Strong Gross Bookings Growth
Gross bookings were $3.3 billion in Q1, matching Q4 2025 and up 22% year-over-year, indicating robust new business demand.
Meaningful Net Business Wins and Book-to-Bill
Net business wins totaled $2.88 billion, up 42% year-over-year, producing a net book-to-bill of 1.42x and direct-fee book-to-bill in excess of 1.3x for the quarter.
Sustained Win Rates Across Large Pharma and Biotech
Win rates remained strong and sustained the step-up seen in Q4 across both large pharma and biotech full-service businesses, with RFP flow notably improving (low double-digit sequential increase in biotech full-service).
Strategic Commercial Wins and Market Diversification
Quarter included a central labs partnership win with a top-5 pharma customer, a new midsized pharma partnership that displaced an incumbent large CRO, and broad-based bookings across therapeutic areas (oncology and cardiometabolic) with cardiometabolic awards diversified into MASH, obesity and kidney disease.
Investment in Oncology Site Network and Lab Capacity
Expanded Accellacare oncology research capabilities (partnership with Brian Moran Cancer Institute) and announced expansion of central laboratory capacity in Singapore to accelerate lab offerings and growth in Asia—steps to address patient access and geographic growth.
Innovation and AI Partnership
Announced partnership with Microsoft to build ICON's Orbis Agentic AI platform and enterprise Copilot deployments to drive efficiency, domain-specific agents and digital transformation across clinical workflows.
Revenue and EPS (Adjusted) In Line with Expectations
Reported revenue of $2.0 billion in Q1 (approximately +0.9% year-over-year reported, -1.9% constant currency) and adjusted diluted EPS of $2.50 for the quarter, with adjusted net income of $192.9 million.
Cash Generation and Balance Sheet Improvements
Q1 cash from operating activities was $167 million; capex was $30.8 million, producing free cash flow of $136.2 million. Cash totaled $765.2 million and net debt improved to $2.6 billion from $2.8 billion at year-end 2025 and $2.9 billion a year earlier, with leverage at 1.8x net debt to adjusted TTM EBITDA.
Guidance Maintained
Full-year 2026 guidance reiterated: revenue $7.85 billion to $8.15 billion and adjusted diluted EPS $10.00 to $11.00, signaling management confidence in the outlook despite near-term headwinds.
Near-Term Margin Momentum Expected
Adjusted EBITDA margin was 15.6% in Q1 (up ~10 basis points sequentially) and management expects modest sequential margin improvement through the year, guiding Q2 margin to roughly ~16% (approximately +0.5% vs Q1).