Good day, and thank you for standing by. Welcome to ONWARD Medical Q1 2026 results webcast and conference call. At this time, all participants are in a listen-only mode. After the speaker presentation, there'll be a question- and- answer session. To ask a question during the session, you will need to press star one and one on your telephone. You will then hear an automated message advising your hand is raised. To withdraw your question, please press star one and one again. Alternatively, you may submit your questions via the webcast. Please be advised that today's conference is being recorded. I would now like to hand the conference over to our first speaker today, Sébastien Cros, VP of Communications. Please go ahead.
Thank you, Sharon. Good morning, good afternoon, everyone, and welcome to ONWARD's webcast following the publication of our results for Q1 earlier today. Before we get started, as usual, please take a moment to read our disclaimer. This presentation includes forward-looking statements, which should be considered with the appropriate level of caution as outlined on this page. This deck and the recording of the webcast will be made available after our call. Today, I'm joined with three members of ONWARD leadership team, Dave, our CEO, Sean Sciara, our Chief Commercial Officer, and Ali Kiboro, Chief Financial Officer. As always, we will present the results and key highlights from Q1 before opening the floor for questions. You may submit your question orally or via the Q&A module of the platform. With that, I'll hand over to Dave.
Thank you, Séb. We had another successful quarter and off to a very good start for the year. We could continue to accelerate the launch of ARC-EX, achieving EUR 2 million in revenue in the first quarter. That was comprised of 70 ARC-EX systems supplied for use in clinics and homes. That means that ARC-EX systems are now available in over 100 clinics across the U.S. and Europe as of the end of the first quarter. We also continued in our execution of the Empower BP pivotal trial for ARC-IM to address blood pressure instability. In fact, the first participant was enrolled and implanted in the first quarter, and as we sit here today, we've now activated 12 sites within that study. We also advanced our pipeline, successfully implanting one additional patient in the Parkinson's disease blood pressure trial. That's an early feasibility study.
We initiated a new mobility feasibility study called EIGER, in which we aim to enroll 12 sub-acute and chronic spinal cord injury patients. We also, last month, raised over EUR 40 million in new equity capital, supported by a EUR 25 million investment from EQT Life Sciences, extending our cash runway into Q1 of 2028. Now let's talk a bit more about the commercial traction with ARC-EX. Those of you who are new to the company, this is ARC-EX pictured in the presentation. This is an external stimulator. It stimulates the spinal cord through the skin to restore strength and sensation lost after spinal cord injury. I'd like to turn it over to Sean Sciara, our Chief Commercial Officer.
That's fantastic. Thank you, Dave. Well, in Q1, we crossed over one year of commercial availability in the United States. You can see the run rate that we're on from a unit perspective. In one year of real-world use, we've established, as you mentioned, presence in over 100 clinics. We've had many thousands of uses with the technology and with multiple healthcare providers. In most of the clinics we're in, we have many hundreds of healthcare providers using ARC-EX technology to care for their patients with spinal cord injury. In this first year, it's been exciting to see the product performing as well as it is. It's been really exciting to see real-world use where the technology is living up to the expectations that were set in the clinical trials.
At the end of Q1, we estimate that we're in approximately 30% of the clinics in the United States that are caring for people with spinal cord injury. That's across your Tier 1 institutions, as well as some of the smaller activity-based centers across the United States that care for patients. Starting in Q1, we have the ARC-EX technology available now not just in the clinic but also in the home. One of our bigger focuses on the year is the United States of Veterans Affairs Administration. And in the VA, w e've exited Q1 in roughly one-half of the hubs that take care of spinal cord injury patients in the VA and have a number of them now actively prescribing for home use.
In Europe, our commercial journey is just beginning as the CE mark came late in the year last year, but we've now launched clinics in over five countries across Europe. Our strategy, as can be seen on the slide, is a combination of both direct and indirect sales. This puts us in a position, I believe, to partner tightly with clinicians in the commercialization of this new therapy in Europe, leveraging a lot of the experiences that we've built in the United States. Like in the United States, these relationships in Europe will be important for commercial efforts, not just for ARC-EX, but they lay the foundation for ARC-IM and ARC-BCI to follow. In Q1 in Europe, we hired and onboarded direct hires for our key markets.
We've identified distribution partners for key markets, and in early April, held a distributor workshop to begin the process of onboarding key distribution partners. We're very excited about the speed of progress that we've had across the first quarter. Back to you, Dave.
Thank you, Sean. Also wanted to update those of you on the call on our progress with Empower BP. Again, this is the global pivotal study to gather the evidence required to submit for regulatory approval for ARC-IM blood pressure instability indication. We announced our first enrollment and first implant in the study in Q1. That was at Craig Hospital in Denver, Colorado, U.S.A. As of this call, we have activated 12 U.S. sites in the study, and more to come. We also initiated the EIGER feasibility study, and this is for mobility. Many of you have asked, "Hey, when is the company going to get back to mobility? What's going to come after blood pressure instability?" We've done a lot of early feasibility work in mobility dating back to when the company was founded in 2015.
Some of that work was done with highly modified pain stimulators, just as proof of concept. Here, we're going to use the purpose-built ARC-IM neurostimulator, and we're doing this study specifically to identify the most viable patient population and to inform the design of an eventual pivotal study that will occur globally. Again, it's called EIGER. We're enrolling 12 patients, six of them with chronic SCI and six with sub-acute SCI. Those that have been injured less than six weeks. The notion is that if we can implant these folks and help them with mobility before their muscles have atrophied a lot following their injury, that they might have a better prognosis. This study's being done in collaboration with the CHUV, the local hospital in Lausanne, with NeuroRestore, of course, and with the paraplegic center up in Zurich called Nottwil, which is a leading center globally.
Lastly, the big news, we had a very successful equity financing last month, raising EUR 40 million, supported by a EUR 25 million investment from EQT Life Sciences and a number of other very high-quality investors. I think there were 30 investors who participated, many of them high quality, long-only sector specialists. In fact, our top two investors are now EQT and Ottobock, that underscores the quality of our cap table and really validates the company and our future prospects. Our cash runway now extends into Q1 2028. Very strong, I think that's as much runway as we've ever had here, at least since I've joined in 2020. It allows us to very much focus on now executing the business, not having so many investor meetings.
That's one of our operating philosophies, is making sure that we raise money before we get too tight, keep a very high-quality cap table, and focus on running the business. I'd like to turn it over to Ali to tell us more about the results.
Thanks, Dave. Next slide. Revenue for the quarter was EUR 2 million, of which EUR 1.3 million of that was product revenue sales. As you've heard from Dave, we strengthened our balance sheet right after the end of the quarter. At the end of Q1, our cash available was EUR 53.4 million. Post the raise of capital in early April, our cash balance at the end of April was EUR 89.8 million, which allows us to execute on our near-term plan and have runway through the first quarter of 2028. Back to you, Dave, for the milestones.
Thank you, Ali. Next slide. As usual, we expect a lot of news flow here. We've completed a lot of major milestones, but many await. With ARC-EX, we still expect to announce first commercial home use sale in Europe and the first commercial clinic sale in the rest of the world. With ARC-IM, we expect to announce additional implants in mobility, particularly around the EIGER trial that I just described. Also, first-in-human use of ARC-IM to address bladder challenges following spinal cord injury. Next spring, we expect to announce the interim analysis, the top-line results from the Empower BP pivotal study. Again, that's for blood pressure. We're continuing to support implants with our brain-computer interface-enabled system called ARC-BCI, both for upper limb, and we also have a grant-funded study using ARC-BCI in stroke. A lot going on as usual.
Thank you for those of you who support the company. Let's roll into the Q&A, Séb and Sharon.
Into the Q&A. Maybe, Sharon, you want to remind people how to submit questions first?
Thank you. To ask a question, you will need to press star one and one on your telephone keypad. That is star one and one on your telephone keypad, and wait for your name to be announced. To withdraw your question, please press star one and one again. If you wish to ask a question via the webcast, please type it into the box and click submit.
Yeah, Sharon, I think before we take any questions, we did get some questions that were submitted in writing from Ed Hall, the analyst at Stifel. First question was the split of units placed, U.S. versus Europe, and clinic versus home. As you would expect, the great majority of units were supplied in the U.S. We did penetrate five different European countries thus far. We're building out a nice foundation of clinics using the device in Europe, taking advantage of the direct and indirect field organization that we're currently putting in place. We're not going to share the exact numbers around U.S. versus OUS or clinic versus home, but I will tell you that for the first time, as you might expect, we sold more personal or home units than clinic units. That's certainly a trend we would expect to continue going forward.
Another question from Ed while we wait is just to describe the current VA clinic penetration. Sean, could you take that one? How are we doing with the VA currently?
Sure, Dave. The progress in the VA has been really fantastic. The VA is a notoriously challenging institution with a lot of highly regional and localized policies instead of one set of governance that governs the entire country. There are 25 hubs. The VA for spinal cord care works on a hub and spoke model. There are 25 hubs. We're in approximately half of those with many of those that we're now in the clinic beginning the process of prescriptions for home use. Off to a really good start, and our target goal is to be in all of the VA hubs by the end of the year.
Okay. Thank you, Sean. We do now, Sharon, have some calls in the queue from our equity research analysts. Can we start with Clément from BNP Paribas?
Of course. [audio distortion], are you on the line?
Hi, everyone.
Your line is open, Clément.
Hello. Good morning.
Hi, Clément. Go ahead.
Hi, did you hear me?
Yes, go ahead, Clément.
Okay. Just a few questions. The first one about the top line. You get EUR 2 million, but only EUR 1.3 million from the sales of ARC-EX. Just wondering where it comes from, the EUR 0.7 million, maybe that grants and for which programs. You say the delivery in Q1, but not the units sold. I guess this is probably less than 70 units. Last question, could you please provide the order you received in Q1, not the sales, but just the order? Thank you.
Thank you, Clément. First, I wouldn't say it's only EUR 1.3 million. It's quite a few units. We continue to see accelerating demand. I think one of the things you're probably getting to is about 1/3 of the units were VA units, and those undergo a bit of a different process. Those military veterans first have a two-month evaluation period, after which we expect a very high percentage to convert into sales. We think that process, even though it's a two-month evaluation, is probably going to take three months just in terms of the information gathering and generation of the PO. We have a lot of demand that we enjoyed in Q1, some of it in sales, the EUR 1.3 million. A lot of it is dry powder that you'll see result in sales next quarter.
We'll be reporting in this way going forward because of the importance of VA and the way that they are purchasing the device. I'm going to turn it over to Ali to talk about the grants, the EUR 700,000 in grants.
Yeah. Clément, the grant income that we had here in the first quarter, that's the EUR 0.7 million that you saw us report primarily from two grants. One is a grant around Parkinson's, which we essentially advanced that during the quarter. The second one is a grant around stroke. As you know, we use these to fund our development of our pipeline. As we've discussed, these could be quite lumpy throughout the course of the year. Here in the first quarter, given where we were in our development, we were able to recognize about EUR 0.7 million across a variety of grants, most of it coming from those two grants that I've mentioned.
Caution for those of you who build models, don't straight line that EUR 700,000, because as Ali said, it's likely to be lumpy and we do not expect grant income to be, what, EUR 2.8 million-EUR 3 million this year.
Yeah.
Significantly less than that.
Yeah.
Okay. Thank you, Clément. Let's move on to Mathijs from KBC.
Can you hear me?
Yes.
Yes, we can.
All right. Top. Yeah, the question also on the VA home use units. How many do you expect to be converted to real sales next quarter? What I understood was that it happens normally after two months, that there is a sort of period where they are on training. Secondly, also on the home use again, how many units did you already sell for self from the self-pay units or the workers' compensation? Yeah, that would be my questions. Thank you.
Yes. Thank you very much. Indeed, just to drill down a bit more on the VA process. Indeed, the veterans do go on a paid two-month evaluation, but then I would build in another 30 days of buffer because the results of the evaluation need to be processed, the POs need to be generated. We're counting on approximately 90-day sales cycle from the point at which the prescription for the veteran is written. We also expect a very high percentage of those to convert into device purchases in the subsequent quarter, by the way. Again, we're still early in this, so I don't want to give you a precise number. We'd rather do that based on actuals once we get further into the year.
Again, based on what we're hearing and the feedback we're getting from the VAs, we expect a very high percentage of those to indeed convert. The last thing is, again, we're not going to provide, during these quarterly updates, granularity on numbers of units sold in the various categories. We will share that in the first quarter, the home or personal units, the number of units did exceed the number of units sold in the clinics, and that's a trend we expect to continue and indeed accelerate because the home use market opportunity is so much bigger. Okay. What else do we have here? Let's go back to another of the questions that Ed Hall asked, which was to comment on future indications for ARC-EX and how we should think about that.
Indeed, we got ARC-EX approved with an indication of addressing hand strength and sensation after spinal cord injury. This is a versatile device, and we think that it can potentially help patients in a number of different ways. That is reflected. Ed, in fact, did a survey of 13 clinics that are using ARC-EX in the United States, and he did find that there was a high percentage of off-label use. This is not something that we promote or encourage, but it nonetheless is happening, and we can learn from this real-world usage of ARC-EX to help us inform the priorities for the next indications that we may pursue for regulatory approval and label expansion. In addition to that, we have an active program where we support and encourage investigator-initiated studies using the ARC-EX device.
There are a number of those studies that are ongoing or pending commencement, and those too will inform the most promising and the next indications that we might pursue for ARC-EX. It's a very rich and fertile ground, and we just want to be careful and prioritize, and really do what is of most need, what the patient population finds the most important. That's all TBD at this point. We're monitoring off-label usage, and we're monitoring the investigator-initiated studies. Okay. We have another question here from David, our analyst from Degroof Petercam, commenting a bit more on EIGER. Okay. Yeah, he's just sort of saying, why do EIGER since we already have compelling clinical feasibility evidence from STIMO, for example, and we're also obtaining evidence through FOXswitch. Those early trials were really proof of concept trials, David. They were more scientific than commercial.
EIGER is very much a commercial early feasibility study whre we're trying to use our device not to see what's possible across the range of injury severities, but looking at the injury severities and the patient population that we think are most likely to be included in a pivotal study and labeling for a device when it's eventually commercialized. You're seeing us go from the realm of scientific exploration and discovery, which was the case in 2015 through 2020, very much to getting onto a commercial pathway that would go from this study to a pivotal study to commercialization of a mobility label for ARC-IM to follow the blood pressure instability label. Those are the key differences, I would say. We're not at this point going to share readout timing or anything else. We're just focused on enrolling and learning and more to come. Okay.
Follow-up from Clément.
Follow-up from Clément from BNP Paribas. Did you sell more home use than clinic use? Indeed, we did sell more devices for home use than clinic use in the first quarter, and that's a trend that we would expect to continue. We have another question from an investor named Nick. How do you interpret the share price performance over the past six months? Which milestones do we think might influence share price for the remainder of the year? Yeah, obviously, we're not happy that the share price is down over the last six months. Looking at the entire MedTech sector, it's down across the board. In fact, MedTech is trading at a historic low relative to the S&P 500. ONWARD has held up very well relative to our peers, despite the fact that our stock is down.
I think that is evidence of the fact that the investor community recognizes that we're executing at a high level. They see the commercial traction that we have been achieving with ARC-EX. They see the clinical traction, getting the IDE approved, and the early progress with Empower BP. They see the quality of the equity financings that we're executing with a cap table led by EQT, followed by Ottobock, and with others like Exane and BNP Paribas. This is the reason that our stock is holding up well. Certainly, we want it to start appreciating, but we also think there may be some sector rotation once AI maybe is not such a bright, shiny object. We'll see. We just have to be a bit patient, and thank you for your patience as well. In terms of milestones and upcoming catalysts, I did discuss some of those earlier.
We've got a big data readout, the interim data from Empower BP that we expect will occur less than a year from now. We expect continued commercial traction also to drive stock price. That's the way currently MedTech companies are being valued by top-line and top-line growth. We also expect continued announcements in the area of Brain-Computer Interfaces, which is typically a catalyst for us and other companies. Thank you, Nick, for that question. Any other questions?
No more questions on the call.
All right. Again, I want to just thank all of you for participating. To summarize, that we're very pleased with the quarter, another quarter of strong commercial traction, 70 units, more than 100 clinics across the U.S. and Europe now using ARC-EX. In the first quarter, let's not take for granted, we expanded the use of ARC-EX into the home, which is quite significant. That's a larger market segment than the clinic. It also allows patients to be more independent, use the device in the privacy and convenience of their home. Also v ery pleased with the traction of Empower BP with first patient enrollment and implant occurring in 12 sites now activated. More to come. We reported ARC-BCI and use of ARC-IM in Parkinson's, which is a huge adjacent population in the first quarter, and we're very pleased with the capital raise.
In this geopolitical environment, tough market for any company that's not in AI to raise money right now. We raised EUR 40 million. We've got a very strong balance sheet into Q1 of 2028. Very happy with the quarter. Thank you for your continued support, and thank you for the team here on the call and the team at ONWARD that is driving this execution. Talk to you in a quarter, everyone.
Thank you.
Thank you.
Back to you, Sharon.
Thank you. This concludes today's conference call. Thank you for participating. You may now disconnect.