ONWARD Medical N.V. has secured U.S. Food and Drug Administration (FDA) investigational device exemption approval to begin a clinical study of its ARC-IM System. The trial will evaluate the safety and efficacy of its implantable spinal stimulation system to address blood pressure instability after a spinal cord injury (SCI).

Empower BP is the company’s second global pivotal study and the first to evaluate the implantable ARC-IM System. The randomized, double-blinded, sham-controlled study is expected to involve roughly 20 neurorehabilitation and neurosurgical research centers in the United States, Canada, and Europe, with first patient enrollment anticipated before the end of 2025. The trial will target participants with injuries at spinal cord levels C2-T6, injury severities of AIS A-D, and blood pressure instability characterized by chronic orthostatic hypotension (OH) and autonomic dysreflexia (AD) episodes.

“This is an important milestone for ONWARD and the SCI community,” ONWARD Medical CEO Dave Marver said. “Our ARC-IM System is designed to address several unmet needs, including blood pressure instability, which is a major recovery target after spinal cord injury. With this IDE approval, we continue to advance our innovation pipeline and inspire realistic hope in restoring autonomic functions and independence after SCI and other movement disabilities.”

More than 50% of SCI patients experience blood pressure instability, affecting nearly 350,000 people in the United States and Europe.¹ Blood pressure instability and persistent low blood pressure can threaten neurological recovery and negatively impact cardiovascular health and quality of life. The most frequent symptoms include dizziness, lightheadedness, blurred vision and fatigue.²

“Blood pressure instability, especially chronic low blood pressure, is one of the most hidden and unrecognized functional complications of spinal cord injury,” explained Dr. James Guest, neurosurgeon and professor of Neurological Surgery at the University of Miami. “It leaves people feeling unwell and can significantly impact their overall quality of life. Blood pressure instability also increases the risk of cardiovascular disease, making addressing this unmet need critical for improving the long-term outcomes of SCI.”

The ONWARD ARC-IM System is an implanted neuromodulation platform designed to deliver targeted and personalized spinal cord stimulation. It is the first neuroprosthetic system that manages blood pressure instability in SCIpatients. It comprises the implanted ONWARD Neurostimulator (IPG) and the ARC-IM Thoracic Lead. The ARC-IM Thoracic Lead is optimized for surgical placement in a specific region of the thoracic spinal cord, called the “Hemodynamic Hotspot.” The location was first discovered by the company’s research partners at the Swiss Federal Institute of Technology Lausanne (EPFL), Centre Hospitalier Universitaire Vaudois (CHUV), and the University of Calgary in a study published in Nature in January 2021.³

In December 2022, ONWARD Medical announced positive top-line interim clinical results from its feasibility studies showing improved blood pressure regulation and improved hemodynamic stability after SCI. In addition to immediate and sustained improved blood pressure levels, participants taking anti-hypotension drugs prior to the study significantly reduced or discontinued their medication. Participants also reported improved general well-being and a reduction in orthostatic hypotension, including reduced dizziness and increased energy. Detailed interim results from these studies are expected to be published later this year. Managing blood pressure instability is among the major unmet needs for which the FDA has awarded the company one of its 10 Breakthrough Device Designations.

ONWARD Medical is a neurotechnology company pioneering therapies to restore movement, function, and independence in people with spinal cord injuries and other movement disabilities. Building on more than a decade of scientific discovery, preclinical research, and clinical studies conducted at hospitals, rehabilitation clinics, and neuroscience laboratories, the company developed ARC Therapy. Its ARC-EX System is cleared for U.S. commercial sale. The company is also developing an investigational implantable system called ARC-IM, which can be paired with a brain-computer interface (BCI) to restore thought-driven movement.

Headquartered in the Netherlands, ONWARD Medical has a Science and Engineering Center in Switzerland and a U.S. office in Boston. The firm is listed on Euronext Paris, Brussels, and Amsterdam, and its U.S. ADRs can be traded on OTCQX.

References
¹ Katzelnick CG et al. Blood Pressure Instability in Persons With SCI: Evidence From a 30-Day Home Monitoring Observation. Am J Hypertens. 2019 Sep 24;32(10):938-944
² Carlozzi, N. E. et al. Impact of blood pressure dysregulation on health-related quality of life in persons with spinal cord injury: development of a conceptual model. Arch. Phys. Med. Rehabil. 94, 1721–1730 (2013)
³ Squair, J.W. et al. Neuroprosthetic baroreflex controls haemodynamics after spinal cord injury. Nature 590, 308–314 (2021)