The clinical trial industry is navigating a period of regulatory uncertainty, geopolitical tension, and potential targeted tariffs. This climate of economic uncertainty is forcing sponsors to reassess their pipelines and scrutinize the efficiency of their R&D investments, while emerging biotechs face a tougher funding environment.

While tariffs and macroeconomic pressures dominate headlines, they’re only part of the story. The broader reality is that trial starts dropped for several quarters before stabilizing again more recently. This change feels structural as much as cyclical, and its ripple effects are being felt across sponsors, CROs, and research sites alike.

Trial starts are stabilizing — and evolving

While new trial starts finally increased again in 2024, the focus of these tr

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