Integrated Pest Management (IPM) is a leading complement and alternative to synthetic pesticides and a form of sustainable intensification with particular importance for tropical smallholders. Global pesticide use has grown over the past 20 years to 3.5 billion kg/year, amounting to a global market worth $45 billion. The external costs of pesticides are $4–$19 (€3–15) per kg of active ingredient applied, suggesting that IPM approaches that result in lower pesticide use will benefit, not only farmers, but also wider environments and human health. Evidence for IPM’s impacts on pesticide use and yields remains patchy. We contribute an evaluation using data from 85 IPM projects from 24 countries of Asia and Africa implemented over the past twenty years. Analysing outcomes on productivity and reliance on pesticides, we find a mean yield increase across projects and crops of 40.9% (SD 72.3), combined with a decline in pesticide use to 30.7% (SD 34.9) compared with baseline. A total of 35 of 115 (30%) crop combinations resulted in a transition to zero pesticide use. We assess successes in four types of IPM projects, and find that at least 50% of pesticide use is not needed in most agroecosystems. Nonetheless, policy support for IPM is relatively rare, counter-interventions from pesticide industry common, and the IPM challenge never done as pests, diseases and weeds evolve and move.