Consolidated Statements of Cash Flows (unaudited) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Operating activities
Net loss	$ (678,224)	$ (563,506)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation	4,483	4,052
Amortization of intangible assets	3,789	3,789
Stock-based compensation expense	70,281	54,795
Amortization of debt issuance costs	5,136	5,568
Paid-in-kind interest capitalized	19,233	17,202
Royalty financing non-cash interest expense	14,979	14,016
Accretion of discount on marketable securities, net	(8,133)	(6,291)
Finance lease amortization expense	2,034	2,034
Non-cash operating lease expense	2,230	8,423
Change in fair value of deferred and contingent consideration liabilities	106,482	12,997
Change in fair value of interest rate swap	1,106	1,650
Changes in operating assets and liabilities:
Accounts receivable	(1,115)	(7,428)
Inventory	(14,922)	(9,179)
Prepaid expenses and other current assets	(16,981)	(1,196)
Other assets	5,625	(16,905)
Accounts payable and accrued liabilities	3,462	(6,554)
Other liabilities	(7,368)	(5,626)
Net cash used in operating activities	(487,903)	(405,428)
Investing activities
Purchase of fixed assets	(15,151)	(11,135)
Purchase of marketable securities	(999,782)	(292,689)
Cash acquired in asset acquisition	0	3,417
Maturities of marketable securities	300,000	75,000
Net cash used in investing activities	(714,933)	(225,407)
Financing activities
Proceeds from exercise of stock options and ESPP	99,503	10,763
Proceeds from issuance of common stock, net	1,084,136	38,014
Payments of finance lease principal	(1,924)	(2,383)
Payment of debt issuance costs	0	(1,218)
Net cash provided by financing activities	1,181,715	45,176
Effect of exchange rates on cash and cash equivalents	198	(1,264)
Net decrease in cash and cash equivalents	(20,923)	(586,923)
Cash and cash equivalents at beginning of period	482,374	1,074,036
Cash and cash equivalents at end of period	461,451	487,113
Supplemental disclosures of cash flow information:
Cash paid for interest	25,327	27,461
Cash paid for income taxes	2,251	1,880
Vertuis Bio, Inc.
Adjustments to reconcile net loss to net cash used in operating activities:
Vertuis / Adrestia acquisition	0	10,250
Adrestia Therapeutics Ltd
Adjustments to reconcile net loss to net cash used in operating activities:
Vertuis / Adrestia acquisition	$ 0	$ 76,481