Private equity continues its infusion into the clinical trials arena with Linden Partners-backed Advarra’s recent acquisition of Quorum, a leading central Institutional Review Board (IRB). The transaction includes Quorum’s research and technology consulting division-Kinetiq. In 2017, Chesapeake IRB and Schulman IRB merged to create Advarra. Now private equity-driven consolidation continues—perhaps fundamentally changing the IRB landscape forever. What was a niche, owner-operated batch of companies has become something very different—significantly sized, corporate entities seeking to maximize profits for private equity shareholders. These new entities seek scale, efficiencies and market leverage as the clinical trials industry demands market-responsive, central review models. To compliment services and organically grow revenues it makes complete sense to include technology and consulting services as well. Another private equity-based consolidator is WIRB-Copernicus (WCG). Backed by Arsenal Capital WCG has evolved from a central IRB to an end-to-end clinical trials technology and services venture. Undoubtedly Advarra and WCG have some clashes ahead.