clinical Research Management, Inc. (ClinicalRM), bolstering its expertise in government-sponsored research and enhancing its capabilities in vaccines and infectious diseases. Later that month, ICON announced plans to acquire HumanFirst, a company renowned for its organised library of digital measurement tools, their supporting evidence, and insights into their use in clinical trials. This acquisition adds to ICON’s growing portfolio, complementing its position as a leader in clinical trials and related services.

Six months later, ICON acquired KCR, a contract research organisation with 27 years of experience and approximately 900 employees. KCR brings expertise in over 20 therapeutic areas, including oncology, immunology, CNS, vaccines and rare diseases. This acquisition strengthens ICON’s offerings in full-service and functional service provision (FSP), integrates KCR’s biotech division into ICON Biotech, and enhances its presence in Central and Eastern Europe. Together, these acquisitions reflect ICON’s commitment to delivering innovative, patient-focused solutions while solidifying its leadership in clinical research and drug development.

3. Parexel

Founded over 40 years ago and providing the full range of Phase I to IV clinical development services to help speed up and ensure the drug approval process runs smoothly, Parexel remains one of the biggest CROs in the world. With a team of more than 21,000 professionals worldwide, the company has a wide range of service offerings, covering nearly every type of clinical trial service to assist sponsors in running successful clinical studies.

At the end of 2021, Parexel was acquired by EQT Private Equity and Goldman Sachs for $8.5 billion. Together, Parexel and Goldman Sachs remain committed to delivering on the patient-first trajectory and driving advancements in drug development.

In 2023, Parexel announced an innovative collaboration with AI company Partex. The partnership combines clinical research expertise with artificial intelligence capabilities to help drug developers better understand the probability of clinical success for their innovative medical advancements.

2024 saw a significant shake-up in the leadership team, with Keri Mattox stepping in as Chief Business Officer and Peyton Howell taking the reins as Chief Executive Officer, succeeding Jamie Macdonald, who had led the company for over six years. In May 2024, Howell made history as the first female CEO of a major company in this sector, marking a groundbreaking milestone for women in life sciences leadership.

Parexel remains the only CRO to be recognised with both an ACE Award and a Catalyst Award, highlighting its ongoing commitment to inclusivity, both within the organisation and in the way it serves patients.

4. PPD, part of Thermo Fisher

Pharmaceutical Product Development, also known as PPD, is a leading global CRO that employs over 30,000 people worldwide. They are considered a premium CRO provider for many pharma and biotech companies and pride themselves on their “4I values” – integrity, innovation, intensity and involvement.

After acquiring Evidera in 2016, PPD solidified itself as a leader in real-world research. The company has leveraged Evidera’s real-world evidence expertise to provide life science companies with an increasingly crucial element of the clinical development process, helping PPD to remain competitive.

In 2021, PPD was officially acquired by Thermo Fisher, becoming part of Thermo Fisher's Laboratory Products and Services Segment. This means PPD is still operating as a CRO with traditional CRO services, as well as their accelerated site solutions. Together, PPD and Thermo Fisher are able to further leverage their capabilities to bring life-changing therapies to market and are set for a very promising future with an established drug development platform, patient enrolment expertise and robust laboratory services.

Most recently, Thermo Fisher Scientific strengthened its Laboratory Products and Biopharma Services segment with the acquisition of CorEvitas. In light of the news, Marc N. Casper, chairman, president and chief executive officer of Thermo Fisher, commented, “CorEvitas expands our clinical research business with highly complementary real-world evidence solutions, which is an increasingly important area and will help to enhance decision-making as well as the time and cost of drug development. We are excited by the opportunity to further accelerate innovation and advance productivity for our pharma and biotech customers in their work to deliver new medicines and therapeutics to benefit patients.”

5. Syneos Health

Formerly known as InVentiv Health Incorporated and INC Research, Syneos Health specialises in supporting companies with late-stage clinical trials. Headquartered in North Carolina, USA, Syneos Health operates in over 100 locations globally. The company was listed on Nasdaq until 2023, when it was taken private by Elliott Investment Management. In recent years, Syneos Health has strengthened its strategy through key collaborations, investments and initiatives to enhance scalability and operational efficiency.

The company recently appointed Costa Panagos as CEO and a member of the Board of Directors, succeeding Colin Shannon, who becomes Executive Chairman. In a press release, Panagos expressed his excitement about leading the company’s next growth phase, emphasising the firm’s unique position in delivering integrated solutions across early development to commercialisation.

6. Fortrea

In 2022, Labcorp announced its plans to spin off its CRO segment. A year later, Fortrea, which stands for “forward trials with ease”, became an independent public trade CRO. Evolving over 30 years – with a long-standing history of product development expertise – the company provides drug and medical device services, including clinical trial management and commercialisation offerings. Assisting clients in biotech, pharma and medtech, Fortea employs over 19,000 people worldwide.

In June 2024, Syneos Health sold its Endpoint Clinical and Fortrea Patient Access businesses to Arsenal Capital Partners. This strategic sale allows Fortrea to focus on growing as a “pure-play CRO” with enhanced financial flexibility. Tom Pike, former Quintiles CEO who led the merger with IMS Health and is now the chair and CEO of Fortrea, stated in the earnings press release that the move positions Fortrea for continued growth in the clinical research space.

7. TFS HealthScience

With nearly 700 professionals across 40 countries, TFS is a global, full-service CRO providing tailored resourcing solutions and clinical development services, helping clients navigate the complexities of drug development efficiently.

The launch of its new mission statement and tagline, "Empowering Partners. Enriching Lives," reflects TFS’s commitment to advancing clinical research, improving patient outcomes and nurturing sustainable partnerships. In early 2024, the company announced its expansion into the Asia Pacific (APAC) region with a new operational base in Melbourne, Australia. This strategic move strengthens TFS’s ability to deliver comprehensive clinical research services and support partners with greater access to patients, driving innovation and global collaboration.

Most recently, TFS Healthcare announced key changes to its senior leadership team, appointing Katarina Ageborg as Chairman of the Board and Markus Granlund as acting CEO, effective immediately. These leadership changes signal an exciting new chapter as TFS continues its mission to empower partners and advance treatments that promote health and well-being worldwide.

8. PSI

PSI is a fast-growing CRO specialising in oncology, haematology, infectious diseases and multiple sclerosis. Established in 1995 and organically grown, PSI now employs 3,000 staff across 56 countries. Over recent years, the company has expanded rapidly, consistently delivering 93% of studies on time or ahead of schedule. Known for a high repeat and referral business rate and low staff turnover, PSI strives to be the best CRO in the world, as rated by employees, customers, investigators and vendors. With a turnover rate of just 9% in 2024, significantly lower than the industry average, PSI’s commitment to excellence is evident.

In 2024, PSI CRO received the CRO Leadership Awards in Expertise, Quality, Compatibility, and Reliability across both Big and Small Pharma. This marks the seventh consecutive year that PSI has earned these prestigious awards, presented by Clinical Leader and Life Science Connect based on research by ISR. The awards recognise CROs that consistently meet or exceed sponsor expectations.

9. Ergomed

With over a quarter of a century in business and a global presence spanning more than 100 countries, Ergomed provides specialised services to the pharmaceutical industry, supporting the development of new drugs. Serving over 300 clients, from top 10 pharma companies and generics organisations to small and mid-sized drug developers, Ergomed has built a strong reputation. Since its IPO in 2014, the company has completed several successful acquisitions, including Ashfield PV, USA MedSource and, most recently in 2022, ADAMAS, a leading global regulatory compliance provider.

In 2024, Ergomed continued its global expansion with new locations in Boston, USA, and Pune, India, further solidifying its commitment to making its services more accessible to clients worldwide.

10. WuXi AppTec, Inc

With a powerful global presence spanning Asia, Europe and North America, WuXi AppTec stands at the forefront of innovation, offering an unrivalled portfolio of R&D and manufacturing services that drive groundbreaking discoveries and bring life-changing treatments to patients worldwide. Through its distinctive business models, WuXi AppTec delivers fully integrated, end-to-end solutions, enabling customers to accelerate healthcare advancements with unmatched efficiency and cost-effectiveness.

In 2024, the company achieved a 5.2% year-over-year revenue growth, reflecting its relentless drive for excellence. Expansion remains a top priority, with continued investment in its global infrastructure. Notably, WuXi doubled the oral dose capacity at its Couvet, Switzerland site and is actively building its Middletown, USA site, set to begin operations in 2026. Additionally, in May 2024, WuXi broke ground on a new R&D and manufacturing site in Singapore, with Phase I expected to commence in 2027.

In recognition of its commitment to sustainability, WuXi AppTec earned an AA ESG rating from MSCI for the fourth consecutive year. The company’s open-access platform empowers over 6,000 customers across 30+ countries, driving advancements in patient health and realising the vision that "every drug can be made and every disease can be treated."

Is your CRO aiming to grow this year?

At Proclinical, we specialise in clinical research recruitment and workforce solutions, supporting life sciences companies in finding top talent to set up and run clinical trials worldwide. Our dedicated CRO recruitment team excels in sourcing skilled professionals for a wide range of roles within Contract Research Organisations, covering preclinical and clinical research, regulatory affairs, pharmacovigilance and post-marketing research.

Discover how our tailored workforce solutions can help your business expand globally by getting in touch today.

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