Bioelectronic medicine & neuromodulation

01Overview and value chain

Markers: [EC: MDR 2017/745 | OECD: Biotech-health | Regulator: FDA (USA), EMA (European Union), NMPA (China)]

Bioelectronic medicine treats disease by electrically stimulating a specific nerve pathway rather than with a drug. SetPoint Medical received FDA approval in July 2025 for its neuroimmune modulation therapy for rheumatoid arthritis, the first clinically proven neuromodulation treatment for the condition, and its RESET-RA study was published in Nature Medicine in January 2026 demonstrating durable efficacy and safety; a May 2026 cost-effectiveness study further confirmed the therapy can reduce total cost of care and improve quality of life. Nevro Corp’s HFX iQ spinal cord stimulation system, which integrates AI-driven personalization with its 10 kHz therapy, received CE Mark certification in Europe in November 2024 and holds an FDA-specific indication for non-surgical back pain. Inspire Medical Systems continued to expand evidence for its next-generation hypoglossal nerve stimulation therapy for obstructive sleep apnea, presenting final ADHERE registry results covering more than 5,000 patients and the OSPREY randomized trial at SLEEP 2026 in June. Galvani Bioelectronics’ splenic neuromodulation therapy for rheumatoid arthritis received FDA approval to progress to the randomized, controlled stage of clinical feasibility testing. Onward Medical reported EUR 2 million in first-quarter 2026 revenue, achieved first-in-human use of its ARC-IM lumbar lead designed to restore standing, stepping and lower-limb mobility after spinal cord injury, and enrolled its first patient in the Empower BP global pivotal study addressing post-injury blood pressure instability. In China, PINS Medical’s implantable deep brain neurostimulation system received NMPA market approval, and the company separately received an innovation green-channel designation for a deep brain stimulator targeting treatment-resistant obsessive-compulsive disorder.

The key directions of bioelectronic medicine & neuromodulation are:

1. Neuroimmune modulation for autoimmune disease (Neuroimmune Modulation): vagus and splenic nerve stimulation that suppresses inflammation as an alternative to immunosuppressive drugs, validated in rheumatoid arthritis — SetPoint Medical’s FDA-approved cervical VNS therapy and Galvani Bioelectronics’ splenic neuromodulation platform.
2. AI-personalized spinal cord stimulation for chronic pain (AI Spinal Cord Stimulation): closed-loop, AI-tuned stimulation for chronic pain including a dedicated non-surgical back pain indication — Nevro Corp’s HFX iQ/HFX AdaptivAI.
3. Hypoglossal nerve stimulation for sleep apnea (Hypoglossal Nerve Stimulation): implantable nerve stimulators that prevent airway collapse during sleep, backed by large-scale registry and randomized-trial evidence — Inspire Medical Systems.
4. Implantable neuromodulation for paralysis and neurological disease (Implantable Neuromodulation for Movement): spinal cord and deep brain stimulation systems restoring movement after spinal cord injury or treating neurological/psychiatric disease — Onward Medical’s ARC-IM/ARC-EX platform and PINS Medical’s deep brain stimulation systems.

Sectoral value chain

[nerve target/stimulation waveform design] ──> [preclinical/clinical validation] ──> [regulatory clearance (FDA/MDR/NMPA)]
                                                    │
                                       (implantation/device programming)
                                                    │
                                                    ▼
[registry/outcomes-driven label expansion] <─── [clinical outcome data generation] <─────┘

Value chain levels

Cross-cutting technologies of the sector:

• Neuroimmune modulation (Neuroimmune Modulation): electrical stimulation of the vagus or splenic nerve to suppress inflammatory cytokine release, offering a drug-free mechanism for autoimmune disease control.
• AI-personalized stimulation tuning (AI Spinal Cord Stimulation): cloud-connected, AI-driven algorithms that adjust stimulation parameters to individual patient response over time.
• Registry-scale evidence generation (Hypoglossal Nerve Stimulation): large longitudinal patient registries (thousands of patients) and randomized trials used to expand and defend a neurostimulation therapy’s indication.

02US

The US hosts the leading concentration of bioelectronic medicine companies, spanning neuroimmune modulation, AI-personalized pain stimulation and sleep-apnea nerve stimulation, each with substantial published clinical evidence.

SetPoint Medical, Nevro Corp, Inspire Medical Systems, FDA

• SetPoint Medical: received FDA approval in July 2025 for its neuroimmune modulation therapy for rheumatoid arthritis, the first clinically proven neuromodulation treatment for the condition, and its RESET-RA study was published in Nature Medicine in January 2026 demonstrating durable efficacy and safety; a May 2026 cost-effectiveness study further confirmed the therapy can reduce total cost of care and improve quality of life.
• Nevro Corp: its HFX iQ spinal cord stimulation system, which integrates AI-driven personalization (HFX AdaptivAI) with its 10 kHz therapy, received CE Mark certification in Europe in November 2024 and holds an FDA-specific indication for non-surgical back pain, based on the SENZA-NSRBP randomized controlled trial.
• Inspire Medical Systems: continued to expand evidence for its next-generation hypoglossal nerve stimulation therapy for obstructive sleep apnea, presenting final ADHERE registry results covering more than 5,000 patients and the OSPREY randomized trial broadening neurostimulation options at SLEEP 2026 in June.
• FDA framework: implantable neurostimulators clear FDA 510(k)/PMA per specific indication, with SetPoint’s and Nevro’s approvals both anchored in dedicated randomized-controlled-trial evidence for their respective indications.

03CN

China’s confirmed bioelectronic medicine activity centers on deep brain stimulation, with a Beijing-based company securing both a core market approval and an innovation fast-track for a psychiatric indication.

PINS Medical, NMPA

• PINS Medical (Beijing, China): its implantable deep brain neurostimulation system received NMPA market approval, reported across multiple Chinese outlets in December 2025; the company separately received an innovation green-channel designation for a deep brain stimulator targeting treatment-resistant obsessive-compulsive disorder in September 2025, and Chinese coverage has also referenced an investigational invasive brain-computer interface product for addiction-related psychiatric disease.
• NMPA pathway: implantable neurostimulators register with NMPA as Class III medical devices, with an innovation green-channel pathway available for devices addressing under-served indications such as treatment-resistant OCD.

04EU

The UK and the Netherlands anchor Europe’s bioelectronic medicine capacity, spanning a splenic-nerve neuroimmune platform and a spinal cord stimulation system restoring movement after paralysis.

Galvani Bioelectronics, Onward Medical, MDR

• Galvani Bioelectronics (UK): its splenic neuromodulation therapy for rheumatoid arthritis received FDA approval to progress to the randomized, controlled stage of clinical feasibility testing, alongside a new Chief Medical Officer appointment.
• Onward Medical (Netherlands): reported EUR 2 million in first-quarter 2026 revenue, achieved first-in-human use of its ARC-IM lumbar lead designed to restore standing, stepping and lower-limb mobility after spinal cord injury, and enrolled its first patient in the Empower BP global pivotal study addressing post-injury blood pressure instability; its non-invasive ARC-EX system, cleared by the FDA in 2024, is already commercially available.
• MDR framework: implantable and external neurostimulators sold in the EU require conformity assessment under the Medical Device Regulation (MDR 2017/745), with Onward Medical’s ARC-EX and ARC-IM programs both progressing through this framework alongside FDA review.

05Leading companies and research institutes

06Tech stack and innovations

The stack applies targeted electrical stimulation to a specific nerve pathway to treat disease mechanistically, as an alternative or complement to pharmacological treatment.

1. Neuroimmune modulation therapy (Neuroimmune Modulation):
   • SetPoint Medical’s FDA-approved cervical vagus nerve stimulator suppresses inflammatory cytokine release in rheumatoid arthritis, with Galvani Bioelectronics developing a splenic-nerve alternative now advancing to randomized controlled testing.
2. AI-personalized spinal cord stimulation (AI Spinal Cord Stimulation):
   • Nevro Corp’s HFX iQ combines 10 kHz high-frequency therapy with AI-driven, cloud-connected personalization (HFX AdaptivAI) and holds a dedicated FDA indication for non-surgical back pain.
3. Hypoglossal nerve stimulation (Hypoglossal Nerve Stimulation):
   • Inspire Medical Systems’ next-generation Inspire V system uses respiratory-sensing hypoglossal nerve stimulation for obstructive sleep apnea, backed by the 5,000-patient ADHERE registry and the OSPREY randomized trial.
4. Implantable neuromodulation for movement restoration (Implantable Neuromodulation for Movement):
   • Onward Medical’s ARC-IM implantable and ARC-EX non-invasive spinal cord stimulation systems restore standing, stepping and lower-limb mobility after spinal cord injury, while PINS Medical’s deep brain stimulation systems treat movement and, via its OCD-focused device, psychiatric indications in China.

07Value chains and production pipelines

Industrial pipeline of a bioelectronic medicine device (FDA 510(k)/PMA / EU MDR 2017/745 / NMPA)

┌───────────────────────────┐      ┌───────────────────────────┐
│ 1. Nerve target/waveform  │ ───> │ 2. Preclinical/clinical   │
│    design                    │      │    validation                │
└───────────────────────────┘      └───────────────────────────┘
                                                   │
                                                   ▼
┌───────────────────────────┐      ┌───────────────────────────┐
│ 4. Implantation/device    │ <─── │ 3. Regulatory clearance  │
│    programming               │      │                           │
└───────────────────────────┘      └───────────────────────────┘
              │
              ▼
┌───────────────────────────┐      ┌───────────────────────────┐
│ 5. Clinical outcome data  │ ───> │ 6. Label expansion        │
└───────────────────────────┘      └───────────────────────────┘

Stage 1: Nerve target and waveform design

A specific nerve pathway (vagus, splenic, spinal cord, hypoglossal, deep brain) and stimulation waveform are selected for a disease mechanism, as with Galvani Bioelectronics’ splenic-nerve approach to rheumatoid arthritis versus SetPoint Medical’s cervical VNS approach to the same disease.

Stage 2: Preclinical and clinical validation

The therapy is validated in animal models and then randomized or registry-based human studies, the evidence base behind SetPoint’s RESET-RA Nature Medicine publication, Nevro’s SENZA-NSRBP trial, and Inspire’s ADHERE registry and OSPREY trial.

Stage 3: Regulatory clearance

The device clears FDA 510(k)/PMA, EU MDR conformity assessment, or NMPA registration for its specific indication, as with SetPoint’s July 2025 FDA approval and PINS Medical’s NMPA-approved deep brain stimulation system.

Stage 4: Implantation and device programming

The device is surgically or non-invasively implanted and programmed to the patient’s specific parameters, as with Onward Medical’s first-in-human ARC-IM lumbar lead implantation.

Stage 5: Clinical outcome data generation

Registry and real-world data on symptom control, safety and cost-effectiveness are collected, exemplified by SetPoint’s May 2026 cost-effectiveness study and Inspire’s 5,000-patient ADHERE registry.

Stage 6: Label expansion

Outcome and registry evidence supports expanding the approved indication or reimbursement scope, the pattern behind Onward Medical’s progression from its commercial ARC-EX system into the ARC-IM pivotal Empower BP study and PINS Medical’s expansion from core deep brain stimulation approval into an OCD-focused innovation pathway.