China's share of trials jumps, along with enrollment times: IQVIA report

Clinical trial geography has undergone a major shift in the past five years, with China’s share of the world’s trials jumping nearly 60% amid declines in Europe, according to a report released July 10 by the IQVIA Institute, the research arm of pharma data and testing solutions provider IQVIA.  

“There has been a significant rebalancing of global clinical trial activity between regions over the past five years, with a notable move away from Europe and toward China and North America,” the report read.  

Though Western Europe still hosts the largest proportion of clinical trials at 25% of the global total, the figure fell 21% between 2019 and 2023, according to the report. Eastern Europe’s share is now 11%, a 33% decline from its 2019 position. Meanwhile, North American trials now make up 23% of the total, a 17% increase from five years ago.  

While China’s share is still small, it’s now ahead of Eastern Europe: The country’s proportion of world trials stood at 15% at the end of 2023, a 57% increase since 2019.  

China’s shift can be explained largely by more of the country’s biotechs sponsoring single-country, early-stage trials, particularly in cancer and cell and gene therapy, according to the report. The number of Chinese companies conducting trials at China-only sites increased from 18% to 26% between 2019 and 2023, according to the IQVIA Institute.  

Though not mentioned by the IQVIA Institute, the report comes amid U.S. scrutiny of Chinese biotechs and CDMOs, particularly WuXi AppTec and WuXi Biologics, tied to the possible passage of the BIOSECURE Act. If approved, the legislation would limit biotech deals with certain countries deemed adversaries. This could have an impact on the global landscape for clinical trials moving forward.  

Though it hasn't yet passed, the BIOSECURE Act is already influencing U.S. biotech's perception of Chinese CROs. A recent survey by L.E.K. consulting found that domestic pharma and biotech firms' confidence in China-based CRO partners has fallen 32% since discussions around the legislation began.

Besides shifts in where trials are taking place, the duration of enrollment periods is changing, too, the IQVIA report found. Phase 1 enrollment periods were about five months longer in 2023 than they were in 2019, an increase of about 39%. Other phases had smaller but still notable bumps—phase 2 trials added six months to recruitment on average, while phase 3 recruitment was three months longer. This was especially pronounced for oncology, neurology and cardiovascular trials.