Ladies and gentlemen, thank you for standing by. At this time, I would like to welcome everyone to the IQVIA Second Quarter 2021 Earnings Conference Call. All lines have been placed on mute to prevent any background noise. After the speakers' remarks, there will be a question and answer session. To pound key.
As a reminder, this call is being recorded. Thank you. I would now like to turn the call over to Nick Childs, Senior Vice President, Investor Relations and Corporate Communications. Mr. Childs, please begin your conference.
Thank you. Good morning, everyone. Thank you for joining our Q2 2021 earnings call. With me today are Ari Boosby, Chairman and Chief Executive Officer Ron Bruman, Executive Vice President and Chief Financial Officer Eric Sherbet, Executive Vice President and General Counsel Mike Fedock, Senior Vice President, Financial Planning and Analysis and Brian Stengel, Associate Director, Investor Relations. This presentation will also be available following this call in the Events and Presentations section of our IQVIA Investor Relations website atir.icuvia.com.
Before we begin, I would like to caution listeners that certain information Discussed by management during this conference call will include forward looking statements. Actual results could differ materially from those stated or implied by forward looking statements due to risks and uncertainties associated with the company's business, which are discussed in the company's filings with the Securities and and Exchange Commission, including our annual report on Form 10 ks and subsequent SEC filings. In addition, we will discuss certain non GAAP financial measures on this call, which should be considered a supplement to and not a substitute For financial measures prepared in accordance with GAAP. A reconciliation of these non GAAP measures to the comparable GAAP measures is included in the press release and conference call presentation. I would now like to turn the call over to Our Chairman and CEO, Ari Bousby.
Thank you, Nick, and good morning, everyone. Thank you for joining today. This morning we reported 2nd quarter results with outstanding double digit growth in all key financial metrics. Following this strong performance, we've once again raised our guidance for the year. As you recall, we're tracking ahead of our pre COVID V22 financial plan.
The health of the life sciences industry continues to Strengthen. New clinical trial starts are trending well above recent historical figures. They're up 22% versus 2020 levels and up 7% compared to 2019. The pipeline of late stage molecules continues to expand to record numbers, indicating a large backlog of potential launches, some of which have been pushed to the right during the pandemic last year. And finally, biotech funding continues to increase significantly.
According to the National Venture Capital Association, funding totaled $25,000,000,000 In the first half of twenty twenty one, this represents an increase of 64% compared to the first half of twenty twenty, which itself was already a record first half year. During 2020, the pandemic disrupted execution of clinical trials and businesses requiring face to face interactions. At the same time, it accelerated change in the industry. It created new demand For new services, and IQVIA is uniquely positioned to deliver based On the differentiated capabilities such as data analytics, advanced technology offerings, and of course our deep scientific and therapeutic expertise, All of which capabilities were highlighted to our clients during the pandemic. We are confident that these capabilities will continue to drive strong demand for both our clinical And commercial offerings in 2021 into 2022 and beyond.
As we begin thinking about our plans during 2022, I am pleased to announce that we will be hosting an investor conference in New York City on November 16, where we will update you on our V22 progress and share our plans For the next phase in IQVIA's evolution. Nick and the team will of course provide more details once all the logistics are Set and available. With that, let's review the Q2 in more detail. Revenue for the 2nd quarter grew 36.4% on a reported basis and 33.2% at constant currency. This represents growth that was $176,000,000 above The midpoint of our guidance range.
About 40% of this beat came from strong operational performance And the reminder was from higher pass throughs. 2nd quarter adjusted EBITDA grew 49 point 5%, reflecting the revenue growth drop through as well as productivity measures. The $20,000,000 beat above the midpoint of our guidance range was entirely due to the stronger Operational performance. 2nd quarter adjusted diluted EPS of $2.13 Grew 80.5%. That was 8% above the midpoint of our guidance range And was driven entirely by the adjusted EBITDA drop through.
I need to provide a little more updates And color on the business during the quarter. Starting with our real world evidence business, It once again performed well, strengthening its leadership position. This included a recent win with a top 20 pharma client To develop an ophthalmology evidence platform for upcoming product launches. The platform integrates primary and secondary data and layers on AIML tools to monitor patient safety in real time. This will allow this client to add new products and indications to the platform without initiating new studies.
This of course will save critical amounts of time and money while also reducing the burden on patients and sites. Turning to our commercial technology business, it continues to increase penetration among top 10 life science companies And emerging biopharma clients, a top 5 pharma clients entered during the quarter Into a commercial agreement to leverage the IQVIA human data science cloud as part of their core data and digital strategy for one of their large therapeutic areas. This client Plans to roll out this platform in over 50 countries to centralize all of their fragmented data assets, resolve data management And improved speed to insights. Our orchestrated customer engagement offering, OCE, Gained additional ground this quarter as 9 new clients adopted the platform for commercial operations, including 2 wins with large biotech clients. 1 of these OC Biotech clients Has the potential for a global rollout to over 20 countries.
The other large biotech win represents A competitive win back of the customer facing team in the U. S. To date, We have 159 client wins for OCE. Our clinical technology solutions team continued our path To innovation in decentralized clinical trials with the introduction of IQVIA's Clinical Data Analytics Suite or CDaaS. This solution built on our human data science cloud platform provides life science companies with new approaches to data use and harmonization as well as producing AI, ML and analytics based insights.
As an open scalable cloud platform, SEDAS seamlessly works with sponsors, Existing data archives and systems. We now have all of the top 10 and 18 Out of the top 20 pharma clients using at least one of the several modules within our clinical technology suite. By connecting the right technology with the right data sources, IQVIA is enabling customers to identify new opportunities To maximize product value, get to market faster, improve departmental and business alignment and reduce costs. Switching to our RMBS business. During the quarter, it continued to build on its Strong momentum with over $2,500,000,000 of net new bookings on a 606 basis.
In the quarter, we achieved a contracted net book to bill ratio of 1 point 34, including pass throughs and 1.37, excluding pass throughs. As of June 30, our LTM contracted book to bill ratio was 1.45, including pass throughs And 1.40 excluding pass throughs. Our contracted backlog in RMBS, including pass throughs, grew 16.7 percent year over year to $23,900,000,000 as of June 30, 2021. As a result, our next 12 months revenue from backlog increased to $6,600,000,000 which is up 19.6% year over year. I want to highlight the lab business, which continues to be a key driver of growth And therefore, will remain an area of strong investment for IQVIA.
You'll recall that on April 1, We completed the acquisition of the remaining interest in Q2 Solutions from Quest Diagnostics. Following this transaction, we announced our plans to expand our laboratory operation in Scotland to bolster our investment in cutting edge technologies, including next generation genomic sequencing and testing. Also in the quarter, we agreed to acquire Myriad's RBM, adding to our capabilities in the lab. RBM specializes in biomarker detection and quantification testing that supports early and late stage drug development in key therapeutic areas such as oncology, CNS and immunology. This acquisition fits nicely into our strategy to develop specialized testing and precision medicine to help support drug development with state of the art solutions.
These actions further demonstrate our commitment to advancing outcomes in this space And we are excited to continue to grow and innovate in the lab business. The Myriad RBM transaction is expected to close sometime in Q3. I'll now turn it over to Ron for more details on our financial performance in the quarter.
Thanks, Ari, and good morning, everyone. Let me first start with revenue. 2nd quarter revenue $3,438,000,000 grew 36.4% on a reported basis And 33.2 percent at constant currency. First half revenue was $6,847,000,000 Growing at 29.8 percent reported and 20 7 percent at constant currency. Technology and Analytics Solutions revenue for the 2nd quarter was $1,353,000,000 that was up 22% reported and 17.9% at constant currency.
For the first CAF Tech and Analytics Solutions revenue was $2,701,000,000 up 21 point 3% reported and 17.5% at constant currency. R and D Solutions 2nd quarter revenue Of $1,891,000,000 was up 53.1% at actual FX rate and 50.7% at constant currency. Excluding the impact of pass through, 2nd quarter R and D revenue grew 44.6% year over year. For the first half, revenue in R and D Solutions was up 44.5% Recorded in 38.5 percent at constant currency. CSMS revenue of $194,000,000 in the quarter grew 9.6% reported and 7.3% on a constant currency basis, and that brings the first half CSMS revenue to $387,000,000 up 3.8% reported and 1.3% at constant currency.
And moving down the P and L and going to adjusted EBITDA, that was $722,000,000 in the 2nd quarter, which represented growth of 49.5 percent, bringing first half adjusted EBITDA to $1,466,000,000 up 40.3% year over year. 2nd quarter GAAP net income was $175,000,000 and GAAP diluted earnings per share was $0.90 For the first half, we had GAAP net income of $387,000,000 or $1.99 per diluted share. Adjusted net income was $416,000,000 for the 2nd quarter and adjusted diluted earnings per share grew 80.5 percent to $2.13 For the first half, adjusted net income was $841,000,000 or $4.32 per share. I'll turn briefly to R and D Solutions. As Ari mentioned, we delivered another outstanding quarter of net new business.
We see backlog Grew 16.7 percent year over year to $23,900,000,000 at June 30, and next 12 month revenue from Claude, at June 30, stood at $6,600,000,000 up 19.6% year over year. Okay. Now on to the balance sheet. June 30, cash and cash equivalents totaled $1,800,000,000 and debt was $12,300,000,000 Which results in net debt of $10,500,000,000 Our net leverage ratio at June 30 came in at 3 point 7.4x trailing 12 month adjusted EBITDA. Cash flow was again strong in the quarter.
Cash flow from Operations was $539,000,000 and CapEx was $145,000,000 resulting in free cash flow of $394,000,000 This brought our free cash flow for the first half of twenty twenty one to over $1,100,000,000
which
It's $45,000,000 of our shares, leaving us with $822,000,000 of share repurchase authorization remaining under our latest program. I'm now on the guidance. We're raising our full year 2021 revenue guidance by $275,000,000
at the
midpoint, Reflecting the strong second quarter and the continued operational momentum that we see in the business, Our new revenue guidance is $13,550,000,000 to $13,700,000,000 which is year over year growth of 19 point 3% to 20.6%. I would note there's no FX impact versus our previous guidance. Compared to prior year, FX continues to be a tailwind of 150 basis points to full year revenue growth. Looking at the segments, we continue to expect full year technology and analytics solutions revenue to grow lowtomidteens And R and D Solutions revenue to grow mid to high 20s, while we now expect the CSMS business to be up low single digit. You saw that we also raised our profit guidance.
As a result of the stronger revenue outlook, we've Increased our full year adjusted EBITDA guidance by $43,000,000 at the midpoint. Our new full year guidance is $2,950,000,000 $3,000,000,000 which represents growth of 23.7 percent to 25.8 percent. Moving to EPS, we adjusted our adjusted excuse me, we increased our adjusted diluted EPS guidance by 0.18 Since at the midpoint, our new guidance range is $8.70 to $8.90 which is Growth year over year at 35.5% to 38.6%. Our full year 2021 guidance assumes that June 30th foreign Currency rates remain in effect for the second half. Now let's review the revenue guidance for the 3rd Quarter 3rd quarter revenue is expected to be between $3,290,000,000 $3,365,000,000 Representing growth of 18.1 percent to 20.8 percent.
We expect adjusted EBITDA to $710,000,000 $730,000,000 up 17.5% to 20.9%. And finally, Adjusted diluted EPS is expected to be between $2.06 $2.13 growing 26.4 percent 30.7%. And again, our Q3 2021 guidance assumes June 30th foreign currency rates remain in effect for the quarter. So to summarize, we delivered very strong second quarter results. We had double digit growth in all key financial metrics.
We posted revenue growth of over 20% in our CAD segment and over 50% in R and Ds segment. R and Ds backlog improved again to $23,900,000,000 up 16.7% Year over year, next 12 months revenue from that backlog increased to $6,600,000,000 that's up 19.6 percent year over year. We reported another strong quarter of free cash flow And given the momentum that we see in the business and our strong second quarter results, we're once again raising our full year guidance for revenue, And so with that, let me hand it back over to the operator for questions and answers.
Your first question comes from the line of Eric Caudwell with Baird.
Thanks very much. Good morning. I have two questions. Ron, first, Congrats on the great cash flow performance year to date. I'm just hoping you can give us some more details on where you're making the biggest gains, changes supporting these improvements and Any color, commentary on your outlook for the future?
2nd question, just COVID related, it's the typical standard ask,
If you
could give any insights on COVID revenue in the quarter, bookings, backlog, thoughts on the tailwind 2022, that would be helpful as well. Thanks very much guys.
Sure. To your first question, Eric, on cash Well, there are 2 principal drivers of our strong cash flow performance. The first, of course, would be our earnings growth, which was quite good. But beyond that, we've made substantial progress and continue to make progress in reducing our day sales outstanding. We had a real focus on that over the past year, bringing down past dues, improving our billing terms with customers, Building sooner because we have substantial unbilled amounts and all of that has contributed to strong collections.
The one caveat I would say is that some of the COVID related work does come with some advances that will burn off over time. So we're still targeting to have cash flow in any given year in the range of 80% to 90 Percent of adjusted net income. Now, obviously substantially stronger than that so far this year. I think it's probably about 125% for the first half. And if we can beat that 80% to 90% range, great, because I think that's a good kind of medium term sort of target for cash Well, in a normal environment.
But we're very happy with the progress we've made on cash flow and expect cash flow to continue to be Sean, for the future.
Yes. I mean, Eric, good morning. And this is thank you for highlighting that aspect of our performance in 2nd quarter, as you know, we were not happy with our cash flow performance back in 20, I guess 2018, our total yearly free cash flow was $600,000,000 So just barely half of what the first half performance was this year. In 2019, I think it was around 800,000,000 And last year in 2020, we bumped that up to $1,300,000,000 or thereabouts. So we're very, very pleased with our performance.
And just for the reasons that Ron highlighted, Especially grateful to the finance team for focusing on the management of our receivables, Collections and generally being to cash type of process improvements That took a lot of efforts, but we think we'll continue to pay dividends. We also remember had Committed to investors that we would reduce our leverage ratio from the mid to high 4s on a net basis to 4 or less by the end of 2022. And I would note that for 2 quarters in a row, We are below that for probably a year early. Now again, we might see the Trade ratio moves up and down depending on circumstances and our spend on M and A and share repurchases, but that's where we are and we're very The second question you had was on COVID work and how much it represents. I think it's always Probably best to look at how much COVID work is in our backlog.
And I just want to say that the Total the large COVID vaccine trials, which have represented the bulk of our work And COVID represent less, actually much less than 5% of our total backlog. And so that gives you a sense. And in terms of now having said that, we expect COVID work to continue to remain part of our business for the foreseeable future. We expect COVID studies to have a long tail through 2021 Well into 2022 and perhaps 2023, there will be a need for vaccines from multiple manufacturers. We still have in our pipeline RFPs for vaccine work from different companies around the world.
There are new vaccines being developed for the variance. There are alternative vaccines that are being needed for adverse safety events, quality issues, manufacturing delays. And then there are a bunch of novel treatment programs that are targeted at specific populations and conditions. So all of that It's still in our pipeline. But again, the large vaccine work is less, way less than 5 percentage points of our total backlog including pass throughs.
So any other commentary you want to make on revenue or impact? I'm really not significant.
Well, look, Even if you were on the revenue side, if you were to pull out all of the COVID related work, we still had very strong revenue growth, Couple of digit revenue growth in both the TAS segment and then the R and D segment. So yes, COVID was a contributor in the quarter, but the underlying Non COVID related work was growing strongly also. And of course, COVID is a reality these days. It's part of the business. We want to participate in that work, and we have been
Your next question comes from the line of Shlomo Rosenbaum with Stifel.
Hi, good morning. Thank you for taking my questions. I have two questions. One It's more of a housekeeping thing. Ron, maybe you could provide the precise organic revenue growth metrics for each segment, TAS and RMDS.
And then Secondly, I wanted to ask you a bit more about what Ari started out with in terms of the growth in the real world evidence business. What's the size of the business At this point in time, what was the growth in the quarter? How is that contributing to the overall business growth? And just more detail, it seems like that's A significant differentiator for IQVIA versus a lot of the competition, I thought we could flesh some of that out.
Let me take the first question, Tremo on organic growth, the contribution of acquisitions in the quarter to our revenue growth was insignificant. If you look back over the past number of quarters, you can see our acquisition activity tailed off quite a bit. And it's only recently beginning to pick back up. So there's almost no contribution whatsoever Of acquisitions to our growth. So organic growth for all intents and purposes equal reported growth in those segments.
Yes. And then, Fomo, on the real world side, that business is about $1,000,000,000 as we've talked about before, continues to grow Double digits, this quarter was high double digits again, continue to see very, very strong results in that business And continue to deliver for us and drive the size growth.
Thank you.
Your next question comes from the line of John Kreuger with William Blair.
Maybe just a quick follow-up on real world evidence. So I think prior previously this year, you talked about doing some significant government COVID tracking work, but that was expected to tail off. What are your current thoughts about The durability of that program and sort of what are you assuming in your guidance for the year?
John, we're expecting that work to continue through the balance of the year, but it will be less Contribution in the second half and the first half, we'll see whether it continues on into 2023 or not. That sort of work tends to be pretty quick burn and rapidly changing, but we do expect Some incremental contribution from the government COVID related work through the balance of the year. I think particular when you get into Q4, the compared to last year's Q4 when we had a substantial amount of it is You're going to be negative, but you see overall for implied Q4 guidance that it remains very strong for the company as a whole.
Thanks, Ron. That's helpful. And maybe a follow-up. Can you guys just talk a little bit about the staffing environment? We hear a lot about labor shortage.
Just Curious if you're seeing any constraints in your ability to recruit and hire and if that's driving any pressure on margins?
Thanks. Yes. Look, there's no secret that Given the strength of the industry backdrop, there's obviously strong competition for talent. And it's also no secret that when people need highly qualified talent, they come after IQVIA talent because they know we train people well And we've got a broad range of skills and training programs. So however, We are confident that we continue to be able to attract and retain the talent simply because we are the Premier company in the industry and also frankly because we've been investing in our employees especially during the pandemic We've been looking after our employees.
We didn't restructure. We continue to pay our people well. Now that it caused certain amount of anxiety in the industry and yes, it's true. And that it caused some level of wage inflation. Yes, that is true.
There is also a little bit of an uptick in attrition levels as As a consequence of all of that, all of that is true. But again, we feel confident. We do not anticipate this to cause Any significant there is some level of headwind to our margins, but we have so many programs and productivity measures and Process improvement measures in place that we are confident we will overwhelm. And you could see that our margins Have been performing very well and growing faster than we had anticipated.
Yes. John, obviously, any The cost pressure we're feeling is fully baked into our 2021 guidance.
Great. Thanks, guys.
Your next question comes from the line of Tycho Peterson with JPMorgan.
Ari, on the 16.7% backlog growth. I'm just wondering if you could provide any more color. How much of this in your view is kind of pent up demand catch up work? And then any kind of lingering concerns around site accessibility and the variant potentially impacting conversion in the back half
of the year?
Well, obviously, you've got a compare issue quarter over quarter that's driving some of that those just unusually high growth rates. But I think we've got the combination of a lot of factors. 1 is catch up work, You're correct. I mean, there's a lot of work that was done last year remotely And we still need to have site document on-site document verification activities that need to take place. So that's another A boost to our growth.
Thirdly, there is the simple fact that projects that were supposed to get Started last year with a push to the right and so that also has a demand. Fourthly, we've been gaining market share. We've been saying it over and over again I think the numbers are pretty clear given our consistently higher book to bill ratios and the size Of our revenues, I think the math clearly will indicate that we are gaining share and we are now beginning to execute on all of these Projects that started with some delay last year. And finally, there is the COVID-nineteen work. So all of that contributes to these very strong growth rates that we have reported.
Your other question, which were operational metrics, Site access and so on. Look, we Essentially, I think we could say about 80 Sant also approaching 80% in terms of site access, given all the flare ups infection in different parts of the world. But our guidance for 2021 takes a lot of Back into account, including site accessibility, we also believe we are at some kind of at critical mass. In other words, at 80%, We can deliver with a combination of different methods we have perfected in terms of remote visits and so on. It's good to monitor site access as a metric when assessing the general recovery, Well, they don't correlate exactly with revenue recognition.
There's many other metrics we track, The 5 startups which have essentially returned to the baseline of 2019, our patients recruitments which are running at or above the 2019 averages, patient visits, which are essentially close to The pre pandemic levels, so all of those bottom line, these metrics provide us with the confidence that the non COVID Trial Pipeline is not only being awarded as exemplified by as illustrated by our strong bookings, But also it's starting to be delivered, meaning the sites are enrolling, the patients are enrolling and the patient visits are taking place. So I hope that clarifies where we are operating in R and D.
That does. That's helpful. And then for a follow-up, Two quick ones. I'm wondering if you can update us on the orchestrated clinical trial rollout, how that's going? And then separately on the acquisitions, I understand they're Not big revenue contributors.
I'm just curious if the accretion assumptions have changed. I think you previously talked about $0.12 accretion from the Q2 acquisition. I just want to make sure that's still the case.
You asked about decentralized, right? Decentralized. Okay. Yes. Again, on the acquisition, just to clarify, on the 40% acquisition of the minority Q2 of the lab that we didn't own, There was zero impact on revenue and EBITDA since we already consolidated as we were a 60% owner.
But there was this accretion on the bottom line and always the accretion, you have the exact number For the balance of the year. For the balance of the year. Yes.
We put that into our guidance.
That's in the guidance. That was already done at the time.
Yes. Nothing has changed. Now I'm
not clear on your first question. Was it about decentralized trials, about OCT?
It's about the orchestrated clinical trials, OCT, the sweet launch and how that's going.
Okay. Dave, fine. So that's going well. I mentioned in my introductory remarks that every single one of our Of the top 10 pharma clients is using 1 module of our clinical technology suite And 18 of the top 20. So we are gaining ground and making progress.
Essentially, all of the suites have been launched and most modules Are being used and the sales pipeline continues to increase. We see a lot of interest from our clients for the platform itself and also for individual Suite for standalone modules, we've seen interest from all customer segments. I talked about the top 20, But it's also true for the mid and BBP. We have demands for multiple products within the digital patient suite. Some of that Driving some of the growth that you saw in on the TAS business.
The CDAS suite, which I talked about in my introductory remarks is the Clinical Data Analytics suite, connects Structured and unstructured data from clinical trials into essential repository that creates One version of the truth that allows predictive analytics to be run, etcetera. It's a key benefit for clients, which As you know, the big vaccine issue in the healthcare is the interoperability Of data between customers, between the people who run the trials like IQVIA in this case And various competitor applications and data sources. So the SEDAS product eliminates the need to reconnect Individual applications to each other and instead these applications they connect directly to SEDAS and enables to Harmonize the data and provide an intuitive and scalable solution to map multiple clinical data sources Enables us to use AIML layers of analytics using this single data ecosystem. So we are very pleased with the progress. Our clients are beginning to understand the value and we are beginning to penetrate that customer Thank you.
Thank you.
Your next question comes from the line of Jack Meehan with Nephron Research.
Thank you. Good morning. Ari, I was hoping you could give a little bit more color on the progress at OCE, so now 109 clients. What's the revenue base for this business and where do you think you are in the growth curve? Is it still in investment mode or has the business turned profitable at this point?
Right. I don't think
we disclosed how much it represents, but we've said that so far in 2021, we've had 19 client Wins, which brings the total since launch 3.5 years ago to 159 client wins. We continue to have a disproportionate share of the wins. I think it's 2 out of 3 and that has been consistent. We are performing well with the large pharma deployments, which we have talked about. I I think Roche already has 15,000 or so users in deployment.
So we haven't seen any Slowdowns in the implementations that are as a result of COVID other than isolated issues which we dealt with. We even see some deployments that are that have accelerated timelines. So the feedback is overall positive. The field reps So very engaged. All is going better than planned for The launch of OC, which I remind you, was only 3.5 years ago.
Great. And then you started by Talking about the strength of the funding environment and the VC activity going on, I was wondering if you're seeing any themes emerge from a therapeutic Area perspective and how you thought IQVIA was stacked up for that? And one specific area I was hoping you could weigh in on is Alzheimer's and Just whether you think that's an area where you could see new investment coming in?
I think, Luke, the undoubtedly, the area where we see the most funding is oncology, Especially those subcategories of oncology where it's been difficult to have effective drugs. So people are pouring a lot of VC funds into oncology, CNS is another area and Alzheimer's, yes, We've got quite a few things going on there. Cardiovascular, strong growth as well. So I would say these are the and of course immunology, prompted by what happened with the virus And COVID, there's a lot of interest in immunology and that also, I would say, is the 4th main area of funding.
Thank you.
Your next question comes from the line of Dan Leonard with Wells Fargo.
Thank you. So hoping first you could elaborate a bit more on your decentralized trial offering and maybe update specifically on StudyHub trends.
Yes. I mean, look, as we mentioned, the Decentralized trial opportunity was identified well before COVID. We talked about it before, we used to call it virtual trials, hybrid trials, we talked about it And we felt we were making great progress. And then the pandemic happened and we saw how critical those capabilities were. And that accelerated the development.
Basically, it's a combination of remote Technology and digital, the part of the clinical trial that can be digitized. So The suite for us combined eConsent, which you're familiar with, telemedicine Modules, ECOA and of course a lot of digital communication. It basically optimizes And virtualizes the relationships between local labs, healthcare providers when it's necessary. This sort of establishes a virtual network of investigators and care professionals. And what we do is that we agree On preset terms with the investigators that agree to participate, we have internally operationalized this Our business and we have a separate team, the decentralized trial team.
For example, we've got decentralized clinical research coordinator that can support the sites in a remote way, help navigate technology. This is new for all of the investigators and certainly for the patients. So we need we figured out in the pandemic that we needed a centralized team To assist sort of a kind of a help desk, if you will, there are there is also So this kind of a sort of a white glove service to help patients and sites through the decentralized trial Process, we also have research nurses and phlebotomy solutions team That build on our global network to support the decentralized studies. So again, we are moving to from we moved From the pre-twenty 20 piloting phase where we had, I believe, at the time, sort of 60 or so small trials that essentially were Experimental in nature and people wanted to sort of try it out to a maturing phase. We have added many wins.
We've So far in 2021, I think we have more than a dozen larger decentralized clinical trials that were won. We added new therapeutic areas. We're working with 5 of the top 10 large pharma clients. And I would note that one of the reasons we were able to win so many So a bigger proportion than anyone else of the COVID work, whether it's therapeutic Trials or vaccine trial was our more advanced decentralized trial capability. And again, we cover probably 10 or so therapeutic areas, Nephrology, oncology, psychiatry, CNS, dermatology, etcetera.
And It's moving to a more mature phase and we will speak more about that in the future. Again, in the context of the very large R and D business we have, it's still not something that's kind of moving the needle in the numbers given the very strong growth that we have. It's not materializing.
Ron, I'll Yes. Just to put some numbers around what Ari just said, I think we had 81 Trials now that are fully deployed on StudyHub and they're approaching 250 trials or So we have some piece of Study Hub. And at any given point in time, we'll have close to 1,000 full service clinical trials going on. It's a piece of our business, it's a growing piece of our business, but still not the majority of what we're doing.
Okay. That's very thorough and helpful. And just a quick follow-up to Jack's question earlier. Possible, I'm curious if you could Frame and size the Alzheimer's opportunity for IQVIA. I remember when something had to come out of backlog a couple of years ago, it was rather sizable And wondering how sizable things coming into backlog could be?
Thank you. Yes.
I don't think it's listen, at the time, our backlog was much Smaller when we came out, it was sizable, but we didn't see it was like seamless. We never felt it. It was not an issue at all. Neither when it left nor when it came back partially. So, I'm not sure what you're It's not significant portion.
I don't know that we disclose that, but it's not it wouldn't be material and would be in the rounding given the size of
Yes. The current Alzheimer's contribution to our backlog is not material. Now could there be more coming in the future? Sure. We hope there is, but we'll see.
Okay. Thank you.
Your next question comes from the line of Patrick Donnelly with Citi.
Great. Thanks for taking the question, guys. Ari, you touched on the M and A a little bit and obviously the cash flow performance, where the leverage is. Can you just talk about Kind of the landscape, what the pipeline looks like, obviously a lot of activity in the space. And then secondarily, given some of the mergers and movements around the Are you seeing any disruption opportunity for share gains and any commentary from customers suggesting this is an opportunity for you guys at the moment?
Yes. I mean, the latter part of your question refers to the consolidation. And assuming enough, we're going to be the only one standing here That's independent. But we look generally the clinical trial Business is an attractive area. It's a high growth area.
It's something that's well into the long term room to deliver Superior returns, we believe as an industry and that is attracting a lot of interest from buyers, whether it's private equity or other large Entities that want to they are in search of accelerate opportunities to accelerate the revenue or profit growth. So that all of that is good news For our industry, in terms of what are the consequences strategically operationally, I think it's pretty clear that First of all, we don't need to participate. Obviously, we look every time and most of these companies have been shocked to Obviously, we look at these companies and in all cases, We've passed because we think the valuations or our ability to gain share does not require us to buy or To participate in this M and A trend, It's hard to gain a lot when you for a CRO to acquire another CRO. I mean, there are Opportunities to complement capabilities, whether it's therapeutic wise or geographic wise, That could be areas of the business, preclinical Phase 1, Phase 2, Phase 3 Complementary strengths. So again, these are the 3 dimensions geography, therapy areas or stage in The drug development process that could lend themselves to more or less complementarity or overlap.
Now the consolidation has taken place. That provides opportunities. As you know, I said before, we have been Gaining share significantly. So we don't need to do that. It is a fact That when there is a large merger or large acquisition, there is disruption.
We've lived it ourselves. So There is generally a loss of talent. We are seeing it coming from others. And there is generally desire by customers to keep 2, 3 or 4 providers. And so if providers overlap when they serve the same customer, you can expect that the sponsor will look to So diversify their provider base.
So all of this is true. Look, we both talent and customer are We're not so focused on this. We're focused on executing on our strategy. It's worked so far. We're confident it will continue to work.
Other acquisitions, obviously, we're looking at things as always. There's a rich pipeline always. You've noted we haven't done much last year. We haven't much this year so far, say for the Q2 minority acquisition. But we are looking at other things always in the technology space and We have a rich pipeline.
It's just it's a binary thing. Acquisition happen or they don't happen. So can't we talk much about that.
No, that's helpful. And maybe just a quick follow-up. CSMS doesn't get the most airtime, but it's nice to see the recovery ongoing. I think you bumped guidance from low single digit decline to low Can you just talk about the market recovery going on there and any outlook?
Yes. I mean, look, a lot of Clients did not cancel contracts last year because they didn't know how long this was going to last. And while our Field reps weren't able to actually be in the field, but many of them remain on the bench with contracts Kind of suspended or renegotiated, that caused some disruption. And as we have begun turning the business around, but So it slipped and went back into the red in terms of revenue growth. But now we're seeing that we're going back.
And I mean, look, this is never going to be a double digit grower, I don't think. So this is the best it's going to be, single digit growth. And we are managing it. It's becoming less of a flashpoint simply because In the size of our company and the growth of the rest of the business, this is becoming relatively small. Now Look, you will recall that shortly after the merger, nearly 5 years ago, we tried to sell it.
As a whole, we then found that we wouldn't fetch much of a value and therefore we pulled the business, Integrated it into our regions. It's very integrated now into our commercial operations. There are contracts which is very useful. In fact, I mentioned before, the decentralized trial business where we are using nurses from that from the CFMS business to help with the Virtual aspects for the going to visit patients at home and so on. So there's a Kind of an added value.
It's not going to move the needle one way or the other as it used to be In the old Quinta days or in the early IQVIA days.
That's helpful. I appreciate it, Ari.
Thank you very much. Okay. Last question? Last one, yes.
Our last question comes from the line of Sandy Draper with Chuy Securities.
Hi, thanks very much. This should be a pretty quick one. Ron, just when I look at the 3rd quarter guidance Looking down sequentially, I just want to confirm, I would assume most of that is because of an expected decline in
pass through revenue in R and D.
Is there anything else?
Yes, that's really the driver. You're correct, Sandy.
Okay. That's my question. Thanks. Congrats.
Thank you, guys. That's it. Well,
Thank you, everyone, for joining us today. We look forward to speaking to all of you again on our Q3 call. Me and the team will be available later for any follow-up questions you might have and look forward to talking to you. Thanks everyone.