A month has gone by since the last earnings report for IQVIA Holdings (IQV). Shares have lost about 5.4% in that time frame, underperforming the S&P 500.Will the recent negative trend continue leading up to its next earnings release, or is IQVIA due for a breakout? Before we dive into how investors and analysts have reacted as of late, let's take a quick look at its most recent earnings report in order to get a better handle on the important drivers. IQVIA Tops Q3 Earnings Estimates, Updates ’18 ViewIQVIA Holdings reported solid third-quarter 2018 results wherein the company’s earnings and revenues surpassed the Zacks Consensus Estimate.Adjusted earnings of $1.42 per share exceeded the Zacks Consensus Estimate by 3 cents and increased 19.3% year over year. The bottom line met the higher end of the company’s guided range of $1.35-$1.42.Total revenues came it at $2.59 billion, which outpaced the consensus mark by $13 million. The top line grew 5.2% on a reported basis and 6.3% on a constant-currency basis. It came above the midpoint of the company’s guided range of $2.55-$2.60 billion.The better-than-expected results were driven by solid growth in the company’s Research & Development Solutions and Technology & Analytics Solutions segments. Segmental RevenuesRevenues from Technology & Analytics Solutions (TAS) totaled $1.01 billion, up 12.9% on a reported basis and 15% on a constant-currency basis. The segment benefited from acquisitions. Strategic deals such as the agreement with Roche, which includes the deployment and usage of IQVIA commercial technologies globally, and launch of clinical technologies suite raise optimism about the segment. The segment accounted for 39% of total revenues.Research & Development Solutions (R&DS) revenues of $1.38 billion increased 3.1% on a reported basis and 3.5% on a constant-currency basis. Substantial organic growth was witnessed. The segment contributed 53% to total revenues.Revenues from Contract Sales & Medical Solutions (CSMS) totaled $198 million, down 12.8% on a reported basis and 11.9% on a constant-currency basis. The segment accounted for 8% of total revenues.Operating PerformanceAdjusted EBITDA was $561 million, up 9.4% on a reported basis and 8.4% on a constant-currency basis.Operating income was $181 million, down 7.2% from the year-ago quarter. Operating income margin decreased to 6.9% from 7.9% in the year-ago quarter.Total selling, general and administrative expenses of $429 million were up 8.9% from the year-ago quarter.Balance Sheet and Cash FlowIQVIA Holdings exited third-quarter 2018 with cash and cash equivalents balance of $827 million compared with $879 million at the end of the prior quarter. Long-term debt at the end of the quarter was $10.5 billion compared with $10.6 billion at the end of the second quarter. The company generated $344 million of cash from operating activities in the reported quarter and spent $123 million on Capex.IQVIA Holdings repurchased shares worth $133 million during the reported quarter. As of Sep 30, the company had $889 million available under its share repurchase authorization.2018 OutlookIQVIA updated its full-year guidance ranges. Revenues are expected in the range of $10.33-$10.38 billion compared with $10.25-$10.40 billion guided earlier. The updated guidance range has been reaffirmed at the mid-point of the range, despite a foreign currency headwind of approximately $35 million. The guidance for adjusted EBITDA has been increased by $10 million at the mid-point of the range. Adjusted EBITDA is now expected in the range of $2.19-$2.22 billion compared with the previous expectation of $2.17-$2.23 billion. The same for adjusted EPS has been increased by 5 cents at the mid-point of the range. Adjusted EPS is now expected in the range of $5.45-$5.55 compared with $5.35-$5.55 guided earlier. How Have Estimates Been Moving Since Then?In the past month, investors have witnessed a downward trend in fresh estimates.VGM ScoresCurrently, IQVIA has an average Growth Score of C, a grade with the same score on the momentum front. Following the exact same course, the stock was allocated a grade of C on the value side, putting it in the middle 20% for this investment strategy.Overall, the stock has an aggregate VGM Score of C. If you aren't focused on one strategy, this score is the one you should be interested in.OutlookEstimates have been broadly trending downward for the stock, and the magnitude of these revisions indicates a downward shift. Notably, IQVIA has a Zacks Rank #3 (Hold). We expect an in-line return from the stock in the next few months.Want the latest recommendations from Zacks Investment Research? Today, you can download 7 Best Stocks for the Next 30 Days. Click to get this free report IQVIA Holdings Inc. (IQV): Free Stock Analysis Report To read this article on Zacks.com click here.