0000950170-24-034167 | 10-K | XBRL Viewer

Collaborative and Licensing Agreements	12 Months Ended
Dec. 31, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Collaborative and Licensing Agreements	12. 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, and $0.8 million, which would become due upon the marketing approval of a licensed product in the U.S. and to pay 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 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.

Collaborative and Licensing Agreements

12 Months Ended

Dec. 31, 2023

Organization, Consolidation and Presentation of Financial Statements [Abstract]

12.

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, and $0.8 million, which would become due upon the marketing approval of a licensed product in the U.S. and to pay 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 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.

Summary of Significant Accounting Policies - Additional Information (Detail)	12 Months Ended
	Dec. 31, 2023 USD ($) Segment
Summary Of Significant Accounting Policies [Line Items]
Dividends, common stock, cash \| $	$ 0
Number of reporting segment	1
Number of operating segment	1
Computer Equipment [Member]
Summary Of Significant Accounting Policies [Line Items]
Property, Equipment and leasehold improvements, useful life	3 years
Furniture and Office Equipment [Member]
Summary Of Significant Accounting Policies [Line Items]
Property, Equipment and leasehold improvements, useful life	5 years

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Current assets:
Cash and cash equivalents	$ 32,397	$ 12,589
Marketable securities	50,574	107,921
Prepaid expenses	3,621	795
Other current assets	955	1,311
Total current assets	87,547	122,616
Operating lease right-of-use assets	1,137	24
Other non-current assets	297	205
Property, equipment and leasehold improvements, net	216	170
Finance lease right-of-use assets	206
Total assets	89,403	123,015
Current liabilities:
Accounts payable	1,809	2,857
Accrued expenses	3,709	3,518
Operating lease liabilities	184	25
Finance lease liabilities	122
Term loan		7,000
Total current liabilities	5,824	13,400
Operating lease liabilities	1,001	2
Finance lease liabilities	31
Term loan		2,151
Other non-current liabilities		3
Total liabilities	6,856	15,556
Commitments and contingencies (Note 13)
Stockholders’ equity:
Preferred stock: $0.001 par value; 5,000,000 shares authorized at December 31, 2023 and December 31, 2022; no shares issued or outstanding at December 31, 2023 and December 31, 2022.
Common stock: $0.001 par value; 200,000,000 shares authorized at December 31, 2023 and December 31, 2022; and 68,283,699 and 59,943,430 shares issued and outstanding at December 31, 2023 and December 31, 2022, respectively.	68	60
Additional paid-in capital	321,642	317,590
Accumulated other comprehensive loss	(29)	(122)
Accumulated deficit	(239,134)	(210,069)
Total stockholders’ equity	82,547	107,459
Total liabilities and stockholders’ equity	$ 89,403	$ 123,015

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Operating activities:
Net loss	$ (29,065)	$ (29,152)
Adjustments to reconcile net loss to net cash used in operating activities:
Stock-based compensation	2,247	2,327
Write off of deferred offering costs	390
Operating lease right-of-use assets	377	0
Accretion/accrual of term loan discounts and debt issuance costs	180	520
Depreciation and amortization	123	43
Loss on disposal of property, equipment and leasehold improvements	10
Accretion of available-for-sale marketable securities, net	(2,125)	(829)
Change in fair value of term loan derivative liability		147
Changes in operating assets and liabilities:
Prepaid expenses and other current assets	(2,850)	(601)
Accounts payable	(1,049)	9
Accrued expenses and other liabilities	52	(639)
Net cash used in operating activities	(31,710)	(28,175)
Investing activities:
Proceeds from maturities of available-for-sale marketable securities	69,497	19,001
Purchases of available-for-sale marketable securities	(9,932)	(126,215)
Purchases of property, equipment and leasehold improvements	(137)	(159)
Net cash provided by (used in) investing activities	59,428	(107,373)
Financing activities:
Proceeds from at-the-market sales, net of commissions	1,710
Proceeds from exercises of stock options	74	139
Proceeds from employee stock purchase plan	68	56
Repayments of term loan, term loan final fee and prepayment premium	(9,409)	(5,833)
Payments of offering costs	(258)	(226)
Payments of finance lease	(95)
Proceeds from sale of common stock and warrants in public offering and private placement, net of issuance costs		105,410
Proceeds from exercises of warrants		11,782
Payments of financing costs of term loan		(21)
Net cash (used in) provided by financing activities	(7,910)	111,307
Net increase in cash and cash equivalents	19,808	(24,241)
Cash and cash equivalents at beginning of period	12,589	36,830
Cash and cash equivalents at end of period	32,397	12,589
Supplemental disclosure of cash flow information:
Interest paid	(331)	(594)
State research tax credits exchanged for cash	$ 55
Supplemental disclosure of non-cash financing activities:
Offering costs included in accrued expenses		$ 15

Debt - Schedule of Outstanding Borrowings under SVB Term Loan (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	May 09, 2023	Dec. 31, 2022	Aug. 13, 2020
Debt Instrument [Line Items]
Less current portion			$ 7,000
Term loan payable, non-current			2,151
SVB Term Loan [Member]
Debt Instrument [Line Items]
Principal outstanding under term loan	$ 0		8,167	$ 14,000
Term loan discount-interest			(24)
Term loan discount-unamortized deferred charges			(29)
Term loan discount-financing costs, net of accretion			(3)
Debt instrument, accrued final payment fee			1,040
Loans Payable, Noncurrent			9,151
Less current portion			7,000
Term loan payable, non-current		$ 5,200	$ 2,151

Commitments and Contingencies

12 Months Ended

Dec. 31, 2023

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

13.

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 12).

Collaborative and Licensing Agreements - Additional Information (Detail) - Endo Pharmaceuticals Inc [Member] $ in Millions	12 Months Ended
	Dec. 31, 2023 USD ($)
Collaborative Arrangements And Noncollaborative Arrangement Transactions [Line Items]
Royalty terms	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
Completion Of Stage One [Member]
Collaborative Arrangements And Noncollaborative Arrangement Transactions [Line Items]
Milestone payments to be paid	$ 0.3
Completion Of Stage Two [Member]
Collaborative Arrangements And Noncollaborative Arrangement Transactions [Line Items]
Milestone payments to be paid	$ 0.8

Marketable Securities

12 Months Ended

Dec. 31, 2023

Investments, Debt and Equity Securities [Abstract]

Marketable Securities

The fair value and amortized cost of available-for-sale marketable securities by major security type are presented in the following tables as of the periods presented (in thousands):


	December 31, 2023
Type of security	Amortized Cost		Gross Unrealized Gains		Gross Unrealized Losses			Estimated Fair Value
Corporate bonds	$	45,686	$	20	$	(53	)	$	45,653
U.S. government agency securities		4,917		9		(5	)		4,921
Total marketable securities	$	50,603	$	29	$	(58	)	$	50,574


	December 31, 2022
Type of Security	Amortized Cost		Gross Unrealized Gains		Gross Unrealized Losses			Estimated Fair Value
Corporate bonds	$	62,573	$	83	$	(143	)	$	62,513
Commercial paper		30,739		—		—			30,739
U.S. treasury securities		9,914		—		(62	)		9,852
U.S. government agency securities		2,905		2		(4	)		2,903
Asset backed securities		1,912		2		—			1,914
Total marketable securities	$	108,043	$	87	$	(209	)	$	107,921

The net amortized cost and fair value of available-for-sale marketable securities are presented in the following table (in thousands) as of the period presented by contractual maturity. Actual maturities may differ from contractual maturities because securities may be restructured, called or prepaid, or the Company may intend to sell a security prior to maturity.


	December 31, 2023
	Amortized Cost		Fair Value
Due to mature:
Less than one year	$	49,651	$	49,618
One year through two years		952		956
Total	$	50,603	$	50,574


	December 31, 2022
	Amortized Cost		Fair Value
Due to mature:
Less than one year	$	69,527	$	69,367
One year through two years		38,516		38,554
Total	$	108,043	$	107,921

During the years ended December 31, 2023 and 2022, there were no realized gains or losses on available-for-sale marketable securities.

As of the years ended December 31, 2023 and 2022, no marketable securities had been in a continuous unrealized loss position for more than 12 months and the Company considered the loss to be temporary in nature. The Company reviewed the securities in the table above and considered the decline in market value for these securities to be primarily attributable to economic and market conditions. As of the periods noted in the table above, the Company did not intend to sell these securities and did not believe it was more likely than not that it would be required to sell these securities before recovery of their amortized cost basis. Accordingly, the Company did not recognize any credit losses related to its marketable securities in an unrealized loss position.

Stockholders' Equity - Shares Reserved For Future Issuances (Detail) - shares	Dec. 31, 2023	Dec. 31, 2022
Class Of Stock [Line Items]
Common Stock, Capital Shares Reserved for Future Issuance	49,223,937	84,187,372
Exercise of Outstanding Warrants And Pre-funded Warrants [Member]
Class Of Stock [Line Items]
Common Stock, Capital Shares Reserved for Future Issuance	40,931,506	48,330,707
LPC Purchase Agreement [Member]
Class Of Stock [Line Items]
Common Stock, Capital Shares Reserved for Future Issuance		30,000,000
2019 Stock Option And Grant Plan [Member] \| 2019 Stock Incentive Plan [Member]
Class Of Stock [Line Items]
Common Stock, Capital Shares Reserved for Future Issuance	6,549,183	4,553,202
2019 Stock Option And Grant Plan [Member] \| 2019 Employee Stock Purchase Plan [Member]
Class Of Stock [Line Items]
Common Stock, Capital Shares Reserved for Future Issuance	1,177,456	701,232
2012 Stock Option And Grant Plan [Member] \| 2012 Stock Incentive Plan [Member]
Class Of Stock [Line Items]
Common Stock, Capital Shares Reserved for Future Issuance	565,792	602,231

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

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+ Details

Stockholders' Equity - Range of Assumptions on Fair Value of the Stock Options Granted (Detail)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Risk-free interest rate, minimum	3.40%	1.90%
Risk-free interest rate, maximum	4.80%	4.20%
Expected volatility, minimum	101.60%	101.70%
Expected volatility, maximum	147.10%	108.60%
Minimum [Member]
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Expected term (in years)	5 years 6 months	5 years 6 months
Maximum [Member]
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Expected term (in years)	7 years	7 years

- Definition

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Reference 23: http://www.xbrl.org/2003/role/disclosureRef
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Reference 24: http://www.xbrl.org/2003/role/disclosureRef
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Reference 28: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-Paragraph 2
-Subparagraph (f)(2)(v)
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-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

+ Details

Fair Value Measurements - Schedule of Financial Assets and Financial Liabilities Measured at Fair Value on Recurring Basis (Detail) - Fair Value, Measurements, Recurring [Member] - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Financial assets:
Total assets	$ 80,978	$ 119,510
Corporate Bonds [Member]
Financial assets:
Marketable securities	45,653	62,513
Commercial Paper [Member]
Financial assets:
Marketable securities		30,739
U.S. Treasury Securities [Member]
Financial assets:
Marketable securities		9,852
U.S. Government Agency Securities [Member]
Financial assets:
Marketable securities	4,921	2,903
Asset Backed Securities [Member]
Financial assets:
Marketable securities		1,914
Level 1 [Member]
Financial assets:
Total assets	30,404	21,441
Level 1 [Member] \| U.S. Treasury Securities [Member]
Financial assets:
Marketable securities		9,852
Level 2 [Member]
Financial assets:
Total assets	50,574	98,069
Level 2 [Member] \| Corporate Bonds [Member]
Financial assets:
Marketable securities	45,653	62,513
Level 2 [Member] \| Commercial Paper [Member]
Financial assets:
Marketable securities		30,739
Level 2 [Member] \| U.S. Government Agency Securities [Member]
Financial assets:
Marketable securities	4,921	2,903
Level 2 [Member] \| Asset Backed Securities [Member]
Financial assets:
Marketable securities		1,914
Money Market Funds [Member]
Financial assets:
Cash equivalents	30,404	11,589
Money Market Funds [Member] \| Level 1 [Member]
Financial assets:
Cash equivalents	$ 30,404	$ 11,589

Debt (Tables)

12 Months Ended

Dec. 31, 2023

Debt Disclosure [Abstract]

Schedule of Outstanding Borrowings under SVB Term Loan

Company had outstanding borrowings of $8.2 million, under the SVB Term Loan and the term loan payable balance as presented in the Company’s Consolidated Balance Sheet was comprised as shown below (in thousands).


	December 31, 2022
Principal outstanding under term loan	$	8,167
Term loan discount-interest		(24	)
Term loan discount-unamortized deferred charges		(29	)
Term loan discount-financing costs, net of accretion		(3	)
Term loan-final payment fee		1,040
		9,151
Less current portion		7,000
Term loan payable, non-current	$	2,151

Schedule of Components of Interest Expense of Term Loan

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 (in thousands). As of December 31, 2022, the weighted average interest rate applicable to borrowings under the SVB Term Loan was 5.36%.


	Year Ended December 31,
	2023		2022
Interest payments	$	202	$	643
Accrual of the final payment fee		150		383
Accretion and amortization of term loan discounts		30		137
	$	382	$	1,163

- Definition

Tabular disclosure of long-debt instruments or arrangements, including identification, terms, features, collateral requirements and other information necessary to a fair presentation. These are debt arrangements that originally required repayment more than twelve months after issuance or greater than the normal operating cycle of the entity, if longer.

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 55
-Paragraph 69B
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481568/470-20-55-69B

Reference 2: http://www.xbrl.org/2003/role/exampleRef
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-Name Accounting Standards Codification
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-URI https://asc.fasb.org//1943274/2147481568/470-20-55-69E

Reference 3: http://www.xbrl.org/2009/role/commonPracticeRef
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-Name Accounting Standards Codification
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-Paragraph 3
-Subparagraph (SX 210.12-04(a))
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-URI https://asc.fasb.org//1943274/2147480678/235-10-S99-3

Reference 4: http://fasb.org/us-gaap/role/ref/legacyRef
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Reference 6: http://fasb.org/us-gaap/role/ref/legacyRef
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Reference 7: http://fasb.org/us-gaap/role/ref/legacyRef
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Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
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+ Details

Leases - Schedule of Supplemental Cash Flow Information Related to Leases (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash outflows relating to operating leases	$ 231	$ 130
Finance lease payments	95
Supplemental non-cash information:
Right-of-use assets obtained in exchange for new operating lease liabilities	1,289	$ 4
Right-of-use assets obtained in exchange for new finance lease liabilities	$ 242

Leases (Tables)

12 Months Ended

Dec. 31, 2023

Leases [Abstract]

Schedule of Lease-related Assets and Liabilities

The following table presents the Company’s lease-related assets and liabilities as presented on its Consolidated Balance Sheets (in thousands):


	Classification on the Condensed Consolidated Balance Sheet	December 31, 2023		December 31, 2022
Assets:
Operating lease assets	Operating lease right-of-use assets	$	1,137	$	24
Finance lease assets	Finance lease right-of-use assets		206		—
Total lease assets		$	1,343	$	24
Liabilities:
Current
Operating lease liabilities	Operating lease liabilities, current portion	$	184	$	25
Finance lease liabilities	Finance lease liabilities, current portion		122		—
Non-current
Operating lease liabilities	Operating lease liabilities, non-current portion		1,001		2
Finance lease liabilities	Finance lease liabilities, non-current portion		31		—
Total lease liabilities		$	1,338	$	27

Schedule of Information Related to Lease Expense

The following table presents information related to the Company’s lease expense for the periods shown (in thousands):


	Year Ended December 31,
	2023		2022
Operating lease expense	$	287	$	123
Finance lease expense		36		—
Total lease expense	$	323	$	123

Schedule of Future Lease Payments of Leases

Future minimum lease payments from December 31, 2023 until the expiration of the leases are as follows (in thousands):


	Operating Leases			Finance Leases
2024	$	303		$	126
2025		349			32
2026		368			—
2027		377			—
2028		95			—
Total minimum lease payments		1,492			158
Less: Amount of lease payments representing interest		(307	)		(5	)
Present value of future minimum lease payments	$	1,185		$	153

Schedule of Information Related to the Lease Terms and Discount Rates of Leases

The following table presents certain information related to the lease terms and discount rates for the Company's leases (in thousands):


	December 31,
	2023	2022
Weighted average remaining lease term:
Operating leases	4.3 years	0.3 years
Finance leases	1.3 years	not applicable

Weighted average discount rate:
Operating leases	11.00%	13.00%
Finance leases	4.37%	not applicable

Schedule of Supplemental Cash Flow Information Related to Leases

The following table presents supplemental cash flow information related to the Company’s leases for the periods shown (in thousands):


	Year Ended December 31,
	2023		2022
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash outflows relating to operating leases	$	231	$	130
Finance lease payments	$	95	$	—
Supplemental non-cash information:
Right-of-use assets obtained in exchange for new operating lease liabilities	$	1,289	$	4
Right-of-use assets obtained in exchange for new finance lease liabilities	$	242	$	—

Fair Value Measurements

12 Months Ended

Dec. 31, 2023

Fair Value Disclosures [Abstract]

Fair Value Measurements

The following table summarizes the Company’s financial assets and financial liabilities measured at fair value on a recurring basis and the basis for that measurement, by level within the fair value hierarchy as follows (in thousands):


		Fair Value Measurement Using:
Balance Sheet Classification	Type of Instrument	Level 1		Level 2		Level 3		Total
December 31, 2023
Financial assets:
Cash equivalents	Money market funds	$	30,404	$	—	$	—	$	30,404
Marketable securities	Corporate bonds		—		45,653		—		45,653
Marketable securities	U.S. government agency securities		—		4,921		—		4,921
Total assets		$	30,404	$	50,574	$	—	$	80,978


		Fair Value Measurement Using:
Balance Sheet Classification	Type of Instrument	Level 1		Level 2		Level 3		Total
December 31, 2022
Financial assets:
Cash equivalents	Money market funds	$	11,589	$	—	$	—	$	11,589
Marketable securities	Corporate bonds		—		62,513		—		62,513
Marketable securities	Commercial paper		—		30,739		—		30,739
Marketable securities	U.S. treasury securities		9,852		—		—		9,852
Marketable securities	U.S. government agency securities		—		2,903		—		2,903
Marketable securities	Asset backed securities		—		1,914		—		1,914
Total assets		$	21,441	$	98,069	$	—	$	119,510

The following table represents a roll-forward of the fair value of Level 3 instruments (significant unobservable inputs) (in thousands):


	December 31,
	2022
Financial liabilities
Balance at beginning of period	$	114
Change in fair value of term loan derivative liability		147
Net settlements (see Note 8)		(261	)
Balance at end of period	$	—

- Definition

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References + Details

Leases - Schedule of Information Related to Lease Expenses (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Leases [Abstract]
Operating lease expense	$ 287	$ 123
Finance lease expense	36
Total lease expense	$ 323	$ 123

Stockholders' Equity - Stock Options, Activity (Detail) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Number of Option Shares
Outstanding, Beginning	4,450,283
Granted	1,563,500
Forfeited	(318,075)
Expired	(237,327)
Exercised	(146,081)
Outstanding, Ending	5,312,300	4,450,283
Options exercisable	2,805,959
Options unvested	2,506,341
Weighted Average Exercise Price
Outstanding, Beginning	$ 3.26
Granted	2.62
Forfeited	1.77
Expired	3.23
Exercised	0.51
Outstanding, Ending	3.24	$ 3.26
Options exercisable	4.16
Options unvested	$ 2.20
Weighted Average Contractual Term, Outstanding	7 years 3 months 18 days	7 years 7 months 6 days
Weighted Average Contractual Term, Options exercisable	6 years
Weighted Average Contractual Term, Options unvested	8 years 9 months 18 days
Aggregate Intrinsic Value, Outstanding	$ 685
Aggregate Intrinsic Value, Options exercisable	273
Aggregate Intrinsic Value, Options unvested	$ 412

Accrued Expenses - Schedule of Accrued Expenses (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Payables and Accruals [Abstract]
Accrued compensation and benefits	$ 1,614	$ 1,508
Accrued R&D projects	1,579	1,130
Accrued consulting and professional fees	510	382
Accrued other	6	498
Total accrued expenses	$ 3,709	$ 3,518

Stockholders' Equity (Stock-Based Awards) - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Thousands				1 Months Ended	12 Months Ended
	Jan. 01, 2023	Jan. 01, 2022	Jan. 01, 2020	Apr. 30, 2019	Dec. 31, 2023	Dec. 31, 2022
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Common stock, capital shares reserved for future issuance					49,223,937	84,187,372
Share based compensation options grants in the period					1,563,500
Share based compensation options to purchase no of common stock					5,312,300	4,450,283
Weighted average fair value of options granted					$ 2.24	$ 0.93
Fair value of stock options vested					$ 1,700	$ 2,900
Fair value of stock options exercised					173	$ 33
Share-based awards, cost not yet recognized, amount					$ 3,800
Share-based award, cost not yet recognized, period for recognition					2 years 8 months 12 days
2019 Stock Incentive Plan [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Share based compensation, award description					The total number of shares of common stock that may be issued under the 2019 Plan and the 2012 Plan was 7,114,975 and 5,155,433 as of December 31, 2023 and 2022, respectively, of which 1,802,675 and 705,150 shares remained available for grant under the 2019 Plan, respectively. 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.
Number of shares available for grant					1,802,675	705,150
Common stock, capital shares reserved for future issuance	2,105,623	1,140,232			1,578,947
Share based compensation grant period					10 years
Share based compensation vesting description					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 years.
Share based compensation options grants in the period					4,746,508	3,848,052
Share based compensation options to purchase no of common stock					4,746,508	3,848,052
2019 Stock Incentive Plan [Member] \| Employees, Officers and Non-employee Consultants [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Share based compensation vesting period					4 years
2019 Stock Incentive Plan [Member] \| Employees, Officers and Non-employee Consultants [Member] \| Vesting First Anniversary Date of Grant [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Share based compensation vesting Percentage					25.00%
2019 Stock Incentive Plan [Member] \| Director [Member] \| Minimum [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Share based compensation vesting period					1 year
2019 Stock Incentive Plan [Member] \| Director [Member] \| Maximum [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Share based compensation vesting period					2 years
2019 Stock Incentive Plan [Member] \| Common Stock [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Increase in additional number of shares to be issued			2,105,623
Percentage of number of common stock, shares outstanding	4.00%	4.00%	4.00%
2019 Plan and 2012 Plan [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Total number of common shares authorized under the plan					7,114,975	5,155,433
2012 Stock Incentive Plan [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Share based compensation grant period					10 years
Share based compensation vesting description					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 years.
Share based compensation options grants in the period					565,792	602,231
Share based compensation options to purchase no of common stock					565,792	602,231
2012 Stock Incentive Plan [Member] \| Employees, Officers and Non-employee Consultants [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Share based compensation vesting period					4 years
2012 Stock Incentive Plan [Member] \| Employees, Officers and Non-employee Consultants [Member] \| Vesting First Anniversary Date of Grant [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Share based compensation vesting Percentage					25.00%
2012 Stock Incentive Plan [Member] \| Director [Member] \| Minimum [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Share based compensation vesting period					1 year
2012 Stock Incentive Plan [Member] \| Director [Member] \| Maximum [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Share based compensation vesting period					2 years
2012 Stock Incentive Plan [Member] \| Common Stock [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Share based compensation options to purchase number of shares outstanding					1,157,894
2012 Stock Incentive Plan [Member] \| Other Equity-Based Award [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Share based compensation options grants in the period					0
2019 Employee Stock Purchase Plan [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Share based compensation, award description					The total number of shares of common stock that may be issued under the 2019 ESPP was 1,177,456 as of December 31, 2023. 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, 2023 and January 1, 2022, 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 526,315 shares and 285,058 shares, equal in each case to the lesser of the 2019 ESPP determined maximum and 1% of the Company’s then-outstanding common stock.
Total number of common shares authorized under the plan					1,177,456
Common stock, capital shares reserved for future issuance				155,106
2019 Employee Stock Purchase Plan [Member] \| Common Stock [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Increase in additional number of shares to be issued	526,315	285,058		526,315
Percentage of number of common stock, shares outstanding	1.00%	1.00%		1.00%

Fair Value Measurements (Tables)

12 Months Ended

Dec. 31, 2023

Fair Value Disclosures [Abstract]

Schedule of Financial Assets and Financial Liabilities Measured at Fair Value on Recurring Basis


		Fair Value Measurement Using:
Balance Sheet Classification	Type of Instrument	Level 1		Level 2		Level 3		Total
December 31, 2023
Financial assets:
Cash equivalents	Money market funds	$	30,404	$	—	$	—	$	30,404
Marketable securities	Corporate bonds		—		45,653		—		45,653
Marketable securities	U.S. government agency securities		—		4,921		—		4,921
Total assets		$	30,404	$	50,574	$	—	$	80,978


		Fair Value Measurement Using:
Balance Sheet Classification	Type of Instrument	Level 1		Level 2		Level 3		Total
December 31, 2022
Financial assets:
Cash equivalents	Money market funds	$	11,589	$	—	$	—	$	11,589
Marketable securities	Corporate bonds		—		62,513		—		62,513
Marketable securities	Commercial paper		—		30,739		—		30,739
Marketable securities	U.S. treasury securities		9,852		—		—		9,852
Marketable securities	U.S. government agency securities		—		2,903		—		2,903
Marketable securities	Asset backed securities		—		1,914		—		1,914
Total assets		$	21,441	$	98,069	$	—	$	119,510

Schedule of Fair Value, Financial Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation

The following table represents a roll-forward of the fair value of Level 3 instruments (significant unobservable inputs) (in thousands):


	December 31,
	2022
Financial liabilities
Balance at beginning of period	$	114
Change in fair value of term loan derivative liability		147
Net settlements (see Note 8)		(261	)
Balance at end of period	$	—

Net Loss per Share - Calculation of Diluted Net Loss Per Share Attributable to Common Stockholders (Detail) - shares	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share, amount	15,016,004	14,153,987
Warrants [Member]
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share, amount	9,703,704	9,703,704
Stock Options [Member]
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share, amount	5,312,300	4,450,283

Nature of the Business

12 Months Ended

Dec. 31, 2023

Organization, Consolidation and Presentation of Financial Statements [Abstract]

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 idiopathic pulmonary fibrosis (“IPF”) and refractory chronic cough. 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 and itch. 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.

The Company’s Consolidated Financial Statements have been prepared on the basis of continuity of operations, realization of assets and the satisfaction of liabilities and commitments in the ordinary course of business. The Company has financed its operations to date primarily through private placements of its redeemable convertible preferred stock and convertible notes prior to its initial public offering (“IPO”), borrowings under its prior term loan facility, proceeds from its IPO and concurrent private placement completed in May 2019, sales of its common stock pursuant to the at-the-market Sales Agreement (the “ATM Sales Agreement”) (Note 9) with SVB Securities LLC (formerly SVB Leerink LLC) (“SVB Securities”) that the Company entered into in June 2020, the term loan facility with Silicon Valley Bank (“SVB”) that the Company entered into in August 2020 (Note 8), proceeds from the private placements completed in October 2021 and April 2022 (Note 9), proceeds from the exercise of common stock warrants that were issued in the October 2021 private placements and proceeds from the public offering completed in October 2022 (Note 9). The Company has incurred recurring losses since inception, including net losses of $29.1 million and $29.2 million for the years ended December 31, 2023 and 2022, respectively. As of December 31, 2023, the Company had cash, cash equivalents and marketable securities of $83.0 million compared to $120.5 million of cash, cash equivalents and marketable securities as of December 31, 2022. The Company had incurred losses and negative cash flows from operations and had an accumulated deficit of $239.1 million as of December 31, 2023. The Company expects to continue to incur losses for the foreseeable future. As of March 20, 2024, the date of issuance of these Consolidated Financial Statements, the Company believes that its cash, cash equivalents and marketable securities as of December 31, 2023, will be sufficient to fund its operating expenses and capital expenditure requirements for 12 months from the date of issuance of these Consolidated Financial Statements.

Property, Equipment and Leasehold Improvements, Net - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Property, Plant and Equipment [Abstract]
Depreciation	$ 81	$ 43

Income Taxes - Reconciliation Between Income Tax Benefit and Expected Tax Benefit at Statutory Rate (Details)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Income Tax Disclosure [Abstract]
Federal statutory income tax rate	21.00%	21.00%
State income tax benefit—net of federal tax	5.80%	5.80%
R&D tax credits	2.90%	2.50%
Refundable tax credit	0.10%	0.10%
Permanent adjustments	(0.60%)	(0.60%)
Change in valuation allowance	(29.10%)	(28.70%)
Effective income tax rate	0.10%	0.10%

Stockholders' Equity - Stock-based Compensation Expenses (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock-based compensation	$ 2,247	$ 2,327
General and Administrative Expense [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock-based compensation	1,376	1,512
Research and Development Expense [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock-based compensation	$ 871	$ 815

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

+ Details

Leases

12 Months Ended

Dec. 31, 2023

Leases [Abstract]

Leases

The Company entered into a lease for office space in New Haven, Connecticut, effective March 1, 2013, and entered into a First Amendment (the “First Amendment”) to such lease on December 5, 2017 and a Second Amendment (the “Second Amendment”) to such lease on November 21, 2022 (collectively, the “Office Space Lease”). The leased space approximated 5,600 square feet and, prior to the Second Amendment, the Office Space Lease had a term of 60 months expiring on February 28, 2023. Under the First Amendment, the Company was required to make monthly payments ranging from approximately $10 to $12 through February 1, 2023 and received two designated months of free rent. As a result of the Company entering into the Second Amendment, the leased space increased to 12,500 square feet effective in March 2023 and the term for the Office Space Lease was extended for an additional 60 months from its prior termination date, until February 28, 2028. The Second Amendment requires monthly payments ranging from approximately $23 to $32 effective in March 2023 through February 2028. The first year of payments are based on 10,500 square feet of occupied space, the second year of payments are based on 11,500 square feet of occupied space and the remaining lease payments are based on 12,500 square feet of occupied space.

In December 2022, the Company entered into a 24 month lease for the financing of the furniture installed in the Company’s new office space. The furniture lease requires monthly payments of approximately $11 starting in March 2023. The Company also entered into an immaterial office equipment lease during 2022 that has a term of 36 months.

The following table presents the Company’s lease-related assets and liabilities as presented on its Consolidated Balance Sheets (in thousands):


	Classification on the Condensed Consolidated Balance Sheet	December 31, 2023		December 31, 2022
Assets:
Operating lease assets	Operating lease right-of-use assets	$	1,137	$	24
Finance lease assets	Finance lease right-of-use assets		206		—
Total lease assets		$	1,343	$	24
Liabilities:
Current
Operating lease liabilities	Operating lease liabilities, current portion	$	184	$	25
Finance lease liabilities	Finance lease liabilities, current portion		122		—
Non-current
Operating lease liabilities	Operating lease liabilities, non-current portion		1,001		2
Finance lease liabilities	Finance lease liabilities, non-current portion		31		—
Total lease liabilities		$	1,338	$	27

The following table presents information related to the Company’s lease expense for the periods shown (in thousands):


	Year Ended December 31,
	2023		2022
Operating lease expense	$	287	$	123
Finance lease expense		36		—
Total lease expense	$	323	$	123

Future minimum lease payments from December 31, 2023 until the expiration of the leases are as follows (in thousands):


	Operating Leases			Finance Leases
2024	$	303		$	126
2025		349			32
2026		368			—
2027		377			—
2028		95			—
Total minimum lease payments		1,492			158
Less: Amount of lease payments representing interest		(307	)		(5	)
Present value of future minimum lease payments	$	1,185		$	153

The following table presents certain information related to the lease terms and discount rates for the Company's leases (in thousands):


	December 31,
	2023	2022
Weighted average remaining lease term:
Operating leases	4.3 years	0.3 years
Finance leases	1.3 years	not applicable

Weighted average discount rate:
Operating leases	11.00%	13.00%
Finance leases	4.37%	not applicable

The following table presents supplemental cash flow information related to the Company’s leases for the periods shown (in thousands):


	Year Ended December 31,
	2023		2022
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash outflows relating to operating leases	$	231	$	130
Finance lease payments	$	95	$	—
Supplemental non-cash information:
Right-of-use assets obtained in exchange for new operating lease liabilities	$	1,289	$	4
Right-of-use assets obtained in exchange for new finance lease liabilities	$	242	$	—

Marketable Securities - Summary Of Contractual Maturities Of Available-for-sale Marketable Securities (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Investments, Debt and Equity Securities [Abstract]
Amortized cost, less than one year	$ 49,651	$ 69,527
Amortized cost, one year through two years	952	38,516
Amortized Cost	50,603	108,043
Fair value, less than one year	49,618	69,367
Fair Value, one year through two years	956	38,554
Fair Value	$ 50,574	$ 107,921

Nature of the Business - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Net loss	$ (29,065)	$ (29,152)
Retained earnings accumulated deficit	(239,134)	(210,069)
Cash, cash equivalents and marketable securities	83,000	120,500
Cash and cash equivalents, at carrying value	$ 32,397	$ 12,589

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References

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+ Details

- Definition

Amount of accumulated undistributed earnings (deficit).

+ References + Details

Debt - Additional Information (Detail) $ in Thousands					1 Months Ended	5 Months Ended	12 Months Ended
Debt - Additional Information (Detail) $ in Thousands	May 09, 2023 USD ($)	Apr. 06, 2022 USD ($)	Jul. 06, 2021 USD ($)	Aug. 13, 2020 USD ($) Installment	Oct. 31, 2021 PrivatePlacement	Oct. 31, 2021 USD ($)	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Aug. 31, 2020 USD ($)
Term loan								$ 2,151
Private Placement [Member]
Number of private placements \| PrivatePlacement					2
SVB Term Loan [Member]
Total payoff amount of term loan	$ 6,500
Term loan	5,200							2,151
Debt instrument accrued interest and prepayment premium	100
Debt instrument, principal amount				$ 14,000			$ 0	$ 8,167
Interest rate, floating								5.36%
Interest-only payment period				24 months
Loan payment, number of consecutive equal monthly installments of principal including accrued interest \| Installment				24
Debt instrument, maturity date							Feb. 01, 2024
Debt instrument, final payment fee amount	$ 1,200			$ 1,200			$ 1,200
Debt default additional interest charge				5.00%
Debt finance costs			$ 68						$ 57
Unamortized deferred charges								$ 29
Financing costs paid									$ 27
Loan discounts-financing costs								3
Accrual of the final payment fee							$ 150	383
Debt instrument, accrued final payment fee								1,040
Contingent interest rate increase							2.00%
Term loan discount interest								$ 24
SVB Term Loan [Member] \| Term Loan Derivative Liability [Member]
Term loan derivative liability				$ 187
SVB Term Loan [Member] \| Minimum [Member]
Interest rate, floating				4.25%
Long term debt percentage bearing adjusted floating interest rate				6.25%
SVB Term Loan [Member] \| First Amendment
Debt instruments percentage of required to deposit unrestricted and unencumbered cash collateral			100.00%
Equity raise requirements, description							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 have been 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 have been used by SVB to prepay the SVB Term Loan at any time.
SVB Term Loan [Member] \| First Amendment \| Minimum [Member]
Proceeds from the sale of equity securities						$ 15,000
Debt instruments amount of required to maintain unrestricted and unencumbered cash			$ 20,000
SVB Term Loan [Member] \| Third Amendment [Member]
Variable interest rate		3.00%
Proceeds from the sale of equity securities		$ 45,000
Debt finance costs							$ 21
SVB Term Loan [Member] \| Third Amendment [Member] \| Minimum [Member]
Interest rate, floating		4.25%
Long term debt percentage bearing adjusted floating interest rate		6.25%
SVB Term Loan [Member] \| Prepayment Prior to First Anniversary of Effective Date [Member]
Prepayment premium percentage on principal amount				3.00%
SVB Term Loan [Member] \| Prepayment After First Anniversary of Effective Date and Prior To Second Anniversary of Effective Date [Member]
Prepayment premium percentage on principal amount				2.00%
SVB Term Loan [Member] \| Prepayment After Second Anniversary of the Effective Date and Prior to February 1, 2024 [Member]
Prepayment premium percentage on principal amount				1.00%
SVB Term Loan [Member] \| Prime Rate [Member]
Variable interest rate				1.00%
SVB Term Loan [Member] \| Prime Rate [Member] \| Third Amendment [Member]
Variable interest rate		1.00%
SVB Term Loan [Member] \| Adjusted Prime Rate [Member]
Variable interest rate				3.00%

Marketable Securities - Schedule of Fair Value And Amortized Cost Of Available-for-sale Marketable Securities (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Schedule Of Investment Income Reported Amounts By Category [Line Items]
Amortized Cost	$ 50,603	$ 108,043
Gross Unrealized Gains	29	87
Gross Unrealized Losses	(58)	(209)
Estimated Fair Value	50,574	107,921
Corporate Bonds [Member]
Schedule Of Investment Income Reported Amounts By Category [Line Items]
Amortized Cost	45,686	62,573
Gross Unrealized Gains	20	83
Gross Unrealized Losses	(53)	(143)
Estimated Fair Value	45,653	62,513
Commercial Paper [Member]
Schedule Of Investment Income Reported Amounts By Category [Line Items]
Amortized Cost		30,739
Estimated Fair Value		30,739
U.S. Treasury Securities [Member]
Schedule Of Investment Income Reported Amounts By Category [Line Items]
Amortized Cost		9,914
Gross Unrealized Losses		(62)
Estimated Fair Value		9,852
U.S. Government Agency Securities [Member]
Schedule Of Investment Income Reported Amounts By Category [Line Items]
Amortized Cost	4,917	2,905
Gross Unrealized Gains	9	2
Gross Unrealized Losses	(5)	(4)
Estimated Fair Value	$ 4,921	2,903
Asset Backed Securities [Member]
Schedule Of Investment Income Reported Amounts By Category [Line Items]
Amortized Cost		1,912
Gross Unrealized Gains		2
Estimated Fair Value		$ 1,914

Net Loss per Share

12 Months Ended

Dec. 31, 2023

Earnings Per Share [Abstract]

Net Loss per Share

11.

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 (in thousands, except share and per share amounts):


	Year Ended December 31,
	2023			2022
Net loss	$	(29,065	)	$	(29,152	)
Weighted average common shares used in net loss per share attributable to common stockholders, basic and diluted		99,033,373			64,541,911
Basic and diluted net loss per common share outstanding	$	(0.29	)	$	(0.45	)

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 December 31, 2023 and 2022, the Company had pre-funded warrants to purchase 31,227,802 and 38,627,003 shares of common stock outstanding, respectively, 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, for the years ended December 31, 2023 and 2022.

The Company’s potential dilutive securities, which include stock options and warrants that are not pre-funded, 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 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 December 31,
	2023		2022
Warrants		9,703,704		9,703,704
Stock Options		5,312,300		4,450,283
		15,016,004		14,153,987

Income Taxes - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Income Taxes [Line Items]
Income tax benefit	$ 32,000	$ 36,000
Operating loss carryforwards		178,400,000
R&D tax credits		5,400,000
Current state and local tax benefits	32,000	36,000
Current research tax credit receivable	32,000	36,000
Deferred tax assets, capitalize research and development expenses	4,837,000	4,825,000
Deferred tax assets, valuation allowance	69,502,000	61,072,000
Increase (decrease) in deferred tax assets valuation allowance	8,400,000
Unrecognized tax benefits or related interest and penalties accrued	0	0
Federal and State [Member]
Income Taxes [Line Items]
Net operating loss carryforwards	8,100,000	8,700,000
Operating loss carryforwards	$ 186,900,000	178,700,000
Federal and State [Member] \| Earliest Tax Year [Member]
Income Taxes [Line Items]
Income tax examination year under examination	2013
Federal and State [Member] \| Latest Tax Year [Member]
Income Taxes [Line Items]
Income tax examination year under examination	2022
Federal [Member]
Income Taxes [Line Items]
R&D tax credits	$ 848,000	756,000
Percentage of taxable income offset by operating loss carryforwards	80.00%
Federal [Member] \| R&D [Member]
Income Taxes [Line Items]
Tax credits carryforwards	$ 6,200,000	5,400,000
Federal [Member] \| Earliest Tax Year [Member]
Income Taxes [Line Items]
Operating loss carryforwards expiration year	2031
Tax credit carryforwards expiration year	2032
Federal [Member] \| Latest Tax Year [Member]
Income Taxes [Line Items]
Operating loss carryforwards expiration year	2037
Tax credit carryforwards expiration year	2043
State [Member]
Income Taxes [Line Items]
R&D tax credits	$ 265,000	118,000
State [Member] \| R&D [Member]
Income Taxes [Line Items]
Tax credits carryforwards	$ 275,000	$ 244,000
State [Member] \| Earliest Tax Year [Member]
Income Taxes [Line Items]
Operating loss carryforwards expiration year	2031
State [Member] \| Latest Tax Year [Member]
Income Taxes [Line Items]
Operating loss carryforwards expiration year	2043

Consolidated Statements of Stockholders' Equity - USD ($) $ in Thousands	Total	At The Market Sales Agreement [Member]	Public And Private Placements [Member]	Common Stock [Member]	Common Stock [Member] At The Market Sales Agreement [Member]	Common Stock [Member] Public And Private Placements [Member]	Additional Paid-in Capital [Member]	Additional Paid-in Capital [Member] At The Market Sales Agreement [Member]	Additional Paid-in Capital [Member] Public And Private Placements [Member]	Accumulated Other Comprehensive Loss [Member]	Accumulated Deficit [Member]
Beginning Balance at Dec. 31, 2021	$ 17,075			$ 29			$ 197,963				$ (180,917)
Beginning Balance (in shares) at Dec. 31, 2021				28,505,804
Stock-based compensation	2,327						2,327
Issuance of common stock from exercise of stock options	139						139
Issuance of common stock from exercise of stock options (in shares)				51,005
Issuance of common stock from employee stock purchase plan	56						56
Issuance of common stock from employee stock purchase plan (in shares)				54,457
Issuance of common stock, net of commissions and allocated fees, less issuance costs		$ (42)	$ 105,395			$ 20		$ (42)	$ 105,375
Issuance of common stock, net of commissions and allocated fees, less issuance costs (in shares)						20,433,624
Issuance of common stock from warrant exercise	11,783			$ 11			11,772
Issuance of common stock from warrant exercise (in shares)				10,898,540
Unrealized gains (losses) on available-for-sale marketable securities	(122)									$ (122)
Net loss	(29,152)										(29,152)
Ending Balance at Dec. 31, 2022	107,459			$ 60			317,590			(122)	(210,069)
Ending Balance (in shares) at Dec. 31, 2022				59,943,430
Stock-based compensation	2,247						2,247
Issuance of common stock from exercise of stock options	$ 74						74
Issuance of common stock from exercise of stock options (in shares)	146,081			146,081
Issuance of common stock from employee stock purchase plan	$ 68						68
Issuance of common stock from employee stock purchase plan (in shares)				50,091
Issuance of common stock, net of commissions and allocated fees, less issuance costs		$ 1,671			$ 1			$ 1,670
Issuance of common stock, net of commissions and allocated fees, less issuance costs (in shares)					750,000
Issuance of common stock from pre-funded warrant exercise				$ 7			(7)
Issuance of common stock from pre-funded warrant exercise (in shares)				7,394,097
Unrealized gains (losses) on available-for-sale marketable securities	93									93
Net loss	(29,065)										(29,065)
Ending Balance at Dec. 31, 2023	$ 82,547			$ 68			$ 321,642			$ (29)	$ (239,134)
Ending Balance (in shares) at Dec. 31, 2023				68,283,699

Income Taxes - Significant Components of Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Income Tax Disclosure [Abstract]
Net operating loss carryforwards	$ 50,305	$ 48,030
Capitalized R&D	9,662	4,825
Federal and state tax credits	6,440	5,569
Other	3,647	2,868
Deferred tax assets	70,054	61,292
Other	(552)	(220)
Deferred tax liabilities	(552)	(220)
Valuation allowance	$ (69,502)	$ (61,072)

Leases - Schedule of Information Related to the Lease Terms and Discount Rates of Leases (Detail)	Dec. 31, 2023	Dec. 31, 2022
Weighted average remaining lease term:
Operating leases	4 years 3 months 18 days	3 months 18 days
Finance leases	1 year 3 months 18 days
Weighted average discount rate:
Operating leases	11.00%	13.00%
Finance leases	4.37%

Net Loss per Share (Tables)

12 Months Ended

Dec. 31, 2023

Earnings Per Share [Abstract]

Schedule of Earnings Per Share, Basic and Diluted

The following table summarizes the computation of basic and diluted net loss per share attributable to common stockholders of the Company (in thousands, except share and per share amounts):


	Year Ended December 31,
	2023			2022
Net loss	$	(29,065	)	$	(29,152	)
Weighted average common shares used in net loss per share attributable to common stockholders, basic and diluted		99,033,373			64,541,911
Basic and diluted net loss per common share outstanding	$	(0.29	)	$	(0.45	)

Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share

The following potential common shares, presented based on shares outstanding 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 December 31,
	2023		2022
Warrants		9,703,704		9,703,704
Stock Options		5,312,300		4,450,283
		15,016,004		14,153,987

Stockholders' Equity (Tables)

12 Months Ended

Dec. 31, 2023

Stockholders' Equity Note [Abstract]

Schedule of Common Stock Reserved for Future Issuance

he Company had reserved shares of common stock for future issuance as shown in the table below:


	December 31,
	2023		2022
Shares of common stock reserved for future issuance upon exercise of outstanding warrants and pre-funded warrants		40,931,506		48,330,707
Shares of common stock reserved for future issuance under the 2019 Stock Incentive Plan		6,549,183		4,553,202
Shares of common stock reserved for future issuance under the 2019 Employee Stock Purchase Plan		1,177,456		701,232
Shares of common stock reserved for future issuance under the 2012 Stock Incentive Plan		565,792		602,231
Shares to be issued upon sales under the LPC Purchase Agreement		—		30,000,000
		49,223,937		84,187,372

Warrant Activity Including Activity Related To Pre-funded Warrants

Warrant activity, including activity related to pre-funded warrants, 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		Weighted Average Contractual Term
Outstanding as of December 31, 2022		38,627,003			9,703,704		48,330,707		$	0.28		5.1
Exercised		(7,399,201	)		—		(7,399,201	)	$	0.001
Outstanding as of December 31, 2023		31,227,802			9,703,704		40,931,506		$	0.33		4.1

Schedule of Share-based Compensation, Stock Options, Activity

A summary of the Company’s combined stock option activity for the 2019 Plan and the 2012 Plan is as follows:


	Number of Option Shares			Weighted Average Exercise Price		Weighted Average Contractual Term		Aggregate Intrinsic Value
						(in years)		(in thousands)
Outstanding as of December 31, 2022		4,450,283		$	3.26		7.6	$	1,672
Granted		1,563,500		$	2.62
Forfeited		(318,075	)	$	1.77
Expired		(237,327	)	$	3.23
Exercised		(146,081	)	$	0.51
Outstanding as of December 31, 2023		5,312,300		$	3.24		7.3	$	685
Options exercisable as of December 31, 2023		2,805,959		$	4.16		6.0	$	273
Options unvested as of December 31, 2023		2,506,341		$	2.20		8.8	$	412

Range of Assumptions on Fair Value of the Stock Options Granted

The range of assumptions that the Company used to determine the fair value of the stock options granted were as follows:


	Year Ended December 31,
	2023		2022
Risk-free interest rate	3.4% - 4.8%		1.9% - 4.2%
Expected volatility	101.6% - 147.1%		101.7% - 108.6%
Expected dividend yield		—		—
Expected term (in years)	5.5 - 7.0		5.5 - 7.0

Schedule of Stock-based Compensation Expenses Recognized

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 Consolidated Statements of Comprehensive Loss (in thousands):


	Year Ended December 31,
	2023		2022
General and administrative expense	$	1,376	$	1,512
Research and development expense		871		815
	$	2,247	$	2,327

Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2023

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

Basis of Presentation

The accompanying 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 December 31, 2023 for potential recognition or disclosure in the Consolidated Financial Statements and concluded there were no subsequent events that required recognition or disclosure.

Use of Estimates

The preparation of financial statements in conformity with accounting principles generally accepted in the U.S. (“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 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. 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.

Cash Equivalents

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 or marketable securities on the Consolidated Balance Sheet. Marketable securities with an original maturity date greater than 90 days at each balance sheet date are classified as short-term. Marketable securities are classified as current assets as these investments are intended to be available to the Company for use in funding current operations. All of the Company’s marketable securities are considered available-for-sale and are reported at fair value. For securities with unrealized gains and losses, when the Company expects to receive cash flows sufficient to recover the amortized cost basis of a security, such gains and losses are included in accumulated other comprehensive income as a component of stockholders’ equity. Credit losses are identified when the Company does not expect to receive cash flows sufficient to recover the amortized cost basis of a security. In the event of a credit loss, only the amount associated with the credit loss is recognized in interest income, net on the Consolidated Statements of Comprehensive Loss. 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 Consolidated Statements of Comprehensive Loss. Realized gains and losses, if any, on marketable securities are included in interest income, net on the 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 credit losses 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 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 approximated its fair value due to its floating market-based interest rate. The fair value of the term loan derivative liability was 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. government agency obligations, corporate bonds, commercial paper, asset-backed securities 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

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).

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 other income, net in the 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 general and administrative expenses. The deferred offering costs are included in Other current and non-current assets on the 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 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 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, 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 it is probable the performance conditions will be 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 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 December 31, 2023 and December 31, 2022. 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. Leases are classified as either operating or finance, based on the Company’s evaluation of certain criteria. If a lease has a term greater than one year, the lease is recognized in the balance sheet as a right-of-use asset and a lease liability at lease commencement. The Company elected the short-term lease practical expedient, therefore, if a lease has a term less than one year, the Company will not recognize the lease on its balance sheet. The right-of-use asset represents the Company’s right of use to an underlying asset for the term of the lease and the lease liability represents the Company’s obligation to make lease payments arising from the lease.

If 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.

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. For operating leases, rent expense is recognized on a straight-line basis over the term of the lease, and right-of-use assets are subsequently re-measured to reflect the effect of uneven lease payments.

For finance leases, right-of-use assets are amortized on a straight-line basis over the shorter of the lease term or the useful life of the underlying asset. Expenses for finance leases include the amortization of right-of-use assets, which is recorded as depreciation and amortization expense, and interest expense, which reflects interest accrued on the lease liability.

Basic and Diluted Net Loss per Common Share

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 year ended December 31, 2023, which materially impacted the Company’s Consolidated Financial Statements.

Recently Issued Accounting Pronouncements

In November 2023, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures, which requires public entities to disclose information about their reportable segments’ significant expenses and other segment items on an interim and annual basis. Public entities with a single reportable segment are required to apply the disclosure requirements in ASU 2023-07, as well as all existing segment disclosures and reconciliation requirements in ASC 280, Segment Reporting, on an interim and annual basis. ASU 2023-07 is effective for fiscal years beginning after December 15, 2023, and for interim periods within fiscal years beginning after December 15, 2024, with early adoption permitted. The Company is currently evaluating the impact of adopting ASU 2023-07.

In December 2023, the FASB issued ASU 2023-09, Improvements to Income Tax Disclosures, which requires entities to disclose disaggregated information about their effective tax rate reconciliation as well as expanded information on income taxes paid by jurisdiction. The disclosure requirements will be applied on a prospective basis, with the option to apply them retrospectively. The standard is effective for fiscal years beginning after December 15, 2024, with early adoption permitted. The Company is currently evaluating the impact of adopting ASU 2023-09.

Net Loss per Share - Computation of Basic and Diluted Net Loss Per Share Attributable to Common Stockholders (Detail) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Earnings Per Share [Abstract]
Net loss	$ (29,065)	$ (29,152)
Weighted average common shares used in net loss per share attributable to common stockholders, basic	99,033,373	64,541,911
Weighted average common shares used in net loss per share attributable to common stockholders, diluted	99,033,373	64,541,911
Basic net loss per common share outstanding	$ (0.29)	$ (0.45)
Diluted net loss per common share outstanding	$ (0.29)	$ (0.45)

- Definition

The amount of net income (loss) for the period per each share of common stock or unit outstanding during the reporting period.

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- Definition

The amount of net income (loss) for the period available to each share of common stock or common unit outstanding during the reporting period and to each share or unit that would have been outstanding assuming the issuance of common shares or units for all dilutive potential common shares or units outstanding during the reporting period.

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+ Details

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References

+ Details

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2023

Income Tax Disclosure [Abstract]

Components of Income Tax Benefit

The components of the income tax benefit for the periods shown are as follows (in thousands):


	Year Ended December 31,
	2023			2022
Current:
Federal	$	—		$	—
State		(32	)		(36	)
		(32	)		(36	)
Deferred:
Federal		—			—
State		—			—
		—			—
Income tax benefit	$	(32	)	$	(36	)

Reconciliation Between Income Tax Benefit and Expected Tax Benefit at Statutory Rate

The following table provides a reconciliation between income tax benefit and the expected tax benefit at the statutory rate:


	Year Ended December 31,
	2023			2022
Federal statutory income tax rate		21.0	%		21.0	%
State income tax benefit—net of federal tax		5.8			5.8
R&D tax credits		2.9			2.5
Refundable tax credit		0.1			0.1
Permanent adjustments		(0.6	)		(0.6	)
Change in valuation allowance		(29.1	)		(28.7	)
Effective income tax rate		0.1	%		0.1	%

Significant Components of Deferred Tax Assets and Liabilities

Significant components of the Company’s deferred tax assets and liabilities are as follows (in thousands):


	December 31,
	2023			2022
Net operating loss carryforwards	$	50,305		$	48,030
Capitalized R&D		9,662			4,825
Federal and state tax credits		6,440			5,569
Other		3,647			2,868
Deferred tax assets		70,054			61,292

Other		(552	)		(220	)
Deferred tax liabilities		(552	)		(220	)

Valuation allowance		(69,502	)		(61,072	)
Net deferred tax asset	$	—		$	—

Summary of Significant Accounting Policies (Policies)	12 Months Ended
Summary of Significant Accounting Policies (Policies)	Dec. 31, 2023
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The accompanying 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 December 31, 2023 for potential recognition or disclosure in the Consolidated Financial Statements and concluded there were no subsequent events that required recognition or disclosure.
Use of Estimates	Use of Estimates The preparation of financial statements in conformity with accounting principles generally accepted in the U.S. (“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 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. 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.
Cash Equivalents	Cash Equivalents 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	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 or marketable securities on the Consolidated Balance Sheet. Marketable securities with an original maturity date greater than 90 days at each balance sheet date are classified as short-term. Marketable securities are classified as current assets as these investments are intended to be available to the Company for use in funding current operations. All of the Company’s marketable securities are considered available-for-sale and are reported at fair value. For securities with unrealized gains and losses, when the Company expects to receive cash flows sufficient to recover the amortized cost basis of a security, such gains and losses are included in accumulated other comprehensive income as a component of stockholders’ equity. Credit losses are identified when the Company does not expect to receive cash flows sufficient to recover the amortized cost basis of a security. In the event of a credit loss, only the amount associated with the credit loss is recognized in interest income, net on the Consolidated Statements of Comprehensive Loss. 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 Consolidated Statements of Comprehensive Loss. Realized gains and losses, if any, on marketable securities are included in interest income, net on the 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 credit losses 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	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 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 approximated its fair value due to its floating market-based interest rate. The fair value of the term loan derivative liability was 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. government agency obligations, corporate bonds, commercial paper, asset-backed securities 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	Property, Equipment and Leasehold Improvements 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).
Foreign Currency Transactions	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 other income, net in the Consolidated Statements of Comprehensive Loss.
Deferred Offering Costs	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 general and administrative expenses. The deferred offering costs are included in Other current and non-current assets on the Consolidated Balance Sheets.
Research and Development ("R&D") Expenses	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 expenses both internal and external R&D expenses as they are incurred.
Accrued R&D Expenses	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 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	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	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, 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	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 it is probable the performance conditions will be achieved. The Company reassesses the probability of achieving the performance conditions at each reporting date. Forfeitures are accounted for as they occur.
Income Taxes	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 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 December 31, 2023 and December 31, 2022. The Company does not have any interest or penalties accrued related to tax positions as it does not have any unrecognized tax benefits.
Leases	Leases Under ASC 842, Leases (“ASC 842”), the Company determines if an arrangement is a lease at its inception. Leases are classified as either operating or finance, based on the Company’s evaluation of certain criteria. If a lease has a term greater than one year, the lease is recognized in the balance sheet as a right-of-use asset and a lease liability at lease commencement. The Company elected the short-term lease practical expedient, therefore, if a lease has a term less than one year, the Company will not recognize the lease on its balance sheet. The right-of-use asset represents the Company’s right of use to an underlying asset for the term of the lease and the lease liability represents the Company’s obligation to make lease payments arising from the lease. If 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. 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. For operating leases, rent expense is recognized on a straight-line basis over the term of the lease, and right-of-use assets are subsequently re-measured to reflect the effect of uneven lease payments. For finance leases, right-of-use assets are amortized on a straight-line basis over the shorter of the lease term or the useful life of the underlying asset. Expenses for finance leases include the amortization of right-of-use assets, which is recorded as depreciation and amortization expense, and interest expense, which reflects interest accrued on the lease liability.
Basic and Diluted Net Loss per Common Share	Basic and Diluted Net Loss per Common Share 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	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 and Issued Accounting Pronouncements	Recently Adopted Accounting Pronouncements There have been no new pronouncements adopted during the year ended December 31, 2023, which materially impacted the Company’s Consolidated Financial Statements. Recently Issued Accounting Pronouncements In November 2023, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures, which requires public entities to disclose information about their reportable segments’ significant expenses and other segment items on an interim and annual basis. Public entities with a single reportable segment are required to apply the disclosure requirements in ASU 2023-07, as well as all existing segment disclosures and reconciliation requirements in ASC 280, Segment Reporting, on an interim and annual basis. ASU 2023-07 is effective for fiscal years beginning after December 15, 2023, and for interim periods within fiscal years beginning after December 15, 2024, with early adoption permitted. The Company is currently evaluating the impact of adopting ASU 2023-07. In December 2023, the FASB issued ASU 2023-09, Improvements to Income Tax Disclosures, which requires entities to disclose disaggregated information about their effective tax rate reconciliation as well as expanded information on income taxes paid by jurisdiction. The disclosure requirements will be applied on a prospective basis, with the option to apply them retrospectively. The standard is effective for fiscal years beginning after December 15, 2024, with early adoption permitted. The Company is currently evaluating the impact of adopting ASU 2023-09.

Retirement Plan	12 Months Ended
Retirement Plan	Dec. 31, 2023
Retirement Benefits [Abstract]
Retirement Plan	14. Retirement Plan In March 2013, the Company adopted and became a participating employer of a multiple employer defined contribution retirement plan that complies with Section 401(k) of the Code. All eligible employees of the Company are able to immediately participate in the plan (with an entry date of the first day of any month), with no minimum service requirement. The 401(k) plan provides that the Company make non-discretionary matching contributions of 50% of the first 6% of elective contributions. Participants are immediately vested in their contributions, as well as any earnings thereon. Vesting in the employer match contribution portion of their accounts, as well as any earnings thereon, is based on years of credited service, vesting over a four-year period, with 25% vesting per completed year. The Company’s expense under the 401(k) plan, representing its employer matching contributions and additional contributions in accordance with regulatory compliance requirements, totaled $126 and $90 for the years ended December 31, 2023 and 2022, respectively.

Document and Entity Information - USD ($) $ in Millions	12 Months Ended
Document and Entity Information - USD ($) $ in Millions	Dec. 31, 2023	Mar. 20, 2024	Jun. 30, 2023
Cover [Abstract]
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2023
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	FY
Entity Registrant Name	TREVI THERAPEUTICS, INC.
Entity Central Index Key	0001563880
Entity Current Reporting Status	Yes
Entity Voluntary Filers	No
Entity Interactive Data Current	Yes
Current Fiscal Year End Date	--12-31
Entity Filer Category	Non-accelerated Filer
Entity Well-known Seasoned Issuer	No
Entity Public Float			$ 105.6
Entity Common Stock, Shares Outstanding		68,960,167
Entity Shell Company	false
Entity Small Business	true
Entity Emerging Growth Company	true
Entity Ex Transition Period	true
Title of 12(b) Security	Common Stock, $0.001 par value per share
Trading Symbol	TRVI
Security Exchange Name	NASDAQ
Entity File Number	001-38886
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	45-0834299
Entity Address, Address Line One	195 Church Street
Entity Address, Address Line Two	16th Floor
Entity Address, City or Town	New Haven
Entity Address, State or Province	CT
Entity Address, Postal Zip Code	06510
City Area Code	203
Local Phone Number	304-2499
Document Annual Report	true
Document Transition Report	false
ICFR Auditor Attestation Flag	false
Document Financial Statement Error Correction	false
Auditor Firm ID	42
Auditor Name	Ernst & Young LLP
Auditor Location	Hartford, Connecticut
Documents Incorporated by Reference	Portions of the Proxy Statement for the registrant’s 2024 Annual Meeting of Stockholders are incorporated by reference into Part III of this Annual Report on Form 10-K.

Leases - Schedule of Lease-related Assets and Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Assets:
Operating lease right-of-use asset	$ 1,137	$ 24
Finance lease right-of-use assets	206
Total lease assets	1,343	24
Liabilities:
Operating lease liabilities, current portion	184	25
Finance lease liabilities, current portion	122
Operating lease liabilities, long term portion	1,001	2
Finance lease liabilities, long term portion	31
Total lease liabilities	$ 1,338	$ 27

Consolidated Balance Sheets (Parenthetical) - $ / shares	Dec. 31, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Preferred Stock, Par or Stated Value Per Share	$ 0.001	$ 0.001
Preferred Stock, Shares Authorized	5,000,000	5,000,000
Preferred Stock, Shares Issued	0	0
Preferred Stock, Shares Outstanding	0	0
Common Stock, Par or Stated Value Per Share	$ 0.001	$ 0.001
Common Stock, Shares Authorized	200,000,000	200,000,000
Common Stock, Shares, Issued	68,283,699	59,943,430
Common Stock, Shares, Outstanding	68,283,699	59,943,430

Property, Equipment and Leasehold Improvements, Net - Summary of Property, Equipment and Leasehold Improvements, Net (Detail) - USD ($) $ in Thousands	Dec. 31, 2023	Dec. 31, 2022
Property Plant And Equipment [Line Items]
Property, equipment and leasehold improvements	$ 350	$ 395
Less: Accumulated depreciation and amortization	(134)	(225)
Total property, equipment and leasehold improvements, net	216	170
Computer, Website Development And Office Equipment [Member]
Property Plant And Equipment [Line Items]
Property, equipment and leasehold improvements	263	175
Furniture And Fixtures [Member]
Property Plant And Equipment [Line Items]
Property, equipment and leasehold improvements	41	37
Leasehold Improvements [Member]
Property Plant And Equipment [Line Items]
Property, equipment and leasehold improvements	29	130
Construction in Progress [Member]
Property Plant And Equipment [Line Items]
Property, equipment and leasehold improvements	$ 17	$ 53

Consolidated Statements of Comprehensive Loss - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Operating expenses:
Research and development	$ 23,683	$ 19,834
General and administrative	10,240	10,073
Total operating expenses	33,923	29,907
Loss from operations	(33,923)	(29,907)
Other income (expense):
Interest income, net	4,748	1,740
Other income, net	469	289
Interest expense	(391)	(1,163)
Change in fair value of term loan derivative liability		(147)
Total other income, net	4,826	719
Loss before income taxes	(29,097)	(29,188)
Income tax benefit	32	36
Net loss	$ (29,065)	$ (29,152)
Basic net loss per common share outstanding	$ (0.29)	$ (0.45)
Diluted net loss per common share outstanding	$ (0.29)	$ (0.45)
Weighted average common shares used in net loss per share attributable to common stockholders, basic	99,033,373	64,541,911
Weighted average common shares used in net loss per share attributable to common stockholders, diluted	99,033,373	64,541,911
Net loss	$ (29,065)	$ (29,152)
Other comprehensive loss:
Net unrealized gains (losses) on available-for-sale marketable securities	93	(122)
Comprehensive loss	$ (28,972)	$ (29,274)

Stockholders' Equity - Additional Information (Detail)								1 Months Ended					12 Months Ended
Stockholders' Equity - Additional Information (Detail)	Aug. 15, 2023 USD ($) shares	Jul. 23, 2023 shares	Sep. 27, 2022 USD ($) $ / shares shares	Apr. 06, 2022 USD ($) $ / shares shares	Oct. 18, 2021 USD ($) PrivatePlacement $ / shares shares	Oct. 05, 2021 USD ($) $ / shares shares	Jun. 18, 2021 shares	Feb. 29, 2024 shares	Jun. 30, 2023 USD ($)	May 31, 2022 USD ($)	Oct. 31, 2021 PrivatePlacement	Jun. 30, 2020 USD ($)	Dec. 31, 2023 USD ($) $ / shares shares	Dec. 31, 2022 USD ($) $ / shares shares
Stockholders Equity [Line Items]
Preferred Stock, Shares Authorized													5,000,000	5,000,000
Preferred Stock, Par or Stated Value Per Share \| $ / shares													$ 0.001	$ 0.001
Common stock, shares authorized													200,000,000	200,000,000
Common stock, par or stated value per share \| $ / shares													$ 0.001	$ 0.001
Estimated commissions and allocated fees \| $													$ 258,000	$ 226,000
Proceeds from sale of common stock and warrants under public and private placements, net of issuance costs \| $														$ 105,410,000
Share based compensation options grants in the period													1,563,500
Subsequent Event [Member] \| Performance-Based Vesting Stock Options [Member]
Stockholders Equity [Line Items]
Share based compensation options grants in the period								832,250
Private Placement [Member]
Stockholders Equity [Line Items]
Number of private placements \| PrivatePlacement											2
Private Placement [Member] \| Investor [Member]
Stockholders Equity [Line Items]
Warrants to purchase aggregate shares of common stock						9,852,138
Private Placement [Member] \| New Enterprise Associates 16, L.P [Member]
Stockholders Equity [Line Items]
Warrants to purchase aggregate shares of common stock					3,703,704
Proceeds from sale of common stock and warrants under public and private placements, net of issuance costs \| $					$ 13,700,000
Number of private placements \| PrivatePlacement					2
Proceeds from issuance of private placement net of issuance costs \| $					$ 1,100,000
September 2022 Offering [Member] \| Underwriting Agreement [Member]
Stockholders Equity [Line Items]
Proceeds from sale of common stock and warrants under public and private placements, net of issuance costs \| $			$ 58,100,000
Warrants expiration date			Sep. 27, 2022
Common Stock [Member] \| Private Placement [Member] \| Investor [Member]
Stockholders Equity [Line Items]
Sale of stock during the period						2,373,201
Warrants to purchase aggregate shares of common stock						4,746,402
Common Stock [Member] \| Private Placement [Member] \| New Enterprise Associates 16, L.P [Member]
Stockholders Equity [Line Items]
Sale of stock during the period					1,851,852
Common Stock [Member] \| Private Placement [Member] \| Securities Purchase Agreement [Member]
Stockholders Equity [Line Items]
Sale of stock during the period				4,580,526
Combined price of each shares \| $ / shares				$ 1.9
Common Stock [Member] \| September 2022 Offering [Member] \| Underwriting Agreement [Member]
Stockholders Equity [Line Items]
Sale of stock during the period			14,252,670
Combined price of each shares \| $ / shares			$ 1.93
Exercise price per share of warrants \| $ / shares			$ 0.001
Pre-funded Warrants [Member] \| Private Placement [Member] \| Investor [Member]
Stockholders Equity [Line Items]
Exercise price per share of warrants \| $ / shares						$ 0.001
Pre-funded Warrants [Member] \| Private Placement [Member] \| Securities Purchase Agreement [Member]
Stockholders Equity [Line Items]
Combined price of each shares \| $ / shares				$ 1.899
Proceeds from sale of common stock and warrants under public and private placements, net of issuance costs \| $				$ 55,000,000
Exercise price per share of warrants \| $ / shares				$ 0.001
Pre-funded Warrants [Member] \| September 2022 Offering [Member] \| Underwriting Agreement [Member]
Stockholders Equity [Line Items]
Warrants to purchase aggregate shares of common stock			14,247,330
Combined price of each shares \| $ / shares			$ 1.929
Options to purchase additional shares			1,600,428
Common Stock and Accompanying Common Stock Warrants [Member] \| Private Placement [Member] \| Investor [Member]
Stockholders Equity [Line Items]
Combined price of each shares \| $ / shares						1.62
Common Stock and Accompanying Common Stock Warrants [Member] \| Private Placement [Member] \| New Enterprise Associates 16, L.P [Member]
Stockholders Equity [Line Items]
Combined price of each shares \| $ / shares					$ 1.62
Proceeds from sale of common stock and warrants under public and private placements, net of issuance costs \| $					$ 3,000,000
Pre-funded Warrant and Accompanying Common Stock Warrants [Member] \| Private Placement [Member] \| Investor [Member]
Stockholders Equity [Line Items]
Combined price of each shares \| $ / shares						$ 1.619
Proceeds from sale of common stock and warrants under public and private placements, net of issuance costs \| $						$ 11,800,000
Common Stock Warrants \| Private Placement [Member] \| Investor [Member]
Stockholders Equity [Line Items]
Warrants to purchase aggregate shares of common stock						7,299,270
Exercise price per share of warrants \| $ / shares						$ 1.37
Warrants expiration date						Apr. 05, 2025
Common Stock Warrants \| Private Placement [Member] \| New Enterprise Associates 16, L.P [Member]
Stockholders Equity [Line Items]
Warrants to purchase aggregate shares of common stock					1,851,852
Exercise price per share of warrants \| $ / shares					$ 1.37
Warrants expiration date					Apr. 18, 2025
Warrants [Member] \| Private Placement [Member] \| Investor [Member]
Stockholders Equity [Line Items]
Warrants to purchase aggregate shares of common stock						7,299,270
Warrants expiration date						Oct. 05, 2028
Warrants [Member] \| Private Placement [Member] \| New Enterprise Associates 16, L.P [Member]
Stockholders Equity [Line Items]
Warrants to purchase aggregate shares of common stock					1,851,852
Warrants expiration date					Oct. 18, 2028
Maximum [Member] \| Pre-funded Warrants [Member] \| Private Placement [Member] \| Investor [Member]
Stockholders Equity [Line Items]
Warrants to purchase aggregate shares of common stock						4,926,069
Maximum [Member] \| Pre-funded Warrants [Member] \| Private Placement [Member] \| Securities Purchase Agreement [Member]
Stockholders Equity [Line Items]
Warrants to purchase aggregate shares of common stock				24,379,673
Maximum [Member] \| Pre-funded Warrants [Member] \| September 2022 Offering [Member] \| Underwriting Agreement [Member]
Stockholders Equity [Line Items]
Warrants to purchase aggregate shares of common stock			4,275,000
ATM Sales Agreement [Member]
Stockholders Equity [Line Items]
Aggregate offering price of common stock which may issue and sell under agreement \| $									$ 75,000,000	$ 50,000,000		$ 12,000,000.0	$ 62,000,000
Sale of stock during the period	4,333,394
Proceeds from issuance of common stock \| $	$ 12,700,000
Proceeds from issuance of common stock, preferred stock, debt securities, units and or warrants \| $									$ 200,000,000
Estimated commissions and allocated fees \| $	$ 1,000,000
Common Stock Purchase Agreement [Member] \| Lincoln Park Capital Fund, LLC [Member]
Stockholders Equity [Line Items]
Shares agreed to be issued over period under equity line financing							24 months
Issuance of common stock to Lincoln Park Capital Fund (in shares)							170,088
Common Stock Purchase Agreement [Member] \| Lincoln Park Capital Fund, LLC [Member] \| Maximum [Member]
Stockholders Equity [Line Items]
Sale of stock during the period		0
Shares agreed to be issued under equity line financing							15,000,000.0

Property, Equipment and Leasehold Improvements, Net

12 Months Ended

Dec. 31, 2023

Property, Plant and Equipment [Abstract]

Property, Equipment and Leasehold Improvements, Net

Property, equipment and leasehold improvements, net consist of the following (in thousands):


	December 31,
	2023			2022
Computer, website development and office equipment	$	263		$	175
Furniture and fixtures		41			37
Leasehold improvements		29			130
Construction in progress		17			53
		350			395
Less: Accumulated depreciation and amortization		(134	)		(225	)
Total property, equipment and leasehold improvements, net	$	216		$	170

Depreciation was $81 and $43 for the years ended December 31, 2023 and 2022, respectively.

Stockholders' Equity - Warrant Activity Including Activity Related To Pre-funded Warrants (Detail) - $ / shares	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Pre-funded Warrants [Member]
Share-Based Compensation Arrangement by Share-Based Payment Award, Non-Option Equity Instruments, Outstanding [Roll Forward]
Outstanding, Beginning	38,627,003
Exercised	(7,399,201)
Outstanding, Ending	31,227,802	38,627,003
Common Stock Warrant [Member]
Share-Based Compensation Arrangement by Share-Based Payment Award, Non-Option Equity Instruments, Outstanding [Roll Forward]
Outstanding, Beginning	9,703,704
Outstanding, Ending	9,703,704	9,703,704
Warrants [Member]
Share-Based Compensation Arrangement by Share-Based Payment Award, Non-Option Equity Instruments, Outstanding [Roll Forward]
Outstanding, Beginning	48,330,707
Exercised	(7,399,201)
Outstanding, Ending	40,931,506	48,330,707
Weighted Average Exercise Price
Outstanding, Beginning	$ 0.28
Exercised	0.001
Outstanding, Ending	$ 0.33	$ 0.28
Weighted Average Contractual Term, Outstanding	4 years 1 month 6 days	5 years 1 month 6 days

Income Taxes

12 Months Ended

Dec. 31, 2023

Income Tax Disclosure [Abstract]

Income Taxes

10.

Income Taxes

The Company recorded an income tax benefit related to state research and development tax credits. The components of the income tax benefit for the periods shown are as follows (in thousands):


	Year Ended December 31,
	2023			2022
Current:
Federal	$	—		$	—
State		(32	)		(36	)
		(32	)		(36	)
Deferred:
Federal		—			—
State		—			—
		—			—
Income tax benefit	$	(32	)	$	(36	)

The following table provides a reconciliation between income tax benefit and the expected tax benefit at the statutory rate:


	Year Ended December 31,
	2023			2022
Federal statutory income tax rate		21.0	%		21.0	%
State income tax benefit—net of federal tax		5.8			5.8
R&D tax credits		2.9			2.5
Refundable tax credit		0.1			0.1
Permanent adjustments		(0.6	)		(0.6	)
Change in valuation allowance		(29.1	)		(28.7	)
Effective income tax rate		0.1	%		0.1	%

Significant components of the Company’s deferred tax assets and liabilities are as follows (in thousands):


	December 31,
	2023			2022
Net operating loss carryforwards	$	50,305		$	48,030
Capitalized R&D		9,662			4,825
Federal and state tax credits		6,440			5,569
Other		3,647			2,868
Deferred tax assets		70,054			61,292

Other		(552	)		(220	)
Deferred tax liabilities		(552	)		(220	)

Valuation allowance		(69,502	)		(61,072	)
Net deferred tax asset	$	—		$	—

For the years ended December 31, 2023 and 2022, the Company generated federal and state net operating losses (“NOLs”) of approximately $8.1 million and $8.7 million, respectively. At December 31, 2023 and 2022, the federal and state net operating loss balances were approximately $186.9 million and $178.7 million, respectively. The federal operating losses generated prior to 2018 will expire in years 2031 through 2037, unless previously utilized. The federal operating losses generated in 2018 or later can be carried forward indefinitely, however will only offset 80% of taxable income in a carryforward year. The state operating losses generated will expire in years 2031 through 2043, unless previously utilized. The Company also generated federal R&D tax credits for the years ended December 31, 2023 and 2022 of approximately $848 and $756, respectively. At December 31, 2023 and 2022, the federal R&D tax credit carryforwards were approximately $6.2 million and $5.4 million, respectively. These credits will expire in years 2032 through 2043, unless previously utilized. The Company completed a detailed Section 382 analysis, and due to multiple historical ownership changes, the Company's NOLs as of December 31, 2022, in the amount of $178.4 million and R&D tax credits in the amount of $5.4 million are subject to limitation. If a further ownership change occurs, the Company's ability to use its tax attributes might be further limited.

The Company also generated state research tax credits for the years ended December 31, 2023 and 2022 of approximately $265 and $118, respectively. At December 31, 2023 and 2022, the state R&D tax credit carryforwards were approximately $275 and $244, respectively. The Company applied to exchange a portion of these credits for cash under a state-run program. These amounts, $32 and $36 for the years ended December 31, 2023 and 2022, respectively, were recognized as current income tax benefits in the Company’s Consolidated Statements of Comprehensive Loss. At each of December 31, 2023 and 2022, the Company’s Consolidated Balance Sheets reflect income tax receivables of $32 and $36 respectively, related to these credits. Because of the net operating loss and research credit carryforwards, tax years 2013 through 2022 remain open to U.S. federal and state tax examinations.

Beginning in 2022, the Tax Cuts and Jobs Act of 2017 ("TCJA") eliminated the option to deduct research and development expenditures in the current year and requires taxpayers to amortize U.S. expenses over five years and non-U.S. expenses over fifteen years pursuant to Internal Revenue Code Section 174. In the future, Congress may consider legislation that would defer the amortization requirement to later years, possibly with retroactive effect. In the meantime, we expect to continue to capitalize research and development expenses under the current tax law. The impact of Section 174 on the Company's deferred tax assets depends on the amount of research and development expenditures incurred by the Company and whether the IRS issues guidance on the provision, which differs from the Company's current interpretation, among other things. For the for the years ended December 31, 2023 and 2022 , this provision resulted in deferred tax assets of $4,837 and $4,825, respectively.

Income taxes are provided using the asset/liability method, in which deferred taxes are recognized for the tax consequences of temporary differences between the financial statement carrying amounts and tax bases of existing assets and liabilities. The Company reviews deferred tax assets for recoverability on a regular basis. In assessing the need for a valuation allowance, the Company considers both positive and negative evidence related to the likelihood of realization of the deferred tax assets. The weight given to the positive and negative evidence is commensurate with the extent to which the evidence may be objectively verified. Accounting guidance states that a cumulative loss in recent years is a significant piece of negative evidence that is difficult to overcome in determining that a valuation allowance is not needed against deferred tax assets. As such, it is generally difficult for positive evidence regarding projected future taxable income exclusive of reversing taxable temporary differences to outweigh objective negative evidence of recent financial reporting losses.

The Company determined that operating losses it incurred since its inception on March 17, 2011, represented negative evidence sufficient to conclude a valuation allowance was necessary. As such, the Company has recorded a valuation allowance of $69.5 million and $61.1 million at December 31, 2023 and 2022, respectively, as a reserve against its net deferred tax assets. These balances reflect increases in the valuation allowance of $8.4 million in each of 2023 and 2022, both representing an increase in net deferred tax assets.

The Company applies the provisions of 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. The financial statements reflect expected future tax consequences of such positions presuming the taxing authorities possess full knowledge of the position and all relevant facts. As a result of the implementation of ASC 740, the Company recognized no adjustment for unrecognized income tax benefits. The Company has not, as of yet, conducted a study of R&D tax credit carryforwards. Such a study could result in an adjustment to the Company’s R&D tax credit carryforwards; however, until a study is completed and any potential adjustment is known, no amounts are being presented as an uncertain tax position. A full valuation allowance has been provided against the Company’s R&D tax credits and, if an adjustment is required in the future, this adjustment would be offset by a corresponding adjustment to the valuation allowance. For the years ended December 31, 2023 and 2022, the Company had no unrecognized tax benefits or related interest and penalties accrued. In the event the Company determines that accrual of interest or penalties are necessary in the future, the amount will be presented as a component of interest expense.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480990/946-20-50-13

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(h)(2))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480678/235-10-S99-1

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org//740/tableOfContent

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 14
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482685/740-10-50-14

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 21
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482685/740-10-50-21

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
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-Name Accounting Standards Codification
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-Paragraph 1
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-URI https://asc.fasb.org//1943274/2147482526/740-270-50-1

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
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-Name Accounting Standards Codification
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-Paragraph 17
-Subparagraph (b)
-Publisher FASB
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 2
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 30
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482603/740-30-50-2

+ Details

Income Taxes - Components of Income Tax Benefit (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Current:
State	$ (32)	$ (36)
Current Federal, State and Local, Tax Expense (Benefit), Total	(32)	(36)
Deferred:
Income tax benefit	$ (32)	$ (36)

- Definition

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References + Details

Net Loss per Share - Additional Information (Detail) - shares	Dec. 31, 2023	Dec. 31, 2022
April 2022 Private Placement [Member]
Earnings Per Share Basic [Line Items]
Pre-funded warrants to purchase of common stock	31,227,802	38,627,003

Accrued Expenses (Tables)

12 Months Ended

Dec. 31, 2023

Payables and Accruals [Abstract]

Schedule of Accrued Expenses

Accrued expenses consist of the following (in thousands):


	December 31,
	2023		2022
Accrued compensation and benefits	$	1,614	$	1,508
Accrued R&D projects		1,579		1,130
Accrued consulting and professional fees		510		382
Accrued other		6		498
Total accrued expenses	$	3,709	$	3,518

Fair Value Measurements - Schedule of Fair Value, Financial Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation (Detail) - Fair Value, Measurements, Recurring [Member] $ in Thousands	12 Months Ended
	Dec. 31, 2022 USD ($)
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Balance at beginning of period	$ 114
Net settlements (see Note 8)	(261)
Term Loan Derivative Liability [Member]
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Change in fair value of term loan derivative liability	$ 147

Accrued Expenses

12 Months Ended

Dec. 31, 2023

Payables and Accruals [Abstract]

Accrued Expenses

Accrued expenses consist of the following (in thousands):


	December 31,
	2023		2022
Accrued compensation and benefits	$	1,614	$	1,508
Accrued R&D projects		1,579		1,130
Accrued consulting and professional fees		510		382
Accrued other		6		498
Total accrued expenses	$	3,709	$	3,518

Debt

12 Months Ended

Dec. 31, 2023

Debt Disclosure [Abstract]

Debt

Silicon Valley Bank Term Loan

On May 9, 2023, the Company paid the remaining amount due under the SVB Loan Agreement, resulting in the full extinguishment of the SVB Term Loan (as described below). The total payoff amount was $6.5 million, consisting of the remaining principal amount due of $5.2 million, the final payment fee of $1.2 million, and $0.1 million of accrued interest and prepayment premium.

On August 13, 2020 (the “Effective Date”), the Company entered into a loan and security agreement (the “SVB Loan Agreement”) with Silicon Valley Bank (“SVB”), as lender, 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 bore 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 was required to make monthly interest payments and 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 were due and payable in full on February 1, 2024. The SVB Loan Agreement permitted voluntary prepayment of all, but not less than all, of the SVB Term Loan, subject to a prepayment premium. Such prepayment premium would have been 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 was required to pay a final payment fee equal to $1.2 million. The SVB Term Loan and related obligations under the SVB Loan Agreement were secured by substantially all of the Company’s properties, rights and assets, except for its intellectual property (which was 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 have been 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 have been 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 have been 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 at-the-market sales agreement entered into with SVB Securities LLC (formerly SVB Leerink LLC) (“SVB Securities”) in June 2020 (the “ATM Sales Agreement”) and two private placements, which took place in October 2021 (see Note 9).

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 have been 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 have terminated and the sole remaining trigger for cash collateralization would have been 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 IPF. In addition, the Third Amendment modified the interest rate on the principal amount outstanding under the SVB Loan Agreement. As a result of the Third Amendment, amounts outstanding under the SVB Loan Agreement accrued 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 contained customary representations, warranties, events of default and covenants. The occurrence and continuation of an event of default could have caused interest to be charged at the rate that was otherwise applicable plus 5.00% (unless SVB selected to impose a smaller increase) and would have provided 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 restricted 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 were 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 were amortized over the 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 were amortized over the life of the SVB Term Loan using the effective interest method.

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 were included as a reduction in the balance of the term loan payable on the Company’s Consolidated Balance Sheets and were accreted over the life of the SVB Term Loan using the effective interest method.

In connection with the SVB Loan Agreement, the Company was obligated to pay a final payment fee of $1.2 million upon repayment in full of the SVB Term Loan. The final payment fee was accrued over the life of the SVB Term Loan using the effective interest method and was included as an increase in the balance of the term loan payable on the Company’s Consolidated Balance Sheets. The Company paid this final payment fee of $1.2 million on May 9, 2023 in connection with the payoff in full of the SVB Term Loan.

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 income (expense), net in the Company’s Consolidated Statements of Comprehensive Loss. The term loan derivative liability was previously presented as a current liability on the Company’s Consolidated Balance Sheets. Upon recording such term loan derivative liability, the Company also recorded an offsetting term loan discount – interest, that was amortized to interest expense in the Company’s Consolidated Statements of Comprehensive Loss through the SVB Term Loan’s maturity date using the effective interest method. 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 in 2022. The term loan derivative liability was then settled and reclassified to both current and non-current interest payable, which were presented as accrued liabilities and other non-current liabilities on the Company’s Consolidated Balance Sheet.

During the year ended December 31, 2023, an immaterial effect from early extinguishment of debt was recorded in connection with the Company paying the remaining amounts due under the SVB Loan Agreement, which was included in other income, net on the Company’s Consolidated Statements of Comprehensive Loss.

As of December 31, 2023, the Company had no outstanding borrowings, and as of December 31, 2022, the Company had outstanding borrowings of $8.2 million, under the SVB Term Loan and the term loan payable balance as presented in the Company’s Consolidated Balance Sheet was comprised as shown below (in thousands).


	December 31, 2022
Principal outstanding under term loan	$	8,167
Term loan discount-interest		(24	)
Term loan discount-unamortized deferred charges		(29	)
Term loan discount-financing costs, net of accretion		(3	)
Term loan-final payment fee		1,040
		9,151
Less current portion		7,000
Term loan payable, non-current	$	2,151


	Year Ended December 31,
	2023		2022
Interest payments	$	202	$	643
Accrual of the final payment fee		150		383
Accretion and amortization of term loan discounts		30		137
	$	382	$	1,163

- Definition

The entire disclosure for information about short-term and long-term debt arrangements, which includes amounts of borrowings under each line of credit, note payable, commercial paper issue, bonds indenture, debenture issue, own-share lending arrangements and any other contractual agreement to repay funds, and about the underlying arrangements, rationale for a classification as long-term, including repayment terms, interest rates, collateral provided, restrictions on use of assets and activities, whether or not in compliance with debt covenants, and other matters important to users of the financial statements, such as the effects of refinancing and noncompliance with debt covenants.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1B
-Subparagraph (h)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1B

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(c))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480678/235-10-S99-1

Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef
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-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org//470/tableOfContent

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1B

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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-Section 50
-Paragraph 1B
-Subparagraph (g)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1B

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-Subparagraph (i)
-Publisher FASB
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
-Section 50
-Paragraph 1C
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-Publisher FASB
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1C

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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-Section 50
-Paragraph 1E
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1E

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
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-Publisher FASB
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Reference 12: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
-Section 50
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-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1I

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
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-Section 50
-Paragraph 1I
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1I

+ Details

Marketable Securities (Tables)

12 Months Ended

Dec. 31, 2023

Investments, Debt and Equity Securities [Abstract]

Schedule of Fair Value And Amortized Cost Of Available-for-sale Marketable Securities

The fair value and amortized cost of available-for-sale marketable securities by major security type are presented in the following tables as of the periods presented (in thousands):


	December 31, 2023
Type of security	Amortized Cost		Gross Unrealized Gains		Gross Unrealized Losses			Estimated Fair Value
Corporate bonds	$	45,686	$	20	$	(53	)	$	45,653
U.S. government agency securities		4,917		9		(5	)		4,921
Total marketable securities	$	50,603	$	29	$	(58	)	$	50,574


	December 31, 2022
Type of Security	Amortized Cost		Gross Unrealized Gains		Gross Unrealized Losses			Estimated Fair Value
Corporate bonds	$	62,573	$	83	$	(143	)	$	62,513
Commercial paper		30,739		—		—			30,739
U.S. treasury securities		9,914		—		(62	)		9,852
U.S. government agency securities		2,905		2		(4	)		2,903
Asset backed securities		1,912		2		—			1,914
Total marketable securities	$	108,043	$	87	$	(209	)	$	107,921

Summary Of Contractual Maturities Of Available-for-sale Marketable Securities


	December 31, 2023
	Amortized Cost		Fair Value
Due to mature:
Less than one year	$	49,651	$	49,618
One year through two years		952		956
Total	$	50,603	$	50,574


	December 31, 2022
	Amortized Cost		Fair Value
Due to mature:
Less than one year	$	69,527	$	69,367
One year through two years		38,516		38,554
Total	$	108,043	$	107,921

Debt - Schedule of Components of Interest Expense of Term Loan (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
Interest expense	$ 391	$ 1,163
SVB Term Loan [Member]
Debt Instrument [Line Items]
Interest payments	202	643
Accrual of the final payment fee	150	383
Accretion and amortization of term loan discounts	30	137
Interest expense	$ 382	$ 1,163

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 835
-SubTopic 30
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
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-URI https://asc.fasb.org//1943274/2147481568/470-20-55-69F

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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-Subparagraph (b)
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

- Definition

Amount of the cost of borrowed funds accounted for as interest expense.

+ References + Details

Retirement Plan - Additional Information (Detail) - USD ($) $ in Thousands		12 Months Ended
	Mar. 31, 2013	Dec. 31, 2023	Dec. 31, 2022
Retirement Benefits [Abstract]
Matching contributions, percent	50.00%
Defined contribution plan elective contributions percent of match	6.00%
Defined contribution plan, vesting period	4 years
Defined contribution plan, employers matching contribution, annual vesting percentage	25.00%
Defined contribution plan employers matching contribution compliance with regulatory capital requirements		$ 126	$ 90

Property, Equipment and Leasehold Improvements, Net (Tables)

12 Months Ended

Dec. 31, 2023

Property, Plant and Equipment [Abstract]

Summary of Property, Equipment and Leasehold Improvements, Net

Property, equipment and leasehold improvements, net consist of the following (in thousands):


	December 31,
	2023			2022
Computer, website development and office equipment	$	263		$	175
Furniture and fixtures		41			37
Leasehold improvements		29			130
Construction in progress		17			53
		350			395
Less: Accumulated depreciation and amortization		(134	)		(225	)
Total property, equipment and leasehold improvements, net	$	216		$	170

Leases - Future Minimum Lease Payments (Detail) $ in Thousands	Dec. 31, 2023 USD ($)
Operating Leases
2024	$ 303
2025	349
2026	368
2027	377
2028	95
Total minimum lease payments	1,492
Less: Amount of lease payments representing interest	(307)
Present value of future minimum lease payments	1,185
Finance Leases
2024	126
2025	32
Total minimum lease payments	158
Less: Amount of lease payments representing interest	(5)
Present value of future minimum lease payments	$ 153

Marketable Securities - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Investments, Debt and Equity Securities [Abstract]
Realized gains or losses on available-for-sale marketable securities	$ 0	$ 0
Marketable securities, continuous unrealized loss position, 12 months or longer	0	0
Credit losses related to its marketable securities	$ 0	$ 0

Leases - Additional Information (Detail) $ in Thousands			3 Months Ended
Leases - Additional Information (Detail) $ in Thousands	Nov. 21, 2022 USD ($) ft²	Dec. 05, 2017 USD ($) ft²	Mar. 31, 2023 USD ($)	Dec. 31, 2023 ft²	Dec. 31, 2022
Leases [Line Items]
First year of payments square feet of occupied space				10,500
Second year of payments square feet of occupied space				11,500
Remaining lease payments square feet of occupied space				12,500
Building [Member]
Leases [Line Items]
Leased spaced area	12,500	5,600
Lease expiration date	Feb. 28, 2028	Feb. 28, 2023
Operating lease term	60 months	60 months
Term of required monthly payments	2028-02
Building [Member] \| Minimum [Member]
Leases [Line Items]
Operating lease rent expense \| $	$ 23	$ 10
Building [Member] \| Maximum [Member]
Leases [Line Items]
Operating lease rent expense \| $	$ 32	$ 12
Furniture [Member]
Leases [Line Items]
Operating lease term					24 months
Operating lease rent expense \| $			$ 11
Office Equipment [Member]
Leases [Line Items]
Operating lease term					36 months

Stockholders' Equity

12 Months Ended

Dec. 31, 2023

Stockholders' Equity Note [Abstract]

Stockholders' Equity

Stockholders’ Equity

Preferred Stock

As of December 31, 2023 and 2022, the Company’s restated certificate of incorporation authorized the Company to issue 5,000,000 shares of preferred stock, with a par value of $0.001 per share.

Common Stock

As of December 31, 2023 and 2022, the Company’s restated certificate of incorporation authorized the Company to issue 200,000,000 shares of common stock, with a par value of $0.001 per share.

The Company had reserved shares of common stock for future issuance as shown in the table below:


	December 31,
	2023		2022
Shares of common stock reserved for future issuance upon exercise of outstanding warrants and pre-funded warrants		40,931,506		48,330,707
Shares of common stock reserved for future issuance under the 2019 Stock Incentive Plan		6,549,183		4,553,202
Shares of common stock reserved for future issuance under the 2019 Employee Stock Purchase Plan		1,177,456		701,232
Shares of common stock reserved for future issuance under the 2012 Stock Incentive Plan		565,792		602,231
Shares to be issued upon sales under the LPC Purchase Agreement		—		30,000,000
		49,223,937		84,187,372

At-the-Market Offering

In June 2020, the Company entered into the ATM Sales Agreement with SVB Securities, under which the Company was able to issue and sell shares of its common stock, from time to time, having an aggregate offering price of up to $12.0 million. In May 2022, the Company and SVB Securities amended the ATM Sales Agreement to increase the maximum aggregate offering price of common stock that it was able to 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.

Sales of common stock under the ATM Sales Agreement were able to be made by any method that was deemed an “at-the-market” offering as defined in Rule 415(a)(4) under the Securities Act of 1933, as amended. The Company was not obligated to make any sales of its common stock under the ATM Sales Agreement. The Company began making sales pursuant to the ATM Sales Agreement in July 2020. As of August 15, 2023, the date of termination of the ATM Sales Agreement, the Company had issued and sold an aggregate of 4,333,394 shares of common stock for gross proceeds of $12.7 million pursuant to the ATM Sales Agreement, before deducting estimated commissions and allocated fees of $1.0 million.

In June 2023, the Company filed with the SEC a universal shelf registration statement on Form S-3 (the “Shelf Registration Statement”), which allows the Company to offer and sell up to $200.0 million of common stock, preferred stock, debt securities, units and/or warrants from time to time pursuant to one or more offerings at prices and terms to be determined at the time of sale. The Shelf Registration Statement was filed to replace the Company’s prior universal shelf registration statement on Form S-3 and was declared effective on August 15, 2023. Further, in June 2023, the Company entered into a 2023 ATM sales agreement with Leerink Partners, LLC (formerly SVB Securities) (the “2023 ATM Sales Agreement”), under which the Company may issue and sell shares of common stock, from time to time 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 under the 2023 ATM Sales Agreement. The Company filed a prospectus under the Shelf Registration Statement for the offer and sale of shares of the Company’s common stock having an aggregate offering price of up to $75.0 million pursuant to the 2023 ATM Sales Agreement. In accordance with the terms of the 2023 ATM Sales Agreement, the ATM Sales Agreement terminated upon effectiveness of the Shelf Registration Statement, at which point the Company was no longer able to issue and sell shares of its common stock under the ATM Sales Agreement. As of December 31, 2023, the Company had not made any sales pursuant to the 2023 ATM Sales Agreement.

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 provided that, subject to the terms and conditions therein, the Company had 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. 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. As of July 23, 2023, no shares had been sold to Lincoln Park and the LPC Purchase Agreement terminated by its terms.

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 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

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, 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, 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		Weighted Average Contractual Term
Outstanding as of December 31, 2022		38,627,003			9,703,704		48,330,707		$	0.28		5.1
Exercised		(7,399,201	)		—		(7,399,201	)	$	0.001
Outstanding as of December 31, 2023		31,227,802			9,703,704		40,931,506		$	0.33		4.1

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

The 2012 Stock Incentive Plan (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 May 7, 2019, that no further equity-based awards may be granted under the 2012 Plan.

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 Plan was 7,114,975 and 5,155,433 as of December 31, 2023 and 2022, respectively, of which 1,802,675 and 705,150 shares remained available for grant under the 2019 Plan, respectively. 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, 2023 and January 1, 2022, respectively, the number of shares reserved for issuance under the 2019 Plan increased, pursuant to the terms of the 2019 Plan, by an additional 2,105,623 shares and 1,140,232 shares, equal to the 2019 Plan determined maximum and 4% of the Company’s then-outstanding common stock, respectively.

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 years. Options granted to directors generally vest over one to two years. The Company generally settles stock option exercises with newly issued common shares. As of December 31, 2023 and 2022, respectively, options to purchase 4,746,508 and 3,848,052 shares of common stock were granted and outstanding, net of cancellations, under the 2019 Plan. As of December 31, 2023 and 2022, respectively, options to purchase 565,792 and 602,231 shares of common stock were granted and outstanding, net of cancellations, under the 2012 Plan.

In February 2024, the Company granted 832,250 stock options with performance-based vesting (“PSOs”) to employees of the Company. The PSOs granted in February 2024 vest based on the timing and results of the Company’s clinical trials.

A summary of the Company’s combined stock option activity for the 2019 Plan and the 2012 Plan is as follows:


	Number of Option Shares			Weighted Average Exercise Price		Weighted Average Contractual Term		Aggregate Intrinsic Value
						(in years)		(in thousands)
Outstanding as of December 31, 2022		4,450,283		$	3.26		7.6	$	1,672
Granted		1,563,500		$	2.62
Forfeited		(318,075	)	$	1.77
Expired		(237,327	)	$	3.23
Exercised		(146,081	)	$	0.51
Outstanding as of December 31, 2023		5,312,300		$	3.24		7.3	$	685
Options exercisable as of December 31, 2023		2,805,959		$	4.16		6.0	$	273
Options unvested as of December 31, 2023		2,506,341		$	2.20		8.8	$	412

The weighted average grant-date fair value per share of stock options granted was $2.24 and $0.93 for the years ended December 31, 2023 and 2022, respectively.

The aggregate fair value of stock options that vested during the years ended December 31, 2023 and 2022 was $1.7 million and $2.9 million, respectively.

The aggregate intrinsic value of stock options is calculated as the difference between the exercise price of the stock options and the fair value of the Company’s common stock for those stock options that had exercise prices lower than the fair value of the Company’s common stock. The aggregate intrinsic value of stock options exercised during the years ended December 31, 2023 and 2022 was $173 and $33, respectively.

The range of assumptions that the Company used to determine the fair value of the stock options granted were as follows:


	Year Ended December 31,
	2023		2022
Risk-free interest rate	3.4% - 4.8%		1.9% - 4.2%
Expected volatility	101.6% - 147.1%		101.7% - 108.6%
Expected dividend yield		—		—
Expected term (in years)	5.5 - 7.0		5.5 - 7.0

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 1,177,456 as of December 31, 2023. 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, 2023 and January 1, 2022, 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 526,315 shares and 285,058 shares, equal in each case to the lesser of the 2019 ESPP determined maximum and 1% of the Company’s then-outstanding common stock.


	Year Ended December 31,
	2023		2022
General and administrative expense	$	1,376	$	1,512
Research and development expense		871		815
	$	2,247	$	2,327

As of December 31, 2023, total unrecognized compensation cost related to the unvested share-based awards was $3.8 million, which is expected to be recognized over a weighted average period of 2.7 years.

- Definition

The entire disclosure for equity.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Subparagraph (b)
-Publisher FASB
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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-Paragraph 14
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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-URI https://asc.fasb.org//505/tableOfContent

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
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+ Details