You should read the following discussion and analysis of our financial condition and results of operations in conjunction with our unaudited condensed consolidated financial statements and the related notes and other financial information included elsewhere in this Quarterly Report on Form 10-Q and our audited consolidated financial statements and notes thereto and the related Management's Discussion and Analysis of Financial Condition and Results of Operations included in our Annual Report on Form 10-K ("Annual Report") for the year ended December 31, 2021, which was filed with the Securities and Exchange Commission ("SEC") on March 9, 2022. Unless the context requires otherwise, references in this Quarterly Report on Form 10-Q to the "Company," "Mirum," "we," "us" and "our" refer to Mirum Pharmaceuticals, Inc. and its consolidated subsidiaries.

Forward-Looking Statements

In addition to historical financial information, this discussion and analysis contains forward-looking statements based upon current expectations that involve risks and uncertainties. Our actual results could differ materially from those anticipated in these forward-looking statements as a result of various factors, including those set forth in the section titled "Risk Factors" under Part II, Item 1A below. In some cases, you can identify forward-looking statements by terminology such as "anticipate," "believe," "continue," "could," "estimate," "expect," "intend," "may," "plan," "potentially," "predict," "should," "will" or the negative of these terms or other similar expressions.

In addition, statements that "we believe" and similar statements reflect our beliefs and opinions on the relevant subject. These statements are based upon information available to us as of the date of this Quarterly Report on Form 10-Q, and while we believe such information forms a reasonable basis for such statements, such information may be limited or incomplete, and our statements should not be read to indicate that we have conducted an exhaustive inquiry into, or review of, all potentially available relevant information. These statements are inherently uncertain and investors are cautioned not to unduly rely upon these statements.

Overview

We are a biopharmaceutical company focused on the identification, acquisition, development and commercialization of novel therapies for debilitating rare and orphan diseases. We focus on diseases for which the unmet medical need is high and the biology for treatment is clear.

Our lead product LIVMARLI (maralixibat) oral solution ("Livmarli"), a novel, oral, minimally-absorbed agent designed to selectively inhibit ASBT, also known as the ileal bile acid transporter ("IBAT"), is approved for the treatment of cholestatic pruritus in patients with Alagille syndrome ("ALGS") 1 year of age and older in the United States. We market and commercialize Livmarli in the United States through our specialized and focused commercial team. We have also filed for approval in Europe of Livmarli for the treatment of cholestatic liver disease in patients with ALGS and plan to commercialize Livmarli in Western Europe with our international team based in Switzerland. We have entered into license and distribution agreements with several rare disease companies for the commercialization of Livmarli in additional countries. We are also developing Livmarli for progressive familial intrahepatic cholestasis ("PFIC") and biliary atresia ("BA"). Livmarli has been granted breakthrough designation for ALGS and PFIC type 2.

We are advancing our second product candidate, volixibat, a novel, oral, minimally-absorbed agent designed to inhibit IBAT, for the treatment of adult patients with cholestatic liver diseases. We are developing volixibat for the treatment of intrahepatic cholestasis of pregnancy ("ICP"), primary sclerosing cholangitis ("PSC") and primary biliary cholangitis ("PBC"). Volixibat has been studied in over 400 adults for up to 48 weeks. Clinical trials of volixibat have shown significant activity on apical sodium bile acid transporter ("ASBT") and bile acid markers such as 7?C4, fecal bile acids and cholesterol, demonstrating potent biological activity.

We were incorporated in May 2018 and commenced operations in November 2018. To date, we have focused primarily on acquiring and in-licensing our product candidates, organizing and staffing our company, business planning, raising capital, advancing our product candidates through clinical development, preparing for commercialization of our product candidates, commercializing Livmarli, and conducting business development activities relating to, among other things, portfolio expansion through collaborations.

We have a limited operating history and incurred significant operating losses since our inception and expect to continue to incur significant operating losses for the foreseeable future. We have only one product approved for commercial sale and have not generated significant revenues from product sales, net as of March 31, 2022. Since inception, we have funded our operations to date primarily through debt, equity, revenue interest financings and, to a lesser extent, cash from our product sales, net and collaboration revenue.

Financing Transactions

In August 2020, the Securities and Exchange Commission ("SEC") declared effective a registration statement on Form S-3 ("Shelf Registration") covering the sale of up to $300.0 million of our securities. Also, in August 2020, we entered into a sales agreement ("Sales Agreement") with SVB Securities LLC ("SVB Securities") pursuant to which we may elect to issue and sell, from time to time, in an at the market offering, shares of common stock having an aggregate offering price of up to $75.0 million under the Shelf Registration through SVB Securities acting as the sales agent and/or principal. During the three months ended March 31, 2022,



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we issued and sold 995,897 shares of common stock pursuant to the Sales Agreement at a weighted-average price of $18.06 per share, resulting in aggregate gross proceeds to us of $18.0 million. The net proceeds to us after deducting sales commissions to SVB Securities and other issuance expenses were approximately $17.4 million. As of March 31, 2022, we issued and sold an aggregate of 1,301,866 shares of common stock pursuant to the Sales Agreement at a weighted-average price of $18.88 per share, resulting in aggregate gross proceeds to us of $24.6 million. The net proceeds to us after deducting sales commissions to SVB Securities and other issuance expenses were approximately $23.7 million. The remaining capacity under the Sales Agreement is approximately $50.4 million as of March 31, 2022.

In December 2020, we completed an underwritten public offering of our common stock pursuant to the Shelf Registration. We sold 3,750,000 shares of common stock at a public offering price of $20.00 per share, resulting in net proceeds of $70.0 million after deducting underwriting discounts, commissions and offering expenses. In addition, we granted the underwriters an option, exercisable for 30 days, to purchase up to 562,500 additional shares of our common stock at the public offering price, less the underwriting discounts and commissions. In January 2021, the underwriters exercised their option for 375,654 shares of our common stock resulting in net proceeds of $7.1 million after deducting underwriting discounts.

Financial Overview

Our net loss was $36.6 million and $50.5 million for the three months ended March 31, 2022 and 2021, respectively. As of March 31, 2022, we had an accumulated deficit of $293.8 million and cash, cash equivalents, restricted cash equivalents and investments of $239.9 million, of which $100.0 million is restricted from use under the terms of the RIPA.

We expect our expenses and operating losses will increase substantially as we conduct our ongoing and planned clinical trials, continue our research and development activities, continue commercial activities for Livmarli, and seek regulatory approvals for our product candidates, as well as hire additional personnel and protect our intellectual property. In addition, as our product candidates progress through development and toward commercialization, we will need to make milestone payments to the licensors and other third parties from whom we have in-licensed or acquired our product candidates. We have also entered into collaboration arrangements with other companies whereby we are entitled to receive upfront and license fees, research and development funding, development and sales-based milestones, and tiered royalties based on sales of commercialized products. Arrangements that include upfront payments may require deferral of revenue recognition to a future period until we perform obligations under these arrangements. The event-based milestone and other contingent payments represent variable consideration, and we use the most likely amount method or expected value method to estimate this variable consideration, depending on the nature of the contingency and the variable payments. Given the high degree of uncertainty around the occurrence of these events, we generally determine the milestone and other contingent amounts to be fully constrained until the uncertainty associated with these payments is resolved. We will recognize revenue from sales-based royalty payments when or as the sales occur. We will re-evaluate the transaction price in each reporting period as uncertain events are resolved and other changes in circumstances occur. The timing of these activities may fluctuate significantly. As a result, our net losses may fluctuate significantly from quarter-to-quarter and year-to-year, depending in particular on the timing of our clinical trials and non-clinical studies and our expenditures on other research and development activities.

We expect our product sales from Livmarli will increase in the future. However, the timing and amount of product sales are unknown. Accordingly, until such time as we can generate substantial product revenues to support our cost structure and sustain operating activities, if ever, we expect to finance our cash needs through equity offerings, debt financings or other capital sources, collaborations, licenses and other similar arrangements. However, we may be unable to raise additional funds or enter into such other arrangements when needed on favorable terms or at all. Our failure to raise capital or enter into such other arrangements when needed could have a negative impact on our financial condition and on our ability to pursue our business plans and strategies. If we are unable to raise additional capital when needed, we could be forced to delay, limit, reduce or terminate the development of one or more of our product candidates or future commercialization efforts or grant rights to develop and market our product candidates even if we would otherwise prefer to develop and market such product candidates ourselves.

Prior to the regulatory approval of Livmarli, the manufacturing and related costs were expensed as research and development as any future economic benefit was not considered probable; accordingly, these costs were not capitalized and as a result gross margins resulting from product sales will initially be higher until we deplete inventories that we had expensed prior to receiving approval

COVID-19

The coronavirus (including its variants, "COVID-19") pandemic has had a significant economic impact across the global marketplace presenting challenges to maintaining business continuity and dramatically changing the ways in which we live and interact with others. Although the initial impact of the pandemic has subsided, we are uncertain as to how more transmissible variants may impact our business. We are working diligently to ensure the advancement of all of our clinical development programs in the safest manner possible. While we are unable to reliably estimate the duration or extent of any potential business disruption or financial impact during this time, we remain committed to (i) prioritizing the safety, health and well-being of patients, their caregivers, healthcare providers and our employees; (ii) ensuring patients are well supported and have continued uninterrupted access to our product candidates, for which we currently do not expect any supply disruption; and (iii) advancing our clinical trials. Examples



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include a "Work from Home Policy" for our employees and access to home health care to assist families with safer participation in our trials.

Although we did not see a significant financial impact to our business operations as a result of COVID-19 for the three months ended March 31, 2022, there may be potential impacts to our business in the future that are highly uncertain and difficult to predict such as temporary closures of our offices or those of our third-party manufacturers or suppliers, disruptions or restrictions on our employees' ability to travel, disruptions to or delays in ongoing non-clinical trials, clinical trials, third-party manufacturing supply and other operations, inability for patients to see their healthcare providers and access our products, the potential diversion of healthcare resources away from the conduct of clinical trials to focus on pandemic concerns, interruptions or delays in the operations of the FDA or other regulatory authorities, and our ability to raise capital and conduct business development activities. The ultimate impact of the COVID-19 pandemic, including any lasting effects on our revenue and the way we conduct our business, is highly uncertain and subject to continued change. We recognize that this pandemic may continue to present unique challenges for us throughout 2022.

We continue to believe that existing cash, cash equivalents and investments, excluding restricted cash equivalents, and existing sources of and access to financing are adequate to satisfy our needs for working capital, capital expenditures, debt service requirements and other business development initiatives that we plan to strategically pursue in the 12 months from the issuance of the unaudited condensed consolidated financial statements included in this Quarterly Report on Form 10-Q. However, should the COVID-19 pandemic and any associated recession or depression continue for a prolonged period, our results of operations, financial condition, liquidity and cash flows could be materially impacted as a result of a lower likelihood of effectively and efficiently developing new medicines and successfully commercializing our products.

License Agreements

Assignment and License Agreement with Shire (Takeda)

In November 2018, we entered into the Shire License Agreement with Shire, which was subsequently acquired by Takeda Pharmaceutical Company Limited ("Takeda"), in which we were granted an exclusive, royalty bearing worldwide license to develop and commercialize our two product candidates, Livmarli and volixibat. As part of the Shire License Agreement, we were assigned license agreements held by Shire with Satiogen Pharmaceuticals, Inc. ("Satiogen" and altogether, the "Satiogen License"), Pfizer Inc., and Sanofi, collectively the Assigned License Agreements ("Assigned License Agreements"). In partial consideration for the rights granted to us under the Shire License Agreement, we made an upfront payment to Shire of $7.5 million and issued Shire 1,859,151 shares of our common stock with an estimated fair value of $7.0 million.

Under the Shire License Agreement and Assigned License Agreements, to date, we have paid aggregate development and regulatory milestones of $51.0 million related to our Livmarli and volixibat programs.

Components of Results of Operations

Revenue

Product Sales, Net

Our approved product, Livmarli, was approved by the FDA in September 2021 for the treatment of cholestatic pruritus in patients with ALGS one year of age and older. We recorded our first product sales of Livmarli in October 2021. We expect our product sales of Livmarli will increase as a result of our continued commercial activities. However, as it is early in our product launch, we do not yet have a trend and while we believe revenue will increase as we further engage with health care providers in the United States and globally, we cannot predict revenues with any certainty.

Our revenue from product sales, net further depends on our prescription mix of U.S. commercial payors, Medicaid and free drugs under our patient assistance program. Our experience to date in our recent product launch is not sufficient to allow us to reliably estimate the payor mix and resulting gross to net adjustments.

License Revenue

Under the exclusive licensing agreements with CANbridge and GC Biopharma, we have recognized as revenue the upfront nonrefundable payments related to the licenses granted upon satisfaction of certain performance obligations. Pursuant to the agreements, we are eligible to receive future milestone payments. These milestone payments are fully constrained and will be recognized in revenue in the period in which achievement of the milestones becomes probable. We are also eligible to receive royalty payments related to the agreements, which will be recognized as the underlying product sales occur.

Cost of Sales

Cost of sales consist of third party manufacturing costs, personnel, facility and other costs of manufacturing commercial products, transportation and freight, amortization of capitalized intangibles associated with contractual milestone payments paid to licensors upon certain regulatory approval and sales-based events and royalty payments payable on net sales of Livmarli under



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licensing agreements. Cost of sales may also include period costs related to certain manufacturing services and inventory adjustment charges. Prior to receiving approval from the FDA in September 2021 to market and sell Livmarli in the United States, we expensed all costs incurred related to the manufacture of Livmarli as research and development expense because of the inherent risks associated with the development of a drug candidate, the uncertainty about the regulatory approval process and the lack of history as a company of regulatory approval of drug candidates. Our inventory of Livmarli produced prior to FDA approval is available for commercial or clinical use.

Operating Expenses

Research and Development Expenses

Research and development expenses primarily relate to clinical development and manufacturing activities of our product candidates. Our research and development expenses include, among other things:

salaries and related expenses for employee personnel, including benefits, travel and expenses related to stock-based compensation granted to personnel in development functions;

external expenses paid to clinical trial sites, contract research organizations and consultants that conduct our clinical trials;

expenses related to drug formulation development and the production of clinical trial supplies, including fees paid to contract manufacturers;

licensing milestone payments related to development or regulatory events;

research and development funding for collaboration arrangements;

expenses related to non-clinical studies;

expenses related to compliance with drug development regulatory requirements; and

other allocated expenses, which include direct and allocated expenses for rent and maintenance of facilities, depreciation of equipment, and other supplies.

We expense research and development costs as incurred. Nonrefundable advance payments for goods or services to be received in the future for use in research and development activities are recorded as prepaid expenses. The prepaid amounts are expensed as the related goods are delivered or the services are performed. Upfront payments, research and development funding and milestone payments made to third parties in connection with licenses and research and development collaborations are expensed as incurred.

We anticipate that our research and development expenses will increase in the future as we continue the clinical and development activity for further indications of Livmarli, as well as expand the clinical and development activity associated with our volixibat pipeline. These increases will likely include increased costs related to hiring of additional development personnel and fees to outside clinical development organizations that support clinical trial activity.

Selling, General and Administrative Expense

Selling expenses consist of professional fees related to preparation and commercialization of Livmarli, finished goods warehousing costs, as well as salaries and related employee benefits for commercial employees, including stock-based compensation.

General and administrative expenses consist primarily of salaries and employee-related costs, including stock-based compensation, for personnel in executive, finance and other administrative functions. Other significant costs include facility-related costs, legal fees relating to intellectual property and corporate matters, professional fees for accounting and consulting services and insurance costs.

We anticipate that our selling, general and administrative expenses will increase in the future to support our continued commercialization efforts of Livmarli in the United States and internationally as well as increased costs of operating as a global commercial stage biopharmaceutical public company. These increases will likely include increased costs related to hiring of additional personnel and fees to outside consultants to support further marketing, legal and accounting activities.

Interest Income

Interest income consists of interest earned on our cash equivalents and investments.

Interest Expense

Interest expense for the three months ended March 31, 2022 was related to the RIPA. Costs during the period consist primarily of costs associated with our liability and non-cash interest costs associated with the amortization of the related debt discount and deferred issuance costs. We impute interest expense associated with this liability using the effective interest rate method which is calculated based on the rate that would enable the debt to be repaid in full over the anticipated life of the arrangement.



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Change in Fair Value of Derivative Liability

Change in fair value of derivative liability consists of the gain or loss from remeasurement of the compound derivative liability related to the revenue interest liability during the period.

Other Income (Expense), Net

Other income (expense), net consists of transactional currency exchange gain or loss.

Critical Accounting Estimates

The preparation of financial statements and related disclosures in conformity with U.S. generally accepted accounting principles ("GAAP") and our discussion and analysis of our financial condition and operating results require our management to make judgements, assumptions and estimates that affect the amounts reported, including the amount of assets, liabilities, expenses and the disclosure of contingent assets and liabilities. Management bases its estimates on historical experience, known trends and events, and on various other assumptions it believes to be reasonable under the circumstances, the results of which form the basis for making judgments about the carrying values of assets and liabilities. Actual results may differ materially from these estimates under different assumptions or conditions.

There have been no significant changes during the three months ended March 31, 2022 in our critical accounting policies and estimates as compared to the critical accounting policies and estimates disclosed in the section titled "Management's Discussion and Analysis of Financial Condition and Results of Operations" included in our Annual Report.

Recent Accounting Pronouncements

A description of recent accounting pronouncements that may potentially impact our financial position, results of operations or cash flows is disclosed in Note 2 to our unaudited condensed consolidated financial statements included elsewhere in this Quarterly Report on Form 10-Q.

Results of Operations for the Three Months Ended March 31, 2022 and 2021

The following table summarizes our results of operations for the three months ended March 31, 2022 and 2021 (in thousands):



                                           Three Months Ended March 31,
                                             2022                 2021             Change
Revenue:
Product sales, net                      $       10,892       $            -     $      10,892
License revenue                                  2,000                    -             2,000
Total revenue                                   12,892                    -            12,892
Operating expenses:
Cost of sales                           $        2,424       $            -     $       2,424
Research and development                        24,088               38,134           (14,046 )
Selling, general and administrative             19,116                9,479             9,637
Total operating expenses                        45,628               47,613            (1,985 )
Loss from operations                           (32,736 )            (47,613 )          14,877
Other income (expense):
Interest income                                     69                  149               (80 )
Interest expense                                (3,774 )             (3,381 )            (393 )
Change in fair value of derivative
liability                                            -                  334              (334 )
Other expense, net                                (154 )                (16 )            (138 )
Net loss before provision for income
taxes                                          (36,595 )            (50,527 )          13,932
Provision for income taxes                          11                    5                 6
Net Loss                                $      (36,606 )     $      (50,532 )   $      13,926


Product Sales, Net

Product sales, net were $10.9 million for the three months ended March 31, 2022, compared to zero for the three months ended March 31, 2021 as a result of our commercial launch of Livmarli in the United States in September 2021.

License Revenue

License revenue was $2.0 million for the three months ended March 31, 2022, compared to zero for the three months ended March 31, 2021. The increase in license revenue was due to the satisfaction by CANbridge of certain performance obligations associated with the license agreement with CANbridge.

Cost of Sales



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For the three months ended March 31, 2022, cost of sales was $2.4 million, compared to zero for the three months ended March 31, 2021, and primarily consisted of amortization of capitalized intangible assets, royalties payable on net sales of Livmarli under licensing agreements and indirect overhead costs associated with the manufacturing and distribution of Livmarli. There were minimal inventory costs reflected in cost of sales as inventory related to current product sold were expensed as research and development costs prior to Livmarli approval in September 2021.

Research and Development Expenses

The following table summarizes the period-over-period changes in research and development expenses relating to our product candidates in development for the periods indicated (in thousands):




                                             Three Months Ended March 31,
                                               2022                 2021             Change
Product-specific costs:
Livmarli                                  $        9,468       $        9,732     $        (264 )
Volixibat                                 $        4,151       $        2,749             1,402
Non product-specific costs:
Collaboration funding                     $            -       $            -                 -
Stock-based compensation                  $        2,585       $        2,743              (158 )
Personnel                                 $        5,821       $        4,913               908
License fees (milestone payments)         $            -       $       17,000           (17,000 )
Other                                     $        2,063       $          997             1,066

Total research and development expenses $ 24,088 $ 38,134 $ (14,046 )

Research and development expenses were $24.1 million for the three months ended March 31, 2022, a decrease of $14.0 million compared to the three months ended March 31, 2021. The decrease was primarily due to:

for Livmarli programs, a decrease of $0.3 million, primarily due to a decrease of $2.0 million in manufacturing activities as a result of prior year completion of New Drug Application ("NDA") registrational production offset by an increase of $1.3 million clinical trial expenses for the EMBARK Phase 2b clinical trial for BA, the Phase 3 MARCH clinical trial in PFIC and safety studies, including $0.2 million in research and development funding pursuant to our license agreements with CANbridge, which was recorded as a reduction of clinical trial expenses, and an increase of $0.5 million of general program expenses;

for volixibat programs, an increase of $1.4 million, primarily due to clinical trial expenses for PSC, PBC and ICP and related manufacturing activities supporting clinical supply;

for personnel related expenses, an increase of $0.9 million, related to an increase in employee headcount to support our development pipeline;

for license fees, a decrease of $17.0 million, related to developmental milestone payments for the three months ended March 31, 2021 consisting of $15.0 million associated with the acceptance of our NDA for filing of Livmarli for the treatment of cholestatic pruritus in patients with ALGS one year of age and older, and $2.0 million associated with the initiation of the VISTAS Phase 2b clinical trial of volixibat in PSC; and

for other expense, an increase of $1.1 million, primarily due to outside consulting expenses and general overhead expenses.

Selling, General and Administrative Expenses

Selling, general and administrative expenses were $19.1 million for the three months ended March 31, 2022, an increase of $9.6 million compared to the three months ended March 31, 2021. The increase was primarily due to an increase of $4.9 million of personnel and other compensation related expenses, including an increase of $1.4 million in stock-based compensation, reflecting an increase in the number of our selling, marketing and administrative employees to support commercial launch activities for Livmarli and increased requirements of operating as a public company, such as regulatory compliance, $2.9 million in professional and consulting service expenses associated with commercial launch activities for Livmarli, and an increase of $1.8 million in expenses primarily related to general legal and public relations, international expansion activities and other general administrative expenses.

Interest Expense

Interest expense was $3.8 million for the three months ended March 31, 2022 compared to $3.4 million for the three months ended March 31, 2021. The increase was related to the accreted interest recognized on the revenue interest liability in connection with the RIPA.



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Liquidity and Capital Resources

Overview

Since inception, we have funded our operations primarily through debt, equity, revenue interest financings and, to a lesser extent, cash from our product sales and collaboration revenue. We had $239.9 million of cash, cash equivalents, restricted cash equivalents and investments as of March 31, 2022, inclusive of $100.0 million restricted cash equivalents, compared to $213.1 million as of March 31, 2021. Since inception, we have incurred operating losses and negative cash flows from operations. As of March 31, 2022, we had an accumulated deficit of $293.8 million.

In August 2020, the SEC declared effective the Shelf Registration covering the sale of up to $300.0 million of our securities. Also, in August 2020, we entered into the Sales Agreement with SVB Securities, pursuant to which we may elect to issue and sell, from time to time, in an at the market offering, shares of common stock having an aggregate offering price of up to $75.0 million under the Shelf Registration through SVB Securities acting as the sales agent and/or principal. During the three months ended March 31, 2022, we issued and sold 995,897 shares of common stock pursuant to the Sales Agreement at a weighted-average price of $18.06 per share, resulting in aggregate gross proceeds to us of $18.0 million. The net proceeds to us after deducting sales commissions to SVB Securities and other issuance expenses were approximately $17.4 million. As of March 31, 2022, we issued and sold an aggregate of 1,301,866 shares of common stock pursuant to the Sales Agreement at a weighted-average price of $18.88 per share, resulting in aggregate gross proceeds to us of $24.6 million. The net proceeds to us after deducting sales commissions to SVB Securities and other issuance expenses were approximately $23.7 million. The remaining capacity under the Sales Agreement is approximately $50.4 million as of March 31, 2022.

In December 2020, we completed an underwritten public offering of our common stock pursuant to the Shelf Registration. We sold 3,750,000 shares of common stock at a public offering price of $20.00 per share, resulting in net proceeds of $70.0 million after deducting underwriting discounts, commissions and offering expenses. In addition, we granted the underwriters an option, exercisable for 30 days, to purchase up to 562,500 additional shares of our common stock at the public offering price, less the underwriting discounts and commissions. In January 2021, the underwriters exercised their option for 375,654 shares of our common stock resulting in net proceeds of $7.1 million after deducting underwriting discounts.

Based on our current and anticipated level of operations, we believe our cash, unrestricted cash equivalents and investments will be sufficient to fund current operations through at least the next 12 months from the filing of this Quarterly Report on Form 10-Q. Our cash, cash equivalents, unrestricted cash equivalents and investments include money market funds, government agency securities, corporate debt and commercial paper. We maintain established guidelines relating to diversification and maturities of our investments to preserve principal and maintain liquidity.

We anticipate that we will continue to incur net losses for the foreseeable future as we continue research efforts and the development of our product candidates, continue commercial launch activities for Livmarli and potentially expand into additional markets, hire additional staff, including clinical, scientific, operational, financial and management personnel and pay potential development and commercial milestones in connection with our license agreements.

Our primary use of cash is to fund operating expenses, which consist primarily of research and development expenditures, and to a lesser extent, selling, general and administrative expenditures, including commercial launch expenses. Cash used to fund operating expenses is impacted by the timing of when we pay these expenses, as reflected in the change in our outstanding accounts payable and accrued expenses.

Although Livmarli has been approved by the FDA for the treatment of cholestatic pruritus in patients with ALGS one year of age and older, and we expect product revenues to increase as we continue commercial activities, Livmarli may not achieve commercial success. Our principal sources of liquidity are cash from the sale of our equity securities, revenue interest financings and collaboration arrangements and, to a lesser extent, from product revenue from the sale of Livmarli. Until such time, if ever, as we can generate substantial product revenue from sales of Livmarli, our current product candidates or any future product candidates, if approved, we expect to finance our cash needs through a combination of equity offerings, debt financings, revenue interest purchase agreements and potential collaboration, license or development agreements. Our primary cash needs are for day-to-day operations, to pay our debt obligations under the RIPA and to fund our working capital requirements. To the extent that we raise additional capital through the sale of equity or convertible debt securities, ownership interest will be diluted, and the terms of these securities may include liquidation or other preferences that adversely affect rights as a stockholder. Debt financing and preferred equity financing, if available, may involve agreements that include covenants limiting or restricting our ability to take specific actions, such as incurring additional debt, making capital expenditures or declaring dividends.



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If we raise additional funds through the RIPA, collaborations, strategic alliances or marketing, distribution or licensing arrangements with third parties, we may be required to relinquish valuable rights to our technologies, future revenue streams, research programs or product candidates or to grant licenses on terms that may not be favorable to us. As a result of the COVID-19 pandemic and actions taken to slow its spread, the global credit and financial markets have experienced volatility and disruptions, including severely diminished liquidity and credit availability, declines in consumer confidence, declines in economic growth, increases in unemployment rates and uncertainty about economic stability. If the equity and credit markets deteriorate, it may make any necessary debt or equity financing more difficult, more costly and more dilutive. If we are unable to raise additional funds through equity or debt financings when needed, we may be required to delay, limit, reduce or terminate our drug development or future commercialization efforts or grant rights to develop and market product candidates that we would otherwise prefer to develop and market ourselves.

Contractual Obligations

In addition to ongoing capital needs to fund our ongoing operations, our material cash requirements include the following contractual and other obligations.

Pursuant to the RIPA, the Purchasers have a right to receive Revenue Interests based on product sales, net of Livmarli. The amounts of quarterly Revenue Interest Payments will change each reporting period based upon the underlying product sales, net of Livmarli and will initially be 9.75% of product sales, net. Under the RIPA, every $100.0 million of net sales generated, less than or equal to $350 million in an annual aggregate, would result in a repayment obligation of approximately $9.8 million. Additionally, every $100.0 million of net sales generated in excess of $350.0 million in an annual aggregate would result in a repayment obligation of approximately $2.0 million. In the future, as net sales thresholds set forth in the agreement are met and the repayment percentage rate changes, the amount of the obligation and timing of payment is likely to change. A significant increase or decrease in actual and forecast net sales will materially impact the revenue interest liability, interest expense and the time period for repayment.

Under the Shire License Agreement, as well as our other license and acquisition agreements, we have payment obligations that are contingent upon future events such as our achievement of specified development, regulatory and commercial milestones and are required to make royalty payments in connection with the sale of products developed under those agreements. The amount and timing of milestone obligations are unknown or uncertain as we are unable to estimate the timing or likelihood of achieving the milestone events. Additionally, the amount of royalty payments are based upon future product sales, which we are unable to predict with certainty. These potential obligations are further described in Note 7 to our unaudited condensed consolidated financial statements.

We additionally have contractual obligations for our operating leases for our corporate headquarters. These obligations are further described in Note 9 to our unaudited condensed consolidated financial statements.

We are party to certain license and collaboration agreements, which contain a number of contractual obligations. Those contractual obligations may entitle us to receive, or may obligate us to make, certain payments. The amount and timing of those payments are unknown or uncertain as we are unable to estimate the timing or likelihood of the events that will obligate those payments.

We enter into contracts in the normal course of business with clinical research organizations and clinical sites for the conduct of clinical trials, non-clinical research studies, professional consultants for expert advice and other vendors for clinical supply manufacturing or other services. These contracts generally provide for termination on notice, and therefore are cancelable contracts.

Cash Flows

The following table provides a summary of the net cash flow activity for the periods indicated (in thousands):



                                                       Three Months Ended March 31,
                                                         2022                 2021
Net cash used in operating activities               $      (39,669 )     $      (25,210 )
Net cash provided by (used in) provided by
investing activities                                        36,500              (32,784 )
Net cash provided by financing activities                   18,104                6,594
Effect of exchange rate on cash, cash equivalents
and restricted cash equivalents                                 (3 )                 (9 )
Net increase (decrease) in cash, cash equivalents
and restricted cash equivalents                     $       14,932       $      (51,409 )

Net Cash Used in Operating Activities



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Net cash used in operating activities was $39.7 million for the three months ended March 31, 2022, reflecting our net loss of $36.6 million partially offset by non-cash items of $10.7 million. Non-cash items consisted primarily of $6.6 million of stock-based compensation, $3.8 million of effective interest expense in connection with the RIPA, and $0.4 million of depreciation and amortization of our fixed assets and operating lease right-of use assets. Additionally, cash used in operating activities reflected changes in net operating assets of $13.8 million, consisting primarily of a $8.1 million decrease in accounts payable, accrued expenses and other liabilities primarily associated with the final payment under the Vivet Collaboration Agreement, a $4.6 million increase in accounts receivable related to sales of Livmarli, $0.9 million increase in prepaid expenses, inventory and other assets, and a $0.2 million decrease in our operating lease liability.

Net cash used in operating activities was $25.2 million for the three months ended March 31, 2021, reflecting our net loss of $50.5 million partially offset by non-cash items of $8.5 million. Non-cash items consisted primarily of $5.3 million of stock-based compensation, $3.4 million of interest expense in connection with the RIPA, $0.3 million related to the change in fair value of the derivative liability, and $0.2 million of depreciation and amortization of our fixed assets and operating lease right-of use assets. Additionally, cash used in operating activities reflected changes in net operating assets of $16.7 million, consisting primarily of a $17.2 million increase in accounts payable, accrued expenses and other liabilities due to a $15.0 million accrual for development milestone payments associated with the acceptance of our NDA for filing for maralixibat for the treatment of cholestatic pruritus in patients with ALGS one year of age and older pursuant to the Shire License Agreement and $2.2 million for clinical and manufacturing activities, offset by a $0.2 million decrease in our operating lease liability, a $0.2 million increase in our other assets and a $0.1 million increase in our prepaid expenses primarily associated with clinical and manufacturing activities.

Net Cash Provided by (Used in) Investing Activities

Net cash provided by investing activities was $36.5 million for the three months ended March 31, 2022, due to $36.5 million from maturities of investments.

Net cash used in investing activities was $32.8 million for the three months ended March 31, 2021 primarily due to $83.4 million used in purchases of investments, partially offset by proceeds of $48.6 million from maturities of investments and proceeds of $2.0 million from paydowns of investments.

Net Cash Provided by Financing Activities

Net cash provided by financing activities was $18.1 million for the three months ended March 31, 2022, due to net proceeds of $17.4 million from the issuance and sale of common stock under the Sales Agreement with SVB Securities, pursuant to which we issued and sold an aggregate of 995,897 shares of common stock at a weighted-average price of $18.06 per share, and proceeds of $1.5 million from employee equity award exercises, partially offset by $0.8 million of revenue interest payments made under the RIPA.

Net cash provided by financing activities was $6.6 million for the three months ended March 31, 2021, due to net proceeds of $6.9 million received from the underwriters when they exercised their option to purchase 375,654 shares of our common stock in January 2021 following the follow-on underwritten public offering of our common stock in December 2020, and proceeds of $0.1 million from employee equity award exercises. These proceeds were offset by payment of $0.4 million issuance costs associated with the RIPA.

JOBS Act

As an emerging growth company under the Jumpstart Our Business Startups Act of 2012 ("JOBS Act"), we can take advantage of an extended transition period for complying with new or revised accounting standards. This allows an emerging growth company to delay the adoption of certain accounting standards until those standards would otherwise apply to private companies. We have irrevocably elected not to avail ourselves of this exemption and, therefore, we will be subject to the same new or revised accounting standards as other public companies that are not emerging growth companies. We intend to rely on other exemptions provided by the JOBS Act, including without limitation, not being required to comply with the auditor attestation requirements of Section 404(b) of the Sarbanes-Oxley Act of 2002, as amended ("Sarbanes-Oxley Act").

We will remain an emerging growth company until the earliest of (i) December 31, 2024, (ii) the last day of the fiscal year in which we have total annual gross revenue of at least $1.07 billion, (iii) the last day of the fiscal year in which we are deemed to be a "large accelerated filer" as defined in Rule 12b-2 under the Securities Exchange Act of 1934, as amended ("Exchange Act"), or (iv) the date on which we have issued more than $1.0 billion in non-convertible debt securities during the prior three-year period.



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