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Consolidated Statements of Cash Flows - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021
Operating activities |  |  |
Net loss | $ (749,567) | $ (481,534) | $ (434,654)
Adjustments to reconcile net loss to net cash used in operating activities: |  |  |
Depreciation | 5,527 | 5,278 | 9,130
Amortization of intangible assets | 5,052 | 5,053 | 5,052
Stock-based compensation expense | 74,778 | 57,686 | 46,021
Loss on extinguishment of debt | 0 | 0 | 17,689
Amortization of debt issuance costs | 7,320 | 3,991 | 1,890
Accretion of debt discount | 0 | 0 | 29,149
Paid-in-kind interest capitalized | 23,372 | 4,165 | 0
Royalty Financing non-cash interest expense | 18,846 | 3,687 | 0
Accretion of discount on marketable securities, net | (9,383) | 0 | 0
Finance lease amortization expense | 2,712 | 1,960 | 1,078
Non-cash operating lease expense | 9,206 | 11,976 | 12,589
Change in fair value of deferred and contingent consideration liabilities | 28,697 | (20,802) | 7,334
Change in fair value of interest rate swap | (320) | 1,526 | 0
Changes in operating assets and liabilities: |  |  |
Accounts receivable | (11,963) | (6,423) | (8,118)
Inventory | (13,613) | (1,714) | (17,456)
Prepaid expenses and other current assets | 2,265 | 2,528 | (5,549)
Other assets | (20,074) | (25,243) | (24,435)
Accounts payable and accrued liabilities | 15,155 | 50,011 | (7,575)
Other liabilities | (10,988) | (12,584) | 4,553
Net cash used in operating activities | (536,247) | (400,439) | (363,302)
Investing activities |  |  |
Purchase of fixed assets | (13,288) | (9,878) | (7,289)
Purchase of marketable securities | (588,733) | (99,706) | (50,292)
Cash acquired in asset acquisition | 3,417 | 0 | 0
Maturities of marketable securities | 375,000 | 75,000 | 0
Cash paid for Business Acquisition, net | 0 | 0 | (6,704)
Net cash used in investing activities | (223,604) | (34,584) | (64,285)
Financing activities |  |  |
Proceeds from exercise of stock options and ESPP | 18,399 | 19,504 | 22,037
Proceeds from issuance of common stock, net | 152,475 | 292,153 | 269,886
Payment on extinguishment of 1.75% convertible senior notes due 2025 | 0 | 0 | (12,578)
Payment of principal of 1.75% convertible senior notes due 2025 | 0 | 0 | (225,000)
Proceeds from issuance of 0.75% convertible senior notes due 2028 | 0 | 0 | 575,000
Proceeds from issuance of Term Loan | 0 | 350,000 | 0
Proceeds from issuance Royalty Financing Agreement | 0 | 150,000 | 0
Payment of debt issuance costs | (1,218) | (17,783) | (15,718)
Payments of finance lease principal | (1,217) | (601) | (1,081)
Net cash provided by financing activities | 168,439 | 793,273 | 612,546
Effect of exchange rates on cash and cash equivalents | (250) | (996) | (933)
Net (decrease) increase in cash and cash equivalents | (591,662) | 357,254 | 184,026
Cash and cash equivalents at beginning of period | 1,074,036 | 716,782 | 532,756
Cash and cash equivalents at end of period | 482,374 | 1,074,036 | 716,782
Supplemental disclosures of cash flow information: |  |  |
Cash paid for interest | 35,787 | 10,157 | 10,890
Cash paid for income taxes | 1,955 | 1,717 | 1,558
Vertuis Bio, Inc. |  |  |
Adjustments to reconcile net loss to net cash used in operating activities: |  |  |
Vertuis acquisition | 10,250 | 0 | 0
Adrestia acquisition | 10,250 | 0 | 0
Adrestia Therapeutics Ltd |  |  |
Adjustments to reconcile net loss to net cash used in operating activities: |  |  |
Vertuis acquisition | 76,481 | 0 | 0
Adrestia acquisition | $ 76,481 | $ 0 | $ 0

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