New study provides overview of all drug trials conducted in Europe 2013-2025

A new study provides an overview and analysis of 25,320 clinical trials of medicines conducted in 30 European countries.

Key findings:

• The number of clinical trials in Europe declined by 14% between 2013-2019 and 2022-2025.

• Throughout the study period, cancer remained the dominant therapeutic area, accounting for a quarter of all trials. Research activity in rare diseases increased and currently stands at over 20% of all trials.

• The proportion of multinational trials increased slightly to 53%. While a large majority of commercial trials are multinational, only a very small number of non-commercial trials takes place in more than one country.

  
  

• In recent years, commercial trials have started to outnumber non-commercial trials. The decline in trials authorised since 2022 appears to be driven disproportionately by a reduction in non-commercial trials (19% reduction).

The study contains a very detailed discussion of ongoing efforts by European regulatory networks to build the capacity of academic researchers to run more multinational trials.

The authors caution that:

“[T]rial counts alone do not fully capture research volume: some studies may be larger, longer, or more resource-intensive than before. Similarly, the increase in multinational trials may reflect a consolidation of research activity into fewer, larger cross-border studies rather than fragmented single-country protocols, although this hypothesis cannot be tested with our data.”

They also note that rising proportions of multi-phase designs and studies involving biologic and advanced therapies suggest growing scientific and operational complexity.

The authors encourage others to build on their work:

“Future analyses focusing on specific therapeutic areas, patient populations, and regional disparities could help identify opportunities to align the research ecosystem with clinical needs, and areas where strengthening regulatory processes, infrastructure, or collaboration would be most beneficial.” 

The study is based on public data from the EudraCT and CTIS trial registries, plus confidential data on a small number of trials that the European Medicines Agency allowed the authors to access. Variables were harmonised between EudraCT and CTIS.

Adult-only phase I trials and trials conducted in the UK were excluded from the analysis. Non-drug trials were not included because the two European registries only contain data on clinical trials of medicines.

The study “Clinical trials on medicinal products in the EU/EEA, 2013–2025: a cross-sectional analysis of CTIS and EudraCT data” is available open access. Due to the confidentiality of some of the data included, the authors did not make their dataset public, but a PDF supplement to the paper includes tables with detailed breakdowns, including of the annual distribution of authorised clinical trials by therapeutic area using MeSH categories. The authors did not make public their code (using the ctrdata R package) but pledged to share it upon request.

A separate study, “Improving clinical research through better use of clinical trial registry data,” may also be of interest.