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Sign InMedpace Holdings, Inc. (MEDP) reported Q1 2026 revenue of $706.6 million, marking a 26.5% year-over-year increase despite significant operational headwinds. However, the Net Book-to-Bill ratio fell to 0.88x as backlog cancellations reached their highest level in over a year, sparking concerns over revenue stability. Consequently, analysts downgraded MEDP stock from 'Strong Buy' to 'Buy,' citing rising direct costs and heightened cancellation risks. Management's cautious outlook regarding near-term growth has prompted a sell-off as market participants weigh these execution risks. The stock's downward movement reflects broader anxieties over the firm's valuation amid a challenging environment for healthcare services.