Saluda Medical, a medical device company specialising in neuromodulation with a portfolio of therapies driven by closed-loop technologies designed to treat debilitating neurological disorders, has received full approval from the United States Food and Drug Administration (FDA) for the Evoke Spinal Cord Stimulation (SCS) System.
The Evoke System is indicated for the treatment of chronic intractable pain of the trunk and/or limbs, including unilateral or bilateral pain associated with failed back surgery syndrome, intractable low back pain, and leg pain.
The Evoke System is the first and only available SCS system capable of instantaneously reading, recording, and responding to evoked compound action potentials (ECAPs) – the nerves’ response to stimulation – to provide precise, continually optimised therapy. Unlike commercially available SCS devices, the Evoke System was designed to maintain optimal pain inhibition by adjusting therapy more than 100 times per second. The Evoke System also captures and records millions of data points per day to provide clinical teams with unparalleled neurophysiological insights in context of therapy performance.
Nagy Mekhail, MD, PhD, professor at the Cleveland Clinic Lerner College of Medicine, director of evidence-based pain medicine research and education in the Department of Pain Management at the Cleveland Clinic, and lead author and medical monitor for the EVOKE Study, said:
“The ground-breaking technology behind the Evoke System’s ability to intelligently measure spinal cord activation has had many of us excited for a long time. More exciting than the technology, though, is the unparalleled quality of the evidence backing this system which demonstrates pain relief coupled with clinically significant improvements in physical and emotional functioning, sleep quality, and health-related quality of life. This evidence gives me confidence that Evoke is well-suited to address the unmet need of providing long-term, durable pain relief with this therapy. Simply put, this is one of the most important innovations in the field of Neuromodulation since Dr. Norman Shealy developed the first spinal cord stimulation device in 1967.”
This is the first Premarket Approval (PMA) based on a double-blind randomised controlled trial (RCT), the EVOKE Study, for an SCS system. This Study substantiated the Evoke System’s designation compared to open-loop SCS in treating overall back and leg pain. In the closed-loop arm of the EVOKE Study, greater improvements in clinical outcomes coincided with more consistent spinal cord activation within subjects’ therapeutic window.
The EVOKE double-blind RCT data demonstrated the following benefits:
Superior pain relief
- Evoke demonstrated superior pain relief compared to open-loop SCS at 12 months with no increase in pain medication (p-value = 0.006).
- Nearly 90% (or 9/10) of subjects implanted with Evoke met the primary endpoint at 12-months, which was statistically superior to open-loop SCS (p = 0.039).
Clinically meaningful patient reported quality of life outcomes
- Percentage of Evoke patients that demonstrated clinically meaningful improvements at 12 months
- Disability (Oswestry Disability Index [ODI]), 78.2%
- Mood (Profile of Mood States [POMS]), 70.9%
- Sleep (Pittsburgh Sleep Quality Index [PSQI]), 76.4%
- Health-related quality of life (European Quality of Life [EQ-5D]), 85.5%
Neurophysiological insights
- Evoke maintained spinal cord activation within the therapeutic window 95.2% of the time (vs. 47.9% with open loop).
Study 24-month data recently published in JAMA Neurology showed that the clinical outcomes were durable at 24-months with zero explants due to loss of efficacy. Reprogramming was practically eliminated between 12- and 24-months.
Timothy R. Deer, MD, president and CEO of the Spine and Nerve Center of The Virginias and clinical investigator, said: “The FDA approval of the Evoke System marks a seminal moment in the field of spinal cord stimulation. For the last 50 years, our field has relied on subjective feedback from the patient to optimise therapy with results in published literature demonstrating good clinical outcomes, but also highlighting challenges with predictable long-term durability. I’ve seen first-hand the clinical benefits of tightly controlling stimulation by measuring the body’s neurophysiological response and how this pioneering closed-loop technology is redefining the SCS experience for patients and clinicians.”
Jim Schuermann, president and CEO, said: “FDA approval for the Evoke System is a significant milestone for Saluda – one resulting from over a decade of advanced research and development and years of patient-centric determination to transform the standard of care. Evoke’s innovations are born from John Parker’s vision and pioneering research, and Saluda’s strong and lasting partnerships with the clinical community and mutual dedication to patients. I’d like to personally thank our employees and their families, our clinical investigators and, most importantly, the patients for the unwavering support throughout the process. This is an exciting step in our mission to revolutionise the field of neuromodulation.”
The company plans to implement a controlled, limited release of the Evoke System in the second half of 2022 among select trial sites before initiating a full commercial release in 2023.
