10 Medium-Sized CROs in North America
In the dynamic world of clinical research, mid-sized Contract Research Organizations (CROs) fill a crucial gap: offering full-service capabilities with greater flexibility, deeper relationships, and specialized expertise than the industry giants. These companies are big enough to handle complex trials but nimble enough to adapt to their clients’ evolving needs.
These companies routinely collaborate with BSC® to provide clinical trial design and analysis beyond what their internal CRO staff can provide.
1. Advanced Clinical
Headquarters: Deerfield, IL, USA
Background: Founded in 1994, Advanced Clinical began as a staffing and resourcing company and evolved into a full-service CRO. It has a strong reputation for supporting mid-sized biopharma clients with clinical operations, biometrics, and regulatory support. It has expanded globally and operates in more than 50 countries. Advanced Clinical has remained privately owned, enabling it to focus on quality service and growth through client satisfaction.
Core Strengths: Full-service clinical trial management (Phases I–IV), Functional Service Provider (FSP), strategic staffing.
Therapeutic Focus: Oncology, rare diseases.
Notable: Known for a personalized, high-touch approach and global reach in 50+ countries.
2. Altasciences
Headquarters: Laval, Quebec, Canada (U.S. offices in Kansas City, Seattle, LA, etc.)
Background: Altasciences has over 30 years of experience and is unique in combining a CRO with a CDMO (contract development and manufacturing organization). Its integrated model is designed to reduce handoffs and accelerate drug development. The company has expanded through key acquisitions, including Vince & Associates Clinical Research and SNBL USA, enabling it to offer services from preclinical to early clinical stages.
Core Strengths: Preclinical and early-phase (Phase I/IIa) development, bioanalysis, CDMO services.
Therapeutic Focus: Translational medicine, first-in-human, pharmacokinetics.
Notable: Integrated CRO/CDMO model, offering smooth transitions from animal to human studies.
3. Worldwide Clinical Trials
Headquarters: Research Triangle Park, NC, USA
Background: Established in 1986 by physician-scientist Dr. Neal Cutler, Worldwide has built its brand around a science-first approach. The company has significantly expanded its global operations while maintaining a mid-size CRO model. Worldwide emphasizes therapeutic alignment, putting subject matter experts at the core of every project. Its reputation is particularly strong among biotech sponsors needing tailored, global support.
Core Strengths: Full-service CRO, early-phase through Phase IV, biometrics, global trial management.
Therapeutic Focus: CNS, cardiometabolic, oncology, rare diseases.
Notable: Named “Most Innovative CRO” and recipient of multiple CRO Leadership Awards.
4. Premier Research
Headquarters: Morrisville, NC, USA
Background: Premier Research was founded in 1989 and has grown with a focus on supporting emerging biotech companies. It has gained prominence for its expertise in complex and underserved patient populations. The company delivers trials in over 20 countries and is known for a consultative approach tailored to innovative therapies. Premier has expanded its capabilities in cell and gene therapy, rare disease, and pediatric trials.
Core Strengths: Full clinical operations, regulatory consulting, biostats, FSP.
Therapeutic Focus: Oncology, neurology, rare diseases, pediatrics, women’s health.
Notable: Focuses on complex conditions and innovative biotech clients.
5. Emmes
Headquarters: Rockville, MD, USA
Background: Founded in 1977, Emmes is one of the longest-standing CROs on this list. It is especially known for its partnerships with the U.S. federal government, including the NIH and CDC. Emmes began as a biostatistics and data coordination company and has expanded into full-service clinical research while retaining its statistical and regulatory strengths. In the past few years, Emmes has made several acquisitions to expand into rare disease and international markets.
Core Strengths: Biostatistics, trial operations, data coordination, public-private partnerships.
Therapeutic Focus: Vaccines, ophthalmology, rare diseases, infectious disease.
Notable: Key player in government research (NIH, BARDA), and expanding in orphan diseases.
6. Allucent
Headquarters: Cary, NC, USA
Background: Rebranded in 2022 from the merger of CATO SMS and Pharm-Olam, Allucent rapidly positioned itself as a CRO focused exclusively on small and mid-sized biotech companies. It combines the operational capabilities of both predecessor organizations and has acquired additional niche CROs and consultancies to broaden its regulatory and modeling services. Allucent aims to be the go-to partner for innovative biotech sponsors seeking hands-on attention.
Core Strengths: Full CRO services, regulatory and modeling consulting, DCT capabilities.
Therapeutic Focus: Oncology, gene therapy, rare diseases, vaccines.
Notable: Formed by the merger of CATO SMS and Pharm-Olam; targets biotech innovators.
7. Caidya
Headquarters: Morrisville, NC, USA (dual HQ with Shanghai, China)
Background: Caidya was launched in 2021 through the merger of Clinipace (USA) and dMed (China). The combined company emphasizes global reach with local delivery, focusing on bringing western and eastern clinical trial expertise together. It serves both U.S.-based and Asia-based sponsors, and continues to grow through strategic partnerships and investments.
Core Strengths: Full-service CRO with tech-enabled operations, regulatory, PV, DCT.
Therapeutic Focus: Oncology, rare diseases, neurology, women’s health.
Notable: Created by merger of Clinipace and dMed; active in global trials across 30+ countries.
8. Celerion
Headquarters: Lincoln, NE, USA
Background: Celerion is one of the largest early-phase CROs in North America, with deep roots in clinical pharmacology. It traces its origins back to Harris Laboratories and later became part of MDS Pharma Services. Spun out as Celerion in 2010, the company now runs some of the most sophisticated Phase I units in the U.S. and Canada, including high-volume clinics with specialized capabilities for adaptive and exploratory studies.
Core Strengths: Phase I/IIa clinical pharmacology, bioanalytical labs, FIH, adaptive SAD/MAD.
Therapeutic Focus: Early-stage methodology across all indications.
Notable: Known for deep early-phase expertise and large bed capacity for in-clinic trials.
9. Veristat
Headquarters: Southborough, MA, USA
Background: Founded in 1994, Veristat is known for its statistical, regulatory, and scientific consulting services. While it has evolved into a full-service CRO, it remains uniquely strong in helping clients obtain regulatory approval. It has supported hundreds of INDs, NDAs, and BLAs, especially for rare diseases and advanced therapies. Its small size and high expertise make it a favorite among emerging biotech firms.
Core Strengths: Biostatistics, regulatory submissions, medical writing, full-service trials.
Therapeutic Focus: Rare diseases, oncology, gene and cell therapy.
Notable: Supported 50+ marketing applications; excels at helping first-time sponsors reach approval.
10. Rho
Headquarters: Durham, NC, USA
Background: A family-founded CRO established in 1984, Rho has grown steadily and built a reputation for integrity and excellence. It has been a key partner on U.S. government clinical research programs and has expanded its presence globally. Rho balances government-funded work with commercial biotech and pharma clients, offering a full range of CRO services with a scientific, quality-focused mindset.
Core Strengths: Study design, biostats, data management, regulatory submissions, FSP.
Therapeutic Focus: Respiratory, CNS, immunology, infectious diseases.
Notable: Trusted by NIH; acquired Dokumeds to expand globally.
Final Thoughts
Choosing the right CRO is as much about culture and alignment as it is about services. These ten organizations provide strong science and operations, while maintaining the agility and partnership spirit many sponsors need.
If you’re a biotech company preparing for your next trial, consider these mid-sized CROs as strategic allies on your path to clinical and regulatory success.
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About BSC®: Since 1986, Biomedical Statistical Consulting® has provided expert biostatistical support for regulatory clinical trials. Our team has supported hundreds of successful FDA submissions and agency interactions, with particular expertise in medical device companies. The firms listed above routinely collaborate with BSC®, with our Team able to provide clinical trial design and analysis beyond what their internal CRO staff can provide.
Contact BSC® to discuss how our regulatory biostatistics expertise can support your trial.