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Consolidated Statements of Cash Flows - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021
Cash flows from operating activities: |  |  |
Net loss | $ (160,276) | $ (137,464) | $ (77,329)
Adjustments to reconcile net loss to net cash used in operating activities: |  |  |
Depreciation and amortization | 1,766 | 1,493 | 815
Amortization of debt discount and debt issuance costs | 2,796 | 6,052 | 1,248
Changes in deferred taxes | 0 | 26,025 | (15,666)
Share-based compensation expense | 15,811 | 7,013 | 8,872
Loss on extinguishment of debt | 13,129 | 0 | 0
Other adjustments | 1,262 | 2,042 | 1,055
Net changes in assets and liabilities |  |  |
Accounts receivable | (12,103) | 0 | 0
Inventories | (9,532) | 0 | 0
Prepaid expenses and other current assets | (3,127) | 30,815 | (439)
Research and development tax credit receivable | 1,884 | 30 | 2,796
Accounts payable & other current liabilities | 1,545 | (3,108) | 4,232
Accrued expenses | 16,892 | 227 | 895
Other assets and liabilities | 1,442 | (3,429) | (3,789)
Net cash used in operating activities | (128,511) | (70,304) | (77,310)
Cash flows from investing activities: |  |  |
Purchases of property and equipment | 0 | (716) | (26)
Proceeds from the disposition of the Hospital Products | 0 | 0 | 16,500
Proceeds from sales of marketable securities | 187,136 | 83,828 | 102,224
Purchases of marketable securities | (237,229) | (3,414) | (61,769)
Net cash (used in) provided by investing activities | (50,093) | 79,698 | 56,929
Cash flows from financing activities: |  |  |
Payments for debt issuance costs | (4,357) | (4,804) | 0
Proceeds from royalty purchase agreement | 30,000 | 0 | 0
Proceeds from stock option exercises and employee share purchase plan | 2,293 | 2,682 | 263
Net cash provided by financing activities | 135,335 | 14,543 | 263
Effect of foreign currency exchange rate changes on cash and cash equivalents | 455 | (664) | (896)
Net change in cash and cash equivalents | (42,814) | 23,273 | (21,014)
Cash and cash equivalents at January 1 | 73,981 | 50,708 | 71,722
Cash and cash equivalents at December 31 | 31,167 | 73,981 | 50,708
Supplemental disclosures of cash flow information: |  |  |
Interest paid | 5,250 | 9,660 | 6,469
Income taxes (refunded) paid, net | 0 | (29,058) | 76
February 2023 Notes |  |  |
Cash flows from financing activities: |  |  |
Payments for Notes | (17,500) | (8,653) | 0
October 2023 Notes |  |  |
Cash flows from financing activities: |  |  |
Payments for Notes | (21,165) | 0 | 0
Public offering |  |  |
Cash flows from financing activities: |  |  |
Proceeds from issuance of shares, net of issue costs | 134,151 | 0 | 0
At-the-market offering program |  |  |
Cash flows from financing activities: |  |  |
Proceeds from issuance of shares, net of issue costs | $ 11,913 | $ 25,318 | $ 0

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