PRESS RELEASE



THIS PRESS RELEASE CONTAINS INSIDE INFORMATION WITHIN THE MEANING OF
ARTICLE 7(1) OF THE EUROPEAN MARKET ABUSE REGULATION (596/2014)



ONWARD Medical Receives FDA IDE Approval to Initiate the
Empower BP Pivotal Study with the ARC-IM System

• The investigational device exemption (IDE) allows initiation of a global pivotal study
designed to assess the safety and efficacy of the ARCIM System®, an implantable
neurostimulation technology developed to address blood pressure instability after spinal
cord injury (SCI).

• Managing blood pressure instability is a major unmet need after SCI, with a significant
impact on cardiovascular health and quality of life.

• Approximately 20 leading neurorehabilitation and neurosurgical research centers across
the US, Canada and Europe are expected to participate.


Eindhoven, the Netherlands, August 18, 2025 — ONWARD Medical N.V. (Euronext: ONWD
and US ADR: ONWRY), the leading neurotechnology company pioneering therapies to restore
movement, function, and independence in people with spinal cord injury and other movement
disabilities, today announces that the US Food and Drug Administration (FDA) has approved an
investigational device exemption for the ARC-IM System. With this approval, the Company can
initiate the Empower BP pivotal study to assess the safety and efficacy of its implantable spinal
stimulation system to address blood pressure instability after 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 approximately 20 leading neurorehabilitation and neurosurgical research centers
across the US, Canada and Europe, with first patient enrollment anticipated before the end of the
year. The study 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 episodes of autonomic dysreflexia (AD).
“This is an important milestone for ONWARD and the SCI community,” said Dave Marver, CEO
of ONWARD. “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.”

Over 50% of people with SCI experience blood pressure instability, affecting nearly 350,000
people in the US 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,” explains 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 designed
to manage blood pressure instability in people with SCI. 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, the Company 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. This award is reserved
for novel, cutting-edge therapies addressing unmet needs and provides potential regulatory and
reimbursement benefits.

To stay informed about ONWARD’s research studies, technologies, and the availability of
therapies in your area, please complete this webform.
About ONWARD Medical

ONWARD Medical is the leading neurotechnology company pioneering therapies to restore
movement, function, and independence in people with spinal cord injuries, and other movement
disabilities. Building on over a decade of scientific discovery, preclinical research, and clinical
studies conducted at leading hospitals, rehabilitation clinics, and neuroscience laboratories, the
Company developed ARC Therapy. It has subsequently been awarded 10 Breakthrough Device
designations from the FDA. The Company’s ARC-EX® System is cleared for commercial sale in
the US. 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, the Company has a Science and Engineering Center in
Switzerland and a US office in Boston, Massachusetts. The Company is listed on Euronext Paris,
Brussels, and Amsterdam (ticker: ONWD) and its US ADRs can be traded on OTCQX (ticker:
ONWRY). For more information, please visit ONWD.com.


For Media Inquiries:
Sébastien Cros, VP Communications
media@onwd.com

For Investor Inquiries:
investors@onwd.com

Notes and 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)
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