enVVeno Medical Corporation (NVNO) experienced a dramatic 76.1% share price decline since August 19 following the FDA's issuance of a not-approvable letter for its VenoValve device. The company had submitted a Premarket Approval (PMA) application seeking approval for VenoValve as a surgical replacement venous valve for treating severe deep chronic venous insufficiency (CVI).
FDA Cites Insufficient Benefit-Risk Data
The FDA's rejection was based on concerns that trial data from the successfully completed pivotal SAVVE study was not sufficient to determine the favorability of the benefit-to-risk profile for VenoValve. Despite the SAVVE study demonstrating that a high percentage of patients who previously failed standard of care treatments showed significant clinical improvement after receiving VenoValve, the FDA found the evidence inadequate.
Specifically, the FDA cited that favorable revised Venous Clinical Severity Score (rVCSS) data, along with improvements in pain scores and venous specific quality of life indicators, does not sufficiently help determine favorability of the benefit-to-risk profile of the surgical replacement valve. The agency also noted that clinical improvement may have occurred as a result of patients being enrolled in a study in the absence of a specific hemodynamic measurement that correlates with patient improvement.
Safety Concerns Highlighted
The FDA also focused on safety concerns attributed to the VenoValve open surgical procedure, which required re-hospitalizations that are unlikely to occur with a non-surgical replacement valve. This emphasis on surgical risks versus non-surgical alternatives represents a significant regulatory hurdle for the device.
Financial Impact and Market Performance
The regulatory setback has severely impacted enVVeno Medical's market position. Shares have lost 66.9% year-to-date, primarily due to the recent crash following the unfavorable FDA outcome, compared with the industry's decline of 6.7%. The S&P 500 Index has increased 9.8% in the same period.
The company maintains a significant cash burn of $4-$5 million per quarter. At this pace, enVVeno Medical expects its cash resources to fund operations through the third quarter of 2026, including pre-commercialization activities for VenoValve and the initiation of a pivotal study on another pipeline candidate, enVVe. However, the FDA's not-approvable letter for VenoValve is likely to delay commercialization, thereby affecting the company's ability to generate a revenue stream.
Next Steps and Pipeline Development
enVVeno Medical is currently reviewing the feedback from the FDA and may meet with the agency to discuss requirements for a potential resubmission of the VenoValve or appeal of the decision. The company is also developing enVVe as a first-in-class non-surgical transcatheter-based replacement venous valve, which has successfully completed a 6-month pre-clinical GLP study. The company is on track to submit an IDE filing for the enVVe pivotal trial in the upcoming months, with potential FDA approval for the IDE filing representing the next potential catalyst for share price recovery.
