OBJECTIVES: To review the numbers of Phase III/IV clinical trials conducted in the four Asian countries with the highest health care spending (China, Japan, Korea and India), and the share of trials sponsored by the 12 multinational companies (MNCs) with the highest revenues and profits, over the past 10 years. METHODS: Searches were performed on ClinicalTrials.gov to identify industry-sponsored Phase III/IV studies added in 2002, 2006 and 2011. The proportion of trials conducted in China, Japan, Korea and India, and the percentages of trials sponsored by 12 MNCs (Pfizer, Johnson & Johnson, Merck, Abbott Laboratories, Eli Lilly, Bristol-Myers Squibb, Amgen, Gilead Sciences, Mylan, Allergan, Biogen Idec and Genzyme), were analysed. RESULTS: The total proportion of industry-sponsored Phase III/IV trials in China, Japan, Korea and India increased over the time period studied (5%, 17% and 22% in 2002, 2006 and 2011, respectively). In 2002 and 2006, the top 12 MNCs sponsored approximately one third of the Phase III/IV trials in the four countries. This figure, however, dropped to about 20% in 2011. Eight Phase III/IV studies in 2011 were co-funded by one western manufacturer and an Asian firm. Notably, no Asian partners were identified in the collaborative Phase III/IV trials in 2002 or 2006. CONCLUSIONS: The period of 2002-2011 saw an increase in the total number of Phase III/IV trials conducted in the four Asian markets. However, the dominance of the top MNCs in these markets seemed to be weakened during this period. Our results also suggest that establishing partnerships with local companies might be a key strategy for entering these major health care markets.