Trevi Therapeutics, Inc. 10-Q

Item 1. Financial Statements. Trevi Therapeutics, Inc. Condensed Consolidated Balance Sheets (Amounts in thousands, except share and per share amounts) September 30, 2022 December 31, 2021 Assets (Unaudited) Current assets: Cash and cash equivalents $ 66,574 $ 36,830 Marketable securities 59,029 — Prepaid expenses 1,294 886 Other current assets 421 241 Total current assets 127,318 37,957 Other non-current assets 922 334 Operating lease right-of-use asset 53 131 Property, equipment and leasehold improvements, net 68 53 Total assets $ 128,361 $ 38,475 Liabilities and stockholders’ equity Current liabilities: Accounts payable $ 2,333 $ 2,849 Accrued expenses 5,249 3,808 Term loan 7,000 5,833 Term loan derivative liability — 114 Operating lease liability 59 120 Total current liabilities 14,641 12,724 Term loan 3,800 8,652 Operating lease liability 2 24 Other non-current liabilities 15 — Total liabilities 18,458 21,400 Commitments and contingencies (Note 12) Stockholders’ equity: Preferred stock: $ 0.001 par value; 5,000,000 shares authorized at September 30, 2022 and December 31, 2021; no shares issued or outstanding at September 30, 2022 and December 31, 2021. — — Common stock: $ 0.001 par value; 200,000,000 shares authorized at September 30, 2022 and December 31, 2021; and 58,322,517 and 28,505,804 shares issued and outstanding at September 30, 2022 and December 31, 2021, respectively. 58 29 Additional paid-in capital 314,672 197,963 Accumulated other comprehensive loss ( 263 ) — Accumulated deficit ( 204,564 ) ( 180,917 ) Total stockholders’ equity 109,903 17,075 Total liabilities and stockholders’ equity $ 128,361 $ 38,475 The accompanying notes are an integral part of these condensed consolidated financial statements. 1 Trevi Therapeutics, Inc. Condensed Consolidated Statements of Comprehensive Loss (unaudited) (Amounts in thousands, except share and per share amounts) Three Months Ended September 30, Nine Months Ended September 30, 2022 2021 2022 2021 Operating expenses: Research and development $ 5,769 $ 4,718 $ 15,517 $ 16,805 General and administrative 2,636 2,229 7,733 7,398 Total operating expenses 8,405 6,947 23,250 24,203 Loss from operations ( 8,405 ) ( 6,947 ) ( 23,250 ) ( 24,203 ) Other income (expense): Change in fair value of term loan derivative liability — ( 5 ) ( 147 ) 29 Other expense — — — ( 375 ) Interest income, net 424 2 623 7 Interest expense ( 292 ) ( 303 ) ( 889 ) ( 893 ) Total other income (expense), net 132 ( 306 ) ( 413 ) ( 1,232 ) Loss before income taxes ( 8,273 ) ( 7,253 ) ( 23,663 ) ( 25,435 ) Income tax benefit (expense) 7 ( 2 ) 16 15 Net loss $ ( 8,266 ) $ ( 7,255 ) $ ( 23,647 ) $ ( 25,420 ) Basic and diluted net loss per common share outstanding $ ( 0.12 ) $ ( 0.34 ) $ ( 0.44 ) $ ( 1.25 ) Weighted average common shares used in net loss per share attributable to common stockholders, basic and diluted 68,898,810 21,607,979 53,221,949 20,390,852 Net loss $ ( 8,266 ) $ ( 7,255 ) $ ( 23,647 ) $ ( 25,420 ) Other comprehensive loss: Net unrealized losses on available-for-sale marketable securities ( 128 ) — ( 263 ) — Comprehensive loss $ ( 8,394 ) $ ( 7,255 ) $ ( 23,910 ) $ ( 25,420 ) The accompanying notes are an integral part of these condensed consolidated financial statements. 2 Trevi Therapeutics, Inc. Condensed Consolidated Statements of Stockholders’ Equity (unaudited) (Amounts in thousands, except share amounts) Additional Other Total Common Stock Paid- Comprehensive Accumulated Stockholders’ Shares Amount in Capital Loss Deficit Equity Balance at June 30, 2022 39,719,572 $ 40 $ 256,908 $ ( 135 ) $ ( 196,298 ) $ 60,515 Stock-based compensation — — 569 — — 569 Issuance of common stock from exercise of stock options 51,005 — 139 — 139 Issuance of common stock and warrants under public offering, less issuance costs 14,252,670 14 51,170 — — 51,184 Issuance of common stock from warrant exercise 4,299,270 4 5,886 — — 5,890 Unrealized losses on available-for-sale marketable securities — — — ( 128 ) — ( 128 ) Net loss — — — — ( 8,266 ) ( 8,266 ) Balance at September 30, 2022 58,322,517 $ 58 $ 314,672 $ ( 263 ) $ ( 204,564 ) $ 109,903 Balance at June 30, 2021 21,459,498 $ 21 $ 182,857 $ — $ ( 165,142 ) $ 17,736 Stock-based compensation — — 540 — — 540 Issuance of common stock under the at-the-market sales agreement, net of commissions and allocated fees 162,026 1 358 — — 359 Net loss — — — — ( 7,255 ) ( 7,255 ) Balance at September 30, 2021 21,621,524 $ 22 $ 183,755 $ — $ ( 172,397 ) $ 11,380 3 Accumulated Additional Other Total Common Stock Paid- Comprehensive Accumulated Stockholders’ Shares Amount in Capital Loss Deficit Equity Balance at December 31, 2021 28,505,804 $ 29 $ 197,963 $ — $ ( 180,917 ) $ 17,075 Stock-based compensation — — 1,826 — — 1,826 Issuance of common stock from exercise of stock options 51,005 — 139 — — 139 Issuance of common stock under the at-the-market sales agreement, net of commissions and allocated fees — — ( 42 ) — — ( 42 ) Issuance of common stock from Employee Stock Purchase Plan 33,972 — 23 — — 23 Issuance of common stock and warrants under public offering and private placement, less issuance costs 18,833,196 19 102,991 — — 103,010 Issuance of common stock from warrant exercise 10,898,540 10 11,772 — — 11,782 Unrealized losses on available-for-sale marketable securities — — — ( 263 ) — ( 263 ) Net loss — — — — ( 23,647 ) ( 23,647 ) Balance at September 30, 2022 58,322,517 $ 58 $ 314,672 $ ( 263 ) $ ( 204,564 ) $ 109,903 Balance at December 31, 2020 18,546,786 $ 19 $ 174,240 $ — $ ( 146,977 ) $ 27,282 Stock-based compensation — — 2,003 — — 2,003 Issuance of common stock under the at-the-market sales agreement, net of commissions and allocated fees 2,895,518 3 7,120 — — 7,123 Issuance of common stock from Employee Stock Purchase Plan 9,132 — 17 — — 17 Issuance of common stock to Lincoln Park Capital Fund (see Note 8) 170,088 — 375 — — 375 Net loss — — — — ( 25,420 ) ( 25,420 ) Balance at September 30, 2021 21,621,524 $ 22 $ 183,755 $ — $ ( 172,397 ) 11,380 The accompanying notes are an integral part of these condensed consolidated financial statements. 4 Trevi Therapeutics, Inc. Condensed Consolidated Statements of Cash Flows (unaudited) (Amounts in thousands) Nine Months Ended September 30, 2022 2021 Operating activities: Net loss $ ( 23,647 ) $ ( 25,420 ) Adjustments to reconcile net loss to net cash used in operating activities: Depreciation 28 38 Accretion of available-for-sale marketable securities, net ( 268 ) — Change in fair value of term loan derivative liability 147 ( 29 ) Accretion/accrual of term loan discounts and debt issuance costs 419 442 Other expense related to transaction with Lincoln Park Capital Fund, LLC — 375 Stock-based compensation 1,826 2,003 Changes in operating assets and liabilities: Prepaid expenses and other current assets ( 492 ) ( 122 ) Accounts payable ( 527 ) 216 Accrued expenses and other liabilities 670 ( 220 ) Net cash used in operating activities ( 21,844 ) ( 22,717 ) Investing activities: Proceeds from maturities of available-for-sale marketable securities 2,001 — Purchases of available-for-sale marketable securities ( 61,025 ) — Purchases of property, equipment and leasehold improvements ( 43 ) — Net cash used in investing activities ( 59,067 ) — Financing activities: Repayments of term loan ( 4,083 ) — Payments of financing costs of term loan ( 21 ) ( 68 ) Proceeds from sale of common stock and warrants under public offering and private placement, net of issuance costs 103,010 — Proceeds from exercises of warrants 11,782 — Proceeds from exercises of stock options 139 — Proceeds from employee stock purchase plan 23 17 Proceeds from at-the-market sales, net of commissions — 7,505 Payments of offering costs ( 195 ) ( 420 ) Net cash provided by financing activities 110,655 7,034 Net increase (decrease) in cash and cash equivalents 29,744 ( 15,683 ) Cash and cash equivalents at beginning of period 36,830 45,001 Cash and cash equivalents at end of period $ 66,574 $ 29,318 The accompanying notes are an integral part of these condensed consolidated financial statements. 5 Trevi Therapeutics, Inc. Notes to Condensed Consolidated Financial Statements (unaudited) (in thousands, except share and per share data) 1. Nature of the Business Trevi Therapeutics, Inc. (“Trevi” or the “Company”) is a clinical-stage biopharmaceutical company focused on the development and commercialization of the investigational therapy Haduvio (oral nalbuphine ER) for the treatment of chronic cough in adults with idiopathic pulmonary fibrosis (“IPF”) and other chronic cough indications, and for the treatment of prurigo nodularis. These conditions share a common pathophysiology that is mediated through opioid receptors in the central and peripheral nervous systems. Due to nalbuphine’s mechanism of action as a modulator of opioid receptors, the Company believes Haduvio has the potential to be effective in treating each of these conditions. Haduvio is an oral extended-release formulation of nalbuphine. Nalbuphine is a mixed κ-opioid receptor agonist and μ-opioid receptor antagonist that has been approved and marketed as an injectable for pain indications for more than 20 years in the United States (“U.S.”) and Europe. The κ- and μ-opioid receptors are known to be critical mediators of cough, itch and certain movement disorders. Nalbuphine’s mechanism of action also mitigates the risk of abuse associated with μ-opioid agonists because it antagonizes or blocks, the μ-opioid receptor. Parenteral nalbuphine is not scheduled as a controlled substance in the U.S. and most of Europe. 2. Summary of Significant Accounting Policies Basis of Presentation The accompanying unaudited interim Condensed Consolidated Financial Statements for the three and nine months ended September 30, 2022 and 2021 included herein have been prepared in accordance with accounting principles generally accepted in the U.S. (“GAAP”) for interim financial information and the rules and regulations of the Securities and Exchange Commission (“SEC”) for interim information. Certain information and footnote disclosures typically prepared in accordance with GAAP have been condensed or omitted pursuant to SEC rules and regulations. The accompanying unaudited Condensed Consolidated Financial Statements and notes should be read in conjunction with the audited consolidated financial statements and related notes included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2021 (the “Annual Report on Form 10-K”). The accompanying Condensed Consolidated Financial Statements include the accounts of Trevi Therapeutics, Inc. and its wholly-owned subsidiary Trevi Therapeutics Limited. Intercompany balances and transactions have been eliminated. All amounts presented are in thousands of dollars, except share and per share amounts, unless noted otherwise. The Company has evaluated events occurring subsequent to September 30, 2022 for potential recognition or disclosure in the Condensed Consolidated Financial Statements and concluded there were no subsequent events that required recognition or disclosure other than those provided in Note 13. Use of Estimates The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities at the date of the financial statements and the reported amounts of the expenses during the reporting periods. Significant estimates and assumptions reflected in these Condensed Consolidated Financial Statements include, but are not limited to, the recognition of research and development (“R&D”) expenses, the valuation of stock-based awards and the valuation allowance of deferred tax assets resulting from net operating losses. In addition, management’s assessment of the Company’s ability to continue as a going concern involves the estimation of the amount and timing of future cash inflows and outflows. Changes in estimates are recorded in the period in which they become known. Actual results could differ from those estimates. Unaudited Interim Financial Information The accompanying interim Condensed Consolidated Balance Sheet as of September 30, 2022 and the Condensed Consolidated Statements of Comprehensive Loss, the Condensed Consolidated Statements of Stockholders’ Equity and the Condensed Consolidated Statements of Cash Flows for the three and nine months ended September 30, 2022 and 2021 are unaudited. The unaudited interim Condensed Consolidated Financial Statements have been prepared on the same basis as the audited annual consolidated financial statements and, in the Company’s opinion, reflect all adjustments, which include only normal recurring adjustments, necessary for the fair statements of its financial position as of September 30, 2022 and the results of its operations and its cash flows for the three and nine months ended September 30, 2022 and 2021. The results for the three and nine months ended September 30, 2022 and 2021 are not necessarily indicative of results to be expected for the year ending December 31, 2022 or any other interim period or any future year or period. Cash Equivalents 6 The Company classifies short-term, highly liquid investments with an original term of three months or less at the date of purchase as cash equivalents. Marketable Securities The Company generally invests its excess cash in money market funds and investment grade short- to intermediate-term fixed income securities. Such investments are included in cash and cash equivalents, short-term marketable securities or long-term marketable securities on the Condensed Consolidated Balance Sheet. Marketable securities with an original maturity date greater than 90 days and less than one year at each balance sheet date are classified as short-term. Marketable securities with a maturity date greater than one year at each balance sheet date are classified as long-term. All of the Company’s marketable securities are considered available-for-sale and are reported at fair value with unrealized gains and losses included as a component of stockholders’ equity. The amortized cost of debt securities is adjusted for amortization of premiums and accretion of discounts to maturity, which is included in interest income, net on the Condensed Consolidated Statements of Comprehensive Loss. Realized gains and losses and declines in value judged to be other-than-temporary, if any, on marketable securities are included in interest income, net on the Condensed Consolidated Statements of Comprehensive Loss. The cost of securities sold is determined using specific identification. The Company evaluates whether declines in the fair values of its marketable securities below their amortized cost are other-than temporary on a quarterly basis. This evaluation consists of several qualitative and quantitative factors regarding the severity and duration of the unrealized loss, as well as the Company’s ability and intent to hold the marketable security until a forecasted recovery occurs. Additionally, the Company assesses whether it has plans to sell the marketable security or whether it is more likely than not that it will be required to sell any marketable securities before recovery of its amortized cost basis. Factors considered include quoted market prices, recent financial results and operating trends, implied values from any recent transactions or offers of investee securities, credit quality of debt instrument issuers, other publicly available information that may affect the value of the marketable security, duration and severity of the decline in value, and the Company’s strategy and intentions for holding the marketable security. Fair Value Measurements The Company’s financial instruments have consisted of cash and cash equivalents, available-for-sale marketable securities, other current assets, accounts payable, accrued expenses, term loans, term loan derivative liability and warrants to acquire the Company’s common stock. Fair value estimates of these instruments are made at a specific point in time, based on relevant market information. The carrying amounts of cash and cash equivalents, other current assets, accounts payable and accrued expenses are generally considered to be representative of their respective fair values because of the short-term nature of those instruments. Available-for-sale marketable securities are reported at their fair values, based upon pricing of securities with the same or similar investment characteristics as provided by third-party pricing services, as described below. The carrying amount of the term loan approximates its fair value due to its floating market-based interest rate. The fair value of the term loan derivative liability is estimated utilizing a probability-weighted cash flow approach. The warrants to acquire the Company’s common stock are not required to be accounted for at fair value. Current accounting guidance defines fair value, establishes a framework for measuring fair value in accordance with Accounting Standards Codification (“ASC”) 820, Fair Value Measurements and Disclosures, and requires certain disclosures about fair value measurements. The valuation techniques included in the guidance are based on observable and unobservable inputs. Observable inputs reflect readily obtainable data from independent sources, while unobservable inputs reflect market assumptions and are classified into the following fair value hierarchy: Level 1—Observable inputs—quoted prices in active markets for identical assets and liabilities. Level 2—Observable inputs other than the quoted prices in active markets for identical assets and liabilities—such as quoted prices for similar instruments, quoted prices for identical or similar instruments in inactive markets, or other inputs that are observable or can be corroborated by observable market data. Level 3—Unobservable inputs—includes amounts derived from valuation models where one or more significant inputs are unobservable and require the company to develop relevant assumptions. Valuation Techniques - Level 2 Inputs The Company estimates the fair values of its financial instruments categorized as level 2 in the fair value hierarchy, including U.S. Treasury securities, U.S. government agency obligations, corporate bonds, commercial paper and municipal bonds, by taking into consideration valuations obtained from third-party pricing services. The pricing services use industry standard valuation models, including both income- and market-based approaches, for which all significant inputs are observable, either directly or indirectly, to estimate fair value. These inputs include reported trades of and broker/dealer quotes on the same or similar securities, benchmark yields, issuer credit spreads, benchmark securities, and other observable inputs. The Company obtains a single price for each financial instrument and does not adjust the prices obtained from the pricing service. Property, Equipment and Leasehold Improvements 7 Property, equipment and leasehold improvements (consisting of furniture, computer and office equipment and leasehold improvements) are stated at cost, net of accumulated depreciation. Depreciation is calculated using the straight-line method over the estimated useful lives of the respective assets ( three years for computer equipment, five years for furniture and office equipment and the shorter of the term of the lease or useful life for leasehold improvements). Impairment of Long-Lived Assets ASC 360, Property, Plant and Equipment, addresses the financial accounting and reporting for impairment or disposal of long-lived assets. The Company reviews the recorded values of long-lived assets for impairment whenever events or changes in business circumstances indicate that the carrying amount of an asset or group of assets may not be fully recoverable. Foreign Currency Transactions The Company, at times, contracts with vendors and consultants outside of the U.S., resulting in liabilities denominated in foreign currency. The transactions are recorded in U.S. dollars on the transaction dates and any currency fluctuation through the payment date is recorded as currency gains or losses in the Condensed Consolidated Statements of Comprehensive Loss. Deferred Offering Costs The Company capitalizes certain legal, professional, accounting and other third-party fees that are directly associated with in-process equity financings as deferred offering costs until such financings are consummated. After consummation of an equity financing, these costs are recorded in stockholders’ equity as a reduction of additional paid-in capital generated as a result of the financings. Should the planned equity financing no longer be considered probable of being consummated, the deferred offering costs are expensed immediately as a charge to operating expenses. The deferred offering costs are included in Other non-current assets on the Condensed Consolidated Balance Sheets. Research and Development (“R&D”) Expenses All of the Company’s R&D expenses consist of expenses incurred in connection with the development of Haduvio. These expenses include certain payroll and personnel expenses, including stock-based compensation, consulting costs, contract manufacturing costs and fees paid to contract research organizations (“CROs”) to conduct certain R&D activities on the Company’s behalf. The Company does not allocate its costs by each indication for which it is developing Haduvio, as a significant amount of the Company’s development activities broadly support all indications. In addition, several of the Company’s departments support the Company’s Haduvio drug candidate development program and the Company does not identify internal costs for each potential indication. The Company expenses both internal and external R&D expenses as they are incurred. Accrued R&D Expenses The Company has entered into agreements with CROs, contract manufacturing organizations (“CMOs”) and other companies that provide services in connection with the Company’s R&D activities. The Company’s R&D accruals are estimated based on the level of services performed, progress of the studies, including the phase or completion of events and contracted costs. The estimated costs of R&D provided, but not yet invoiced, are included in accrued expenses on the Condensed Consolidated Balance Sheets. If the actual timing of the performance of services or the level of effort varies from the original estimates, the Company will adjust the accrual accordingly. Payments made to CROs, CMOs and other companies under these arrangements in advance of the performance of the related services are recorded as prepaid expenses or as other non-current assets, as applicable, and are recognized as expenses as the goods are delivered or the related services are performed. Patent Costs All patent-related costs in connection with filing and prosecuting patent applications are expensed to general and administrative expense as incurred, as recoverability of such expenditures is uncertain. Warrants The Company determines the accounting classification of warrants that are issued, as either liability or equity, by first assessing whether the warrants meet liability classification in accordance with ASC 480, Distinguishing Liabilities from Equity (“ASC 480”), and then in accordance with ASC 815, Derivatives and Hedging (“ASC 815”), depending on the specific terms of the warrant. Under ASC 480, warrants are considered liability classified if the warrants are mandatorily redeemable, obligate the issuer to settle the warrants or the underlying shares by paying cash or other assets, or must or may require settlement by issuing variable number of shares. If the warrants do not meet liability classification under ASC 480, the Company assesses the requirements under ASC 815, which states that contracts that require or may require the issuer to settle the contract for cash are liabilities recorded at fair value, irrespective of the likelihood of the transaction occurring that triggers the net cash settlement feature. If the warrants do not require liability classification under ASC 815, in order to conclude equity classification, the Company assesses whether the warrants are indexed to its common stock and whether the warrants are classified as equity under ASC 815 or other applicable GAAP. After all relevant assessments are made, the Company concludes whether the warrants are classified as liability or equity. Liability classified warrants are required to be accounted for at fair value both on the date of issuance and on subsequent accounting period ending dates, 8 with all changes in fair value after the issuance date recorded in the statements of comprehensive loss as a gain or loss. For equity classified warrants, no changes in fair value are recognized after the issuance date. Stock-Based Compensation The Company accounts for stock-based compensation arrangements with employees and non-employees for consultancy services in accordance with ASC 718, Stock Compensation (“ASC 718”). ASC 718 requires the recognition of compensation expense, using a fair-value based method, for costs related to all stock-based awards including stock options. The Company’s determination of the fair value of stock-based awards on the date of grant utilizes the Black-Scholes valuation model for stock options with time-based and performance-based vesting and is impacted by the price of its common stock as well as changes in assumptions regarding a number of subjective variables. These variables include the expected term that stock options will remain outstanding, expected common stock price volatility over the term of the stock options, risk-free interest rates and expected dividends. Changes in the variables can materially affect the fair value and ultimately how much stock-based compensation expense is recognized. These inputs are subjective and generally require analysis and judgment to develop. Expected Term—The expected term assumption represents the weighted average period that the stock-based awards are expected to be outstanding. The Company has elected to use the “simplified method” for estimating the expected term of its stock options, whereby the expected term equals the arithmetic average of the vesting term and the original contractual term of the stock option. Expected Volatility—For all stock options granted to date, the volatility data was estimated based on a study of publicly traded industry peer companies. For purposes of identifying these peer companies, the Company considered the industry, stage of development, size and financial leverage of potential comparable companies. Expected Dividend—The Black-Scholes valuation model calls for a single expected dividend yield as an input. The Company currently has no history or expectation of paying cash dividends on its common stock. Risk-Free Interest Rate—The risk-free interest rate is based on the yield available on U.S. Treasury zero-coupon issues similar in duration to the expected term of the stock-based award. The fair value is recognized over the period during which an optionee is required to provide services in exchange for the stock option, known as the requisite service period (usually the vesting period) on a straight-line basis. For performance-based vesting, the fair value is recognized when the performance conditions are probable of being achieved. The Company reassesses the probability of achieving the performance conditions at each reporting date. Forfeitures are accounted for as they occur. Income Taxes The Company accounts for income taxes using the asset and liability method. Under this method, deferred tax assets and liabilities are determined based on differences between the financial reporting and tax bases of assets and liabilities and are measured using the enacted tax rates and laws that will be in effect when the differences are expected to reverse. Deferred income tax assets are reduced, as necessary, by a valuation allowance when management determines it is more likely than not that some or all of the tax benefits will not be realized. The Company applies the provisions of ASC 740, Income Taxes (“ASC 740”), which prescribes a comprehensive model for how a company should recognize, measure, present and disclose in its financial statements uncertain tax positions that the company has taken or expects to take on a tax return. These Condensed Consolidated Financial Statements reflect expected future tax consequences of such positions presuming the taxing authorities possess full knowledge of the position and all relevant facts. There are no material uncertainties regarding the tax positions that the Company has taken through September 30, 2022 and December 31, 2021. The Company does not have any interest or penalties accrued related to tax positions as it does not have any unrecognized tax benefits. Leases Under ASC 842, Leases (“ASC 842”), the Company determines if an arrangement is a lease at its inception. If an operating lease has a term greater than one year, the lease is recognized in the balance sheet as a right-of-use asset and an operating lease liability at lease commencement. The Company elected the short-term lease practical expedient, therefore, if an operating lease has a term less than one year, the Company will not recognize the lease on its balance sheet. The operating right-of-use asset represents the Company’s right of use to an underlying asset for the term of the lease and the operating liability represents the Company’s obligation to make lease payments arising from the lease. Operating lease right-of-use assets and operating lease liabilities are determined and recognized on the commencement date of the lease based on the present value of lease payments over the term of the lease. As the Company’s leases do not provide an implicit rate within the lease, the Company uses its incremental borrowing rate, based on information available at the commencement date of the lease to determine the present value of the lease payments. Basic and Diluted Net Loss per Common Share 9 Basic and diluted net loss per common share outstanding is determined by dividing net loss by the weighted average common shares outstanding during the period. Basic shares outstanding includes the weighted average effect of the Company’s outstanding pre - funded warrants, the exercise of which requires little or no consideration for the delivery of shares of common stock. For all periods presented, shares issuable upon exercise of stock options and warrants to purchase shares of common stock (other than pre-funded warrants) have been excluded from the calculation because their effects would be anti-dilutive. Therefore, the weighted average common shares used to calculate both basic and diluted net loss per share are the same for each of the periods presented. Segments The Company has one reporting segment which is also the Company’s only operating segment. Management uses one measurement of profitability and does not segregate its business for internal reporting. All long-lived assets are maintained in the U.S. Recently Adopted Accounting Pronouncements There have been no new pronouncements adopted during the nine months ended September 30, 2022, which could be expected to materially impact the Company’s Condensed Consolidated Financial Statements. Recently Issued Accounting Pronouncements There have been no new pronouncements issued during the nine months ended September 30, 2022, which could be expected to materially impact the Company’s Condensed Consolidated Financial Statements. 3. Marketable Securities The fair value and amortized cost of available-for-sale marketable securities by major security type as of September 30, 2022 are presented in the following table (in thousands): September 30, 2022 Type of security Amortized Cost Gross Unrealized Gains Gross Unrealized Losses Estimated Fair Value U.S. treasury securities $ 21,830 $ — $ ( 92 ) $ 21,738 Corporate bonds 15,425 — ( 171 ) 15,254 Commercial paper 22,037 — — 22,037 Total marketable securities $ 59,292 $ — $ ( 263 ) $ 59,029 As of September 30, 2022, all remaining contractual maturities of the Company’s available-for-sale marketable securities were due to mature in less than one year. During the three and nine months ended September 30, 2022, there have been no realized gains or losses on available-for-sale marketable securities. During the three and nine months ended September 30, 2022, no marketable securities had been in a continuous unrealized loss position for more than 12 months and the Company did no t recognize any other-than-temporary impairment losses on marketable securities. 4 . Fair Value Measurements The following table summarizes the financial assets and financial liabilities measured at fair value on a recurring basis as of September 30, 2022 and December 31, 2021, and the basis for that measurement, by level within the fair value hierarchy: Fair Value Measurement Using: Balance Sheet Classification Type of Instrument Level 1 Level 2 Level 3 Total September 30, 2022 Financial assets: Cash equivalents Money market funds $ 65,574 $ — $ — $ 65,574 Marketable securities U.S. treasury securities 21,738 — — 21,738 Marketable securities Corporate bonds — 15,254 — 15,254 Marketable securities Commercial paper — 22,037 — 22,037 Total assets $ 87,312 $ 37,291 $ — $ 124,603 10 Fair Value Measurement Using: Balance Sheet Classification Type of Instrument Level 1 Level 2 Level 3 Total December 31, 2021 Financial assets: Cash equivalents Money market funds $ 35,835 $ — $ — $ 35,835 Total assets $ 35,835 $ — $ — $ 35,835 Financial liabilities: Term loan derivative liability $ — $ — $ 114 $ 114 Total liabilities $ — $ — $ 114 $ 114 The following table represents a roll-forward of the fair value of Level 3 instruments (significant unobservable inputs): September 30, 2022 December 31, 2021 Financial liabilities Balance at beginning of period $ 114 $ 196 Change in fair value of term loan derivative liability 147 ( 82 ) Net settlements (see Note 7) ( 261 ) — Balance at end of period $ — $ 114 5 . Leases Effective March 1, 2013, the Company entered into a lease for office space in New Haven, CT and commencing March 1, 2018, the Company entered into the First Amendment to the lease (collectively, the “Office Space Lease”). The leased space approximates 5,600 square feet and the Office Space Lease has a term of 60 months. The Office Space Lease requires monthly payments ranging from approximately $ 10 to $ 12 through February 1, 2023 and provides for two designated months of free rent. The Company also entered into an immaterial office equipment lease during the three months ended June 30, 2022 that has a term of 36 months. The incremental borrowing rate used on the Office Space Lease was 13.0 %. The right-of-use asset also includes any lease payments related to initial direct costs and prepayments and excludes lease incentives. Lease expense is recognized on a straight-line basis over the lease term. The Company had no significant new leases during the nine months ended September 30, 2022. The Office Space Lease is an operating lease and the remaining term as of September 30, 2022 is less than one year . The Company has no financing leases. The following table summarizes the Company’s operating leases as presented on its Condensed Consolidated Balance Sheets: September 30, 2022 December 31, 2021 Assets: Operating lease right-of-use asset $ 53 $ 131 Liabilities: Operating lease liabilities, current portion 59 120 Operating lease liabilities, long term portion 2 24 Total operating lease liabilities $ 61 $ 144 Future minimum lease payments from September 30, 2022 until the expiration of the operating leases are as follows: 2022 $ 36 2023 25 2024 2 2025 1 Total lease payments 64 Less: imputed discount rate ( 3 ) Carrying value of operating lease liabilities $ 61 Lease expense under operating leases, including leases of office equipment, was $ 31 and $ 29 for the three months ended September 30, 2022 and 2021, respectively, and $ 92 and $ 90 for the nine months ended September 30, 2022 and 2021, respectively. Lease payments made in the three months ended September 30, 2022 and 2021 were $ 36 and $ 35 , respectively, and $ 95 and $ 104 for 11 the nine months ended September 30, 2022 and 2021 , respectively , with such amounts reflected in the Condensed Consolidated Statement s of Cash Flows in operating activities. 6 . Accrued Expenses Accrued expenses consisted of the following: September 30, 2022 December 31, 2021 Accrued R&D projects $ 3,018 $ 2,303 Accrued compensation and benefits 1,069 1,250 Accrued consulting and professional fees 747 176 Accrued other 415 79 Total accrued expenses $ 5,249 $ 3,808 7 . Debt Silicon Valley Bank Term Loan On August 13, 2020 (the “Effective Date”), the Company entered into a loan and security agreement (the “SVB Loan Agreement”) with Silicon Valley Bank, as lender (“SVB”), pursuant to which SVB provided a term loan to the Company in the original principal amount of $ 14.0 million (the “SVB Term Loan”). The SVB Term Loan bears interest at a floating rate per annum equal to the greater of (A) the prime rate plus 1.00 % and (B) 4.25 %. If SVB received evidence satisfactory to it that the Company had (i) received positive data for the Phase 2b/3 clinical trial of Haduvio sufficient to advance Haduvio into a second Phase 3 clinical trial for prurigo nodularis, and (ii) raised sufficient financing to fund such Phase 3 clinical trial and the Company’s operations, (together, the “Phase 3 Event”), the interest rate under the SVB Term Loan would have been adjusted to a floating rate equal to the greater of (A) the prime rate plus 3.00 % and (B) 6.25 % (see term loan derivative liability discussion below). Commencing on March 1, 2022 and on the first business day of each month thereafter, the Company is required to make monthly interest payments and the Company will be required to repay the SVB Term Loan in 24 consecutive installments of principal plus monthly payments of accrued interest. All outstanding principal and accrued and unpaid interest under the SVB Term Loan and all other outstanding obligations with respect to the SVB Term Loan are due and payable in full on February 1, 2024 . The SVB Loan Agreement permits voluntary prepayment of all, but not less than all, of the SVB Term Loan, subject to a prepayment premium. Such prepayment premium would be 3.00 % of the principal amount of the SVB Term Loan if prepaid prior to the first anniversary of the Effective Date, 2.00 % of the principal amount of the SVB Term Loan if prepaid on or after the first anniversary of the Effective Date but prior to the second anniversary of the Effective Date, and 1.00 % of the principal amount of the SVB Term Loan if prepaid on or after the second anniversary of the Effective Date but prior to February 1, 2024. Upon repayment in full of the SVB Term Loan, the Company will be required to pay a final payment fee equal to $ 1.2 million. The SVB Term Loan and related obligations under the SVB Loan Agreement are secured by substantially all of the Company’s properties, rights and assets, except for its intellectual property (which is subject to a negative pledge under the SVB Loan Agreement). On July 6, 2021, the Company and SVB entered into a First Amendment (the “Loan Amendment”) to the SVB Loan Agreement. The Loan Amendment modified the conditions under which the Company was required to cash collateralize all outstanding amounts owed to SVB under the SVB Loan Agreement . Under the Loan Amendment, if the Company failed to receive positive data in its Phase 2b/3 PRISM trial or to raise by June 30, 2022 sufficient net proceeds from the sale of equity securities to finance its planned second Phase 3 clinical trial of Haduvio for prurigo nodularis and its ongoing operations (each a “Milestone Condition”), the Company would be required to deposit unrestricted and unencumbered cash equal to 100 % of all outstanding amounts owed to SVB in a cash collateral account with SVB, which could be used by SVB to prepay the SVB Term Loan at any time. In addition, the Loan Amendment provided that if the Company failed to maintain at least $ 20.0 million in unrestricted and unencumbered cash in its accounts with SVB at any time prior to the satisfaction of all the Milestone Conditions (the “Minimum Required Cash”), the Company would be required to cash collateralize all outstanding amounts owed to SVB under the SVB Loan Agreement . The Company would also have been required to cash collateralize all outstanding amounts owed to SVB under the SVB Loan Agreement if it did not raise at least $ 15.0 million in net proceeds from the sale of equity securities during the period from June 1, 2021 through October 31, 2021. The Company satisfied this equity funding condition through a combination of equity issuances under the Company’s ATM Sales Agreement and two private placements, which took place in October 2021 (see Note 8). On April 6, 2022, the Company and SVB entered into a Third Amendment (the “Third Amendment”) to the SVB Loan Agreement . The Third Amendment principally modified the conditions under which the Company would be required to cash collateralize all outstanding amounts owed to SVB under the SVB Loan Agreement . Under the terms of the Third Amendment, if the Company raised $ 45.0 million in net proceeds from the sale of equity securities (the “2022 Equity Event”), the Company’s obligations to achieve the Milestone Conditions and maintain the Minimum Required Cash would terminate and the sole remaining trigger for cash collateralization would be if the Company did not receive positive final data by December 31, 2022 from either its Phase 2b/3 PRISM trial of Haduvio for prurigo nodularis or its Phase 2 CANAL trial of Haduvio for the treatment of chronic cough in adults with 12 IPF. In addition, the Third Amendment modifie d the interest rate on the principal amount outstanding under the Loan Agreement. As a result of the Third Amendment, amounts outstanding under the Loan Agreement accrue interest at a floating per annum rate equal to ( i ) prior to the occurrence of the 2022 Equity Event, the greater of (A) the prime rate plus 1.00 % and (B) 4.25 %, and (ii) upon and after the occurrence of the 2022 Equity Event, the greater of (A) the prime rate plus 3.00 % and (B) 6.25 %. The closing of the April 2022 Private Placement, as discussed in Note 8 below, constituted the 2022 Equity Event and thereby terminated the Company’s obligations to achieve the Milestone Conditions and maintain the Minimum Required Cash. On August 3 , 2022, SVB confirmed that the reported data from the Phase 2b/3 PRISM trial satisfied the requirement for positive final data and that the cash collateralization requirements of the SVB Loan Agreement were no longer in effect. The SVB Loan Agreement contains customary representations, warranties, events of default and covenants. The occurrence and continuation of an event of default could cause interest to be charged at the rate that is otherwise applicable plus 5.00 % (unless SVB elects to impose a smaller increase) and would provide SVB with the right to accelerate all obligations under the SVB Loan Agreement and exercise remedies against the Company and the collateral securing the SVB Term Loan and other obligations under the SVB Loan Agreement, including foreclosure against assets securing the SVB Term Loan and other obligations under the SVB Loan Agreement, including the Company’s cash. The SVB Loan Agreement also restricts the payment of dividends on the Company’s common stock. In August 2020, in connection with the SVB Term Loan, the Company paid $ 57 in financing costs to a third-party, which were recorded as deferred charges and will be amortized over the life of the SVB Term Loan using the effective interest method. In connection with the Loan Amendment, the Company paid $ 68 in financing costs to a third-party, which were recorded as deferred charges and will be amortized over the remaining life of the SVB Term Loan using the effective interest method. In connection with the Third Amendment, the Company paid $ 21 in financing costs to a third party, which were recorded as deferred charges and will be amortized over the remaining life of the SVB Term Loan using the effective interest method. Amortization of these deferred financing charges totaled $ 17 and $ 11 for the three months ended September 30, 2022 and 2021, respectively, and $ 54 and $ 22 for the nine months ended September 30, 2022 and 2021, respectively, and is included in interest expense in the Company’s Condensed Consolidated Statements of Comprehensive Loss. The unamortized deferred charges totaled $ 43 and $ 76 at September 30, 2022 and December 31, 2021, respectively, and are included as a direct reduction of the carrying value of the term loan payable on the Company’s Condensed Consolidated Balance Sheets. In August 2020, in connection with the execution of the SVB Loan Agreement, the Company paid $ 27 in financing costs to SVB, which were recorded as loan discounts. These loan discounts are included as a reduction in the balance of the term loan payable on the Company’s Condensed Consolidated Balance Sheets and will be accreted over the life of the SVB Term Loan using the effective interest method. Accretion of these loan discounts totaled $ 2 and $ 3 for the three months ended September 30, 2022 and 2021, respectively, and $ 7 and $ 8 for the nine months ended September 30, 2022 and 2021, respectively, and is included in interest expense in the Company’s Condensed Consolidated Statements of Comprehensive Loss. At September 30, 2022 and December 31, 2021, the loan discount-financing costs balance was $ 5 and $ 12 , respectively. In connection with the SVB Loan Agreement, the Company is obligated to pay a final payment fee of $ 1.2 million upon repayment in full of the SVB Term Loan. The final payment fee is being accrued over the life of the SVB Term Loan using the effective interest method and is included as an increase in the balance of the term loan payable on the Company’s Condensed Consolidated Balance Sheets. Accrual of this final payment fee totaled $ 89 and $ 118 for the three months ended September 30, 2022 and 2021, respectively, and $ 309 and $ 355 for the nine months ended September 30, 2022 and 2021, respectively, and is included in interest expense in the Company’s Condensed Consolidated Statements of Comprehensive Loss. At September 30, 2022 and December 31, 2021, $ 966 and $ 657 was accrued for the final payment fee, respectively. Prior to the Third Amendment, the SVB Loan Agreement provided that upon SVB receiving evidence satisfactory to it that the Company had (i) received positive data for the Phase 2b/3 PRISM trial sufficient to advance Haduvio into a second Phase 3 clinical trial for prurigo nodularis and (ii) raised sufficient financing to fund such Phase 3 clinical trial and the Company’s operations, the interest rate on the SVB Term Loan would increase by 2.00 % (the “Contingent Interest Rate Increase”) as described above. The Contingent Interest Rate Increase represented a free-standing financial instrument. Accordingly, the Company accounted for the Contingent Interest Rate Increase as a derivative under ASC 815, Derivatives and Hedging and therefore, recorded a term loan derivative liability for the Contingent Interest Rate Increase at its fair value of $ 187 on the Effective Date of the SVB Loan Agreement. The Company adjusted this liability to fair value at each reporting date it remained outstanding, with such adjustments recorded as non-cash charges in other expense, net in the Company’s Condensed Consolidated Statements of Comprehensive Loss . The term loan derivative liability was presented as a current liability on the Company’s Condensed Consolidated Balance Sheets as of December 31, 2021. Upon recording such term loan derivative liability, the Company also recorded an offsetting term loan discount – interest, to be amortized to interest expense in the Company’s Condensed Consolidated Statements of Comprehensive Loss through the SVB Term Loan’s maturity date using the effective interest method. Such amortization was $ 14 and $ 19 for the three months ended September 30, 2022 and 2021 , respectively, and $ 49 and $ 56 for the nine months ended September 30, 2022 and 2021, respectively. At September 30, 2022 and December 31, 2021, the balance of the term loan discount – interest was $ 35 and $ 84 , respectively, and is included as a reduction in the balance of the term loan payable on the Company’s Condensed Consolidated 13 Balance Sheet s . Upon entering into the Third Amendment, the Contingent Interest Rate Increase became effective and the Company recorded an increase to the total fair value of the term loan derivative liability of $ 136 for the three months ended June 30, 2022 . The term loan derivative liability was then settled and reclassed to both current and non-current interest payable, which are presented as accrued liabilities and other non-current liabilities on the Company’s Condensed Consolidated Balance Sheet as of September 30, 2022 . Fair values of the term loan derivative liability were estimated utilizing a probability-weighted cash flow approach, including variables for the timing of the Phase 3 Event and other probability estimates. For the fair value calculations of the term loan derivative liability at June 30, 2022 and December 31, 2021, significant inputs included the Contingent Interest Rate Increase of 2.00 %, a discount rate of 12.0 % and the SVB Term Loan maturity date of February 1, 2024. As of September 30, 2022 and December 31, 2021, the Company had outstanding borrowings of $ 9.9 million and $ 14.0 million, respectively, under the SVB Term Loan and the term loan payable balance as presented on the Company’s Condensed Consolidated Balance Sheets as of September 30, 2022 and December 31, 2021 was comprised as shown below. September 30, 2022 December 31, 2021 Principal outstanding under term loan $ 9,917 $ 14,000 Term loan discount-interest ( 35 ) ( 84 ) Term loan discount-unamortized deferred charges ( 43 ) ( 76 ) Term loan discount-financing costs, net of accretion ( 5 ) ( 12 ) Term loan-final payment fee 966 657 10,800 14,485 Less current portion 7,000 5,833 Term loan payable, non-current $ 3,800 $ 8,652 Interest expense on the SVB Term Loan, which is comprised of interest payments, accretion and amortization of term loan discounts and the accrual of the final payment fee, is shown below for the three and nine months ended September 30, 2022 and 2021, respectively. For the three and nine months ended September 30, 2022, the weighted average interest rate applicable to borrowings under the SVB Term Loan was 6.97 % and 5.27 %, respectively. For the three and nine months ended September 30, 2021, the weighted average interest rate applicable to borrowings under the SVB Term Loan was 4.25 %. Three Months Ended September 30, Nine Months Ended September 30, 2022 2021 2022 2021 Interest payments $ 170 $ 152 $ 470 $ 451 Accrual of the final payment fee 89 118 309 355 Accretion and amortization of term loan discounts 33 33 110 87 $ 292 $ 303 $ 889 $ 893 8 . Stockholders’ Equity As of September 30, 2022 and December 31, 2021, the Company had reserved shares of common stock for future issuance as shown in the table below: September 30, 2022 December 31, 2021 Shares of common stock reserved for future issuance under the 2012 Stock Incentive Plan 607,494 665,720 Shares of common stock reserved for future issuance under the 2019 Stock Incentive Plan 4,547,939 3,400,489 Shares of common stock reserved for future issuance under the 2019 Employee Stock Purchase Plan 721,717 470,631 Shares to be issued upon exercise of common stock warrants and pre-funded warrants 48,330,707 20,602,244 Shares to be issued upon sales under the LPC Purchase Agreement 30,000,000 30,000,000 84,207,857 55,139,084 At-the-Market Offering In June 2020, the Company entered into the ATM Sales Agreement with SVB Leerink LLC, under which the Company may issue and sell shares of its common stock, from time to time, having an aggregate offering price of up to $ 12.0 million. Sales of common stock under the ATM Sales Agreement may be made by any method that is deemed an “at-the-market” offering as defined in Rule 415(a)(4) under the Securities Act of 1933, as amended. The Company is not obligated to make any sales of its common stock 14 under the ATM Sales Agreement. The Company began making sales pursuant to the ATM Sales Agreement in July 2020. During the three and nine months ended September 30, 2021 , the Company issued and sold an aggregate of 162,026 and 2,895,518 shares of common stock, respectively, for gross proceeds of $ 0.3 million and $ 7.7 million, respectively, before deducting estimated commissions and allocated fees of less than $ 0.1 million and $ 0.6 million, respectively. No sales were made during the three and nine months ended September 30, 2022. As of September 30, 2022 , the Company had issued and sold an aggregate of 3,583,394 shares of common stock for gross proceeds of $ 11.0 million, before deducting estimated commissions and allocated fees of $ 0.8 million. In May 2022, the Company amended the ATM Sales Agreement with SVB Leerink LLC to increase the maximum aggregate offering price of common stock that it may issue and sell from time to time under the ATM Sales Agreement by $ 50.0 million, from $ 12.0 million to up to $ 62.0 million. Equity Purchase Agreement On June 18, 2021, the Company entered into a common stock purchase agreement (“LPC Purchase Agreement”) with Lincoln Park Capital Fund, LLC (“Lincoln Park”). The LPC Purchase Agreement provides that, subject to the terms and conditions therein, the Company has the right, but not the obligation, to sell, at its discretion, to Lincoln Park up to $ 15.0 million of shares of common stock over a 24 -month period commencing on July 23, 2021. In addition, under the LPC Purchase Agreement, the Company issued 170,088 shares of common stock to Lincoln Park as consideration for Lincoln Park’s commitment to purchase shares of the Company’s common stock under the LPC Purchase Agreement. The purchase price per share of the shares sold will be based on the market prices prevailing immediately preceding the time of sale as computed under the LPC Purchase Agreement. Lincoln Park has covenanted not to cause or engage in any manner whatsoever, any direct or indirect short selling or hedging of the Company’s common stock. The agreement may be terminated by the Company at any time, at its sole discretion, without any additional cost or penalty. Under the terms of the October 2021 private placements described below, the Company agreed to not issue or sell additional shares under the LPC Purchase Agreement on or prior to April 6, 2023. Private Placements On October 5, 2021, the Company issued and sold to an initial investor, in a private placement priced at-the-market under Nasdaq rules, (i) 2,373,201 shares of the Company’s common stock and accompanying warrants to purchase an aggregate of 4,746,402 shares of the Company’s common stock, and (ii) pre-funded warrants to purchase up to an aggregate of 4,926,069 shares of the Company’s common stock and accompanying warrants to purchase an aggregate of 9,852,138 shares of the Company’s common stock. Each share of the Company’s common stock and accompanying common stock warrants were sold together at a combined price of $ 1.62 , and each pre-funded warrant and accompanying common stock warrants were sold together at a combined price of $ 1.619 , for gross proceeds of approximately $ 11.8 million. Each pre-funded warrant had an exercise price of $ 0.001 per share, became exercisable immediately upon issuance and was exercisable until exercised in full. Of the accompanying common stock warrants, warrants to purchase an aggregate of 7,299,270 shares will expire on April 5, 2025 , and warrants to purchase an aggregate of 7,299,270 shares will expire on October 5, 2028 . The accompanying common stock warrants have an exercise price of $ 1.37 per share and became exercisable immediately upon issuance. On October 18, 2021, the Company issued and sold to New Enterprise Associates 16, L.P., an existing stockholder of the Company (“NEA”) and related party, in a private placement, 1,851,852 shares of the Company’s common stock and accompanying warrants to purchase an aggregate of 3,703,704 shares of the Company’s common stock. Each share of the Company’s common stock and accompanying common stock warrants were sold together at a combined price of $ 1.62 for gross proceeds of approximately $ 3.0 million. Of the accompanying common stock warrants, warrants to purchase an aggregate of 1,851,852 shares of the Company’s common stock will expire on April 18, 2025 , and warrants to purchase an aggregate of 1,851,852 shares of the Company’s common stock will expire on October 18, 2028 . The accompanying common stock warrants have an exercise price of $ 1.37 per share and became exercisable immediately upon issuance. Total net proceeds from the two October 2021 private placements were $ 13.7 million, after deducting issuance costs of $ 1.1 million . On April 6, 2022, the Company entered into a securities purchase agreement (the “Securities Purchase Agreement”) with certain purchasers, pursuant to which the Company agreed to issue and sell to the purchasers, in a private placement priced at-the-market under Nasdaq rules, (i) 4,580,526 shares of the Company’s common stock at a purchase price of $ 1.90 per share, and (ii) pre-funded warrants to purchase up to an aggregate of 24,379,673 shares of common stock at a purchase price of $ 1.899 per warrant (the “April 2022 Private Placement”). Each pre-funded warrant has an exercise price of $ 0.001 per share, is exercisable immediately and will be exercisable until the pre-funded warrant is exercised in full. The April 2022 Private Placement, which closed on April 11, 2022, resulted in gross proceeds to the Company of approximately $ 55.0 million. NEA, an existing stockholder of the Company and a related party, as well as an affiliate of NEA, participated in the offering. Public Offering 15 On September 27, 2022, the Company issued and sold 14,252,670 shares of the Company’s common stock and, in lieu of common stock to certain investors, pre-funded warrants to purchase 14,247,330 shares of common stock in a public offering (the “September 2022 Offering”), at a public offering price of $ 1.93 per share of common stock and $ 1.929 per pre-funded warrant pursuant to an underwriting agreement (the “Underwriting Agreement”) with SVB Securities LLC, Stifel, Nicolaus & Company, Incorporated and Oppenheimer & Co. Inc., as representatives of the several underwriters (the “Underwriters”). Each pre-funded warrant has an exercise price of $ 0.001 per share, is exercisable immediately and will be exercisable until the pre-funded warrant is exercised in full. Under the terms of the Underwriting Agreement, the Company agreed not to issue and sell additional shares until after November 21, 2022 except in certain circumstances, including the issuance and sale of additional shares pursuant to the Underwriting Agreement. Under the terms of the Underwriting Agreement, the Company granted the Underwriters an option (the “Option”), exercisable for 30 days, to purchase up to an additional 4,275,000 shares of common stock (the “Additional Shares”), at the public offering price of $ 1.93 per share. The Underwriters partially exercised the Option to purchase 1,600,428 Additional Shares, which shares were issued and sold on October 25, 2022. The September 2022 Offering , including the initial closing on September 27, 2022 and the Option closing on October 25, 2022, resulted in aggregate gross proceeds to the Company of approximately $ 58.1 million. Warrants Warrant activity, including activity related to pre-funded warrants, for the nine months ended September 30, 2022 is shown in the table below: Number of Pre-funded Warrant Shares Number of Common Stock Warrant Shares Total Number of Warrant Shares Weighted Average Exercise Price Outstanding as of December 31, 2021 2,300,000 18,302,244 20,602,244 $ 1.22 Issued 38,627,003 — 38,627,003 $ 0.001 Exercised ( 2,300,000 ) ( 8,598,540 ) ( 10,898,540 ) $ 1.37 Outstanding as of September 30, 2022 38,627,003 9,703,704 48,330,707 $ 0.28 As of March 31, 2022, all of the pre-funded warrants from the October 2021 private placements had been exercised at the exercise price of $ 0.001 per share. The pre-funded and common stock warrants are classified as equity in accordance with ASC 815 given that the pre-funded and common stock warrants are indexed to the Company’s own shares of common stock and meet the requirements to be classified in permanent equity. Stock-Based Awards In April 2019, the Company’s board of directors adopted the 2019 Stock Incentive Plan (the “2019 Plan”), which became effective on May 7, 2019. The 2019 Plan provides for the grant of incentive stock options, non-statutory stock options, stock appreciation rights, restricted stock awards, restricted stock units and other stock-based awards. The Company’s employees, officers, directors, consultants and advisors are eligible to receive awards under the 2019 Plan. The 2019 Plan is administered by the Company’s board of directors. The total number of shares of common stock that may be issued under the 2019 Plan and the 2012 Stock Incentive Plan (the “2012 Plan”) was 5,155,433 as of September 30, 2022, of which 1,013,526 shares remained available for grant under the 2019 Plan. Awards may be made under the 2019 Plan for up to such number of shares of the Company’s common stock as is equal to the sum of: i) 1,578,947 shares; plus ii) the number of shares (up to 1,157,894 shares) of the Company’s common stock subject to outstanding awards under the 2012 Plan that expire, terminate or are otherwise cancelled, forfeited or repurchased by the Company at their original issuance price pursuant to a contractual repurchase right; plus iii) an annual increase to be added on the first day of each fiscal year, beginning with 2020 and continuing through 2029, equal to the least of (a) 2,105,623 shares of common stock, (b) 4 % of the number of outstanding shares of the Company’s common stock on such date, and (c) an amount determined by the Company’s board of directors. Effective January 1, 2022 and January 1, 2021, respectively, the number of shares reserved for issuance under the 2019 Plan increased, pursuant to the terms of the 2019 Plan, by an additional 1,140,232 shares and 741,871 shares, equal to 4 % of the Company’s then-outstanding common stock. The 2012 Plan was adopted by the Company’s board of directors and stockholders. The 2012 Plan provides for the issuance of stock-based awards to the Company’s employees, officers, directors, consultants and advisors. The Company’s board of directors administers the 2012 Plan. In April 2019, the Company’s board of directors adopted a resolution effective on May 7, 2019, that no further equity-based awards may be granted under the 2012 Plan. Options granted under the 2019 Plan and the 2012 Plan have a maximum term of ten years . Options granted to employees, officers and non-employees generally vest over four years based on varying vesting schedules that primarily include: 25 % vesting on the first anniversary date of grant and the balance ratably over the next 36 months or vesting in equal monthly or quarterly installments over four ye ars. Options granted to directors generally vest over one to two years . As of September 30, 2022 and December 31, 2021, respectively, options to purchase 3,534,413 shares and 2,263,752 shares of common stock were granted and outstanding, net of 16 cancellations, under the 2019 Plan. As of September 30, 2022 and December 31, 2021 , respectively, options to purchase 607,494 and 665,720 shares of common stock, were granted and outstanding, net of cancellations, under the 2012 Plan. In February 2021, the compensation committee of the Company’s board of directors approved the grant of stock options to purchase 450,875 shares of common stock with performance-based vesting (“PSOs”) to employees of the Company. The PSOs granted in February 2021, vest based on the timing and successful results of the Company’s PRISM or CANAL clinical trials. A summary of the Company’s combined stock option activity for the 2019 Plan and the 2012 Plan for the nine months ended September 30, 2022 is as follows: Number of Option Shares Weighted Average Exercise Price Outstanding as of December 31, 2021 2,929,472 $ 4.51 Granted 1,352,250 $ 0.90 Forfeited ( 52,513 ) $ 3.59 Expired ( 36,297 ) $ 5.67 Exercised ( 51,005 ) $ 2.73 Outstanding as of September 30, 2022 4,141,907 $ 3.35 Options exercisable as of September 30, 2022 2,107,177 $ 4.68 Options unvested as of September 30, 2022 2,034,730 $ 1.99 In April 2019, the Company’s board of directors adopted the 2019 Employee Stock Purchase Plan (the “2019 ESPP”), which became effective on May 7, 2019. The 2019 ESPP is administered by the Company’s board of directors. The total number of shares of common stock that may be issued under the 2019 ESPP was 803,976 as of September 30, 2022, of which 721,717 shares remain available for issuance. The number of shares of the Company’s common stock that have been approved to be issued under the 2019 ESPP is equal to the sum of i) 155,106 shares plus ii) an annual increase to be added on the first day of each fiscal year, beginning with the fiscal year ending December 31, 2020 and continuing for each fiscal year until and including, the fiscal year ending December 31, 2029, equal to the least of (a) 526,315 shares of common stock, (b) 1 % of the number of outstanding shares of the Company’s common stock on such date and (c) an amount determined by the Company’s board of directors. Effective January 1, 2022 and January 1, 2021, respectively, the aggregate number of shares of the Company’s common stock that may be issued under the 2019 ESPP increased, pursuant to the terms of the 2019 ESPP, by an additional 285,058 shares and 185,467 shares, in each case equal to 1 % of the Company’s then-outstanding common stock . The following table summarizes the classifications of stock-based compensation expenses for the 2012 Plan, the 2019 Plan and the 2019 ESPP recognized in the Condensed Consolidated Statements of Comprehensive Loss: Three Months Ended September 30, Nine Months Ended September 30, 2022 2021 2022 2021 General and administrative expense $ 371 $ 371 $ 1,195 $ 1,410 Research and development expense 198 169 631 593 $ 569 $ 540 $ 1,826 $ 2,003 9 . Income Taxes As of September 30, 2022 and December 31, 2021, the Company maintained a full valuation allowance on deferred tax assets. The income tax benefit (expense) recorded during the three and nine months ended September 30, 2022 and 2021 was to align the Company’s estimates for its state research and development tax credits in each given year. 10 . Net Loss per Share The following table summarizes the computation of basic and diluted net loss per share attributable to common stockholders of the Company: Three Months Ended September 30, Nine Months Ended September 30, 2022 2021 2022 2021 Net loss $ ( 8,266 ) $ ( 7,255 ) $ ( 23,647 ) $ ( 25,420 ) Weighted average common shares used in net loss per share attributable to common stockholders, basic and diluted 68,898,810 21,607,979 53,221,949 20,390,852 Basic and diluted net loss per common share outstanding $ ( 0.12 ) $ ( 0.34 ) $ ( 0.44 ) $ ( 1.25 ) 17 Basic shares outstanding includes the weighted average effect of the Company’s pre-funded warrants from the date of issuance, the exercise of which requires little or no consideration for the delivery of shares of common stock. As of September 30, 2022, the Company had pre-funded warrants to purchase 38,627,003 shares of common stock outstanding, which were issued in the April 2022 Private Placement and the September 2022 Offering, which warrants are included in the weighted average common shares used in calculating the net loss per share attributable to common stockholders, basic and diluted in both the three and nine months ended September 30, 2022 . The Company’s potential dilutive securities, which include stock options and warrants, have been excluded from the computation of diluted net loss per share attributable to common stockholders whenever the effect of including them would be to reduce the net loss per share. In periods where there is a net loss, the weighted average number of common shares outstanding used to calculate both basic and diluted net loss per share attributable to common stockholders is the same. The following potential common shares, presented based on shares outstanding as of September 30, 2022 and 2021, respectively, were excluded from the calculation of diluted net loss per share attributable to common stockholders for the periods indicated because including them would have had an anti-dilutive effect: Shares as of September 30, 2022 2021 Stock Options 4,141,907 3,049,180 Warrants 9,703,704 — 13,845,611 3,049,180 1 1 . Collaborative and Licensing Agreements The Company enters into collaborative and licensing agreements with pharmaceutical companies to in-license, develop, manufacture and/or market products that fit within its business strategy. Endo Pharmaceuticals Inc. In May 2011, the Company entered into an agreement with Penwest Pharmaceuticals Co., which subsequently merged into its parent, Endo Pharmaceuticals Inc. (“Endo”), for an exclusive worldwide sublicensable license under certain patent rights and know-how controlled by Endo to develop and commercialize products incorporating nalbuphine hydrochloride in any formulation, including an extended-release formulation such as Haduvio, in all fields and for any use. Under the license agreement, the Company paid Endo a non-creditable, non-refundable upfront license fee. The Company may also become obligated to make milestone payments to Endo of $ 0.3 million, which would become due upon the successful completion of the first Phase 3 clinical trial of a licensed product candidate, such as the Phase 2b/3 PRISM trial, and $ 0.8 million, which would become due upon the marketing approval of a licensed product in the U.S. and to pay mid-single-digit royalties based on net sales of the licensed products by the Company, its affiliates and sublicensees. In addition, the Company is obligated to pay Endo a low-to-mid double-digit percentage of certain income it receives from sublicensees, based on the date of the definitive agreement under which the sublicense was granted. The Company’s royalty obligation with respect to each licensed product in each country commences upon the first commercial sale of the product in that country and extends until the later of the expiration, unenforceability or invalidation of the last valid claim of any licensed patent or application covering the licensed product in the country or the expiration of 10 years after the first commercial sale of the licensed product in the country, which period is referred to as the royalty term. Upon the expiration of the royalty term for a product in a country , the Company is thereafter obligated to pay a low single-digit know-how and trademark royalty. Under the agreement, the Company has granted Endo a non-exclusive, royalty-free (except for pass-through payments to third parties), sublicensable license under its relevant patent rights to use any improvement the Company makes to Endo’s controlled release technology for any product other than the products under which it is licensed by Endo. Both the Company and Endo have the right to terminate the agreement if the other party materially breaches the agreement and fails to cure the breach within specified cure periods. Endo also has the right to terminate in the event the Company undergoes specified bankruptcy, insolvency or liquidation events. The Company has the right to terminate the agreement at its convenience at any time on 180 days’ notice to Endo. Additionally, if the Company or any of the Company’s sublicensees challenge the validity or enforceability of any licensed patent rights covering a licensed product and that challenge is not terminated within a specified period, the agreement will immediately terminate and all licenses granted under the agreement shall be revoked. Upon termination of the agreement, the Company must transfer to Endo all regulatory filings and approvals relating to the development, manufacture or commercialization of the licensed products and all trademarks, other than the Company’s corporate trademarks, then being used in connection with the licensed products. If the agreement is terminated under certain specified circumstances, the Company will be deemed to have granted Endo a perpetual, royalty-free (except for pass-through payments to third 18 parties), worldwide, exclusive, sublicensable license under any improvements the Company made to the licensed know-how and any related patent rights the Company has to manufacture and commercialize the licensed products. 1 2 . Commitments and Contingencies A significant portion of the Company’s development activities are outsourced to third parties under agreements, including with CROs and contract manufacturers in connection with the production of clinical trial materials. These arrangements may require the Company to pay termination costs to the third parties for reimbursement of costs and expenses incurred in the event of the orderly termination of contractual services. The Company also has commitments under lease and licensing agreements (Note 5 and Note 11). 13. Subsequent Event On October 25, 2022, the Company sold 1,600,428 shares of common stock at $ 1.93 per share to the Underwriters upon the exercise of the Option pursuant to the Underwriting Agreement for gross proceeds of approximately $ 3.1 million (Note 8).