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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 | $ (184,678) | $ (181,119) | $ (69,612)
Adjustments to reconcile net loss to net cash used in operating activities: |  |  |
Stock-based compensation expense | 32,553 | 19,831 | 20,804
Gain on sale of priority review voucher |  |  | (100,000)
Depreciation and amortization | 1,758 | 1,672 | 1,158
Non-cash interest expense and amortization of debt issuance costs | 13,360 | 5,389 |
Non-cash accretion & amortization of short-term investments | (9,835) | (2,314) |
Non-cash rent expense | 401 | (267) | (250)
Loss on RareStone equity investment |  | 1,040 |
Change in fair value of embedded derivative liability | (190) | (250) |
Acquired IPR&D assets classified as investing activities | 5,667 |  |
Changes in operating assets and liabilities: |  |  |
Accounts receivable | (8,643) | (5,199) | (1,250)
Inventory | (5,707) | (2,806) | (11)
Prepaid expenses and other current assets | 2,876 | 498 | (3,339)
Deferred revenue | (148) | (6,606) |
Other long-term assets, net | 1,656 | (4,840) | (11,815)
Accounts payable, accrued expenses and other liabilities | 14,773 | 1,543 | 18,312
Net cash used in operating activities | (136,157) | (173,428) | (146,003)
Investing activities |  |  |
Purchases of short-term investments | (354,918) | (251,937) | (524,972)
Maturities of short-term investments | 354,967 | 284,247 | 361,247
Proceeds from sale of priority review voucher |  |  | 100,000
Proceeds from out-license agreement |  |  | 7,000
Payment of milestone obligation under license agreement |  | (4,000) | (5,000)
Acquisition of IPR&D assets, including transaction costs | (5,667) |  |
Purchases of property and equipment | (47) | (281) | (434)
Net cash (used in) provided by investing activities | (5,665) | 28,029 | (62,159)
Financing activities |  |  |
Repayment of deferred royalty obligation | (7,398) |  |
Net proceeds from issuance of common stock | 48,875 | 131,112 | 161,726
Proceeds from the exercise of stock options | 7,468 | 9,752 | 4,134
Proceeds from issuance of common stock from ESPP | 1,053 | 626 | 621
Proceeds from royalty financing agreement, net of issuance costs | 24,370 | 72,338 |
Net cash provided by financing activities | 74,368 | 213,828 | 166,481
Effect of exchange rates on cash | (142) |  |
Net (decrease) increase in cash, cash equivalents and restricted cash | (67,596) | 68,429 | (41,681)
Cash, cash equivalents and restricted cash at beginning of period | 128,005 | 59,576 | 101,257
Cash, cash equivalents and restricted cash at end of period | $ 60,409 | $ 128,005 | $ 59,576

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