Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2019	Sep. 30, 2018
Cash flows from operating activities:
Net loss	$ (55,195)	$ (30,247)
Adjustments to reconcile net loss to net cash used in operating activities:
Non cash interest expense on liability related to royalty monetization	6,179	4,880
Depreciation and amortization	89	33
Change in fair value of financial instruments		(1)
Gain on sale of property, plant and equipment		(14)
Stock-based compensation expense	5,698	3,868
Foreign currency adjustments	8,317	4,802
Changes in operating assets and liabilities:
Prepaid expenses and other current assets	(1,861)	(1,122)
Other assets	(238)	379
Accounts payable	(935)	2,292
Accrued expenses	(2,397)	(1,516)
Other current and long-term liabilities	(176)	(160)
Net cash used in operating activities	(40,519)	(16,806)
Cash flows from investing activities:
Purchase of property, plant and equipment	(523)	(61)
Proceeds from sale of property, plant and equipment		14
Net cash used in investing activities	(523)	(47)
Cash flows from financing activities:
Proceeds from issuance of common stock, net of issuance costs	20,774	94,139
Royalty monetization		44,525
Proceeds from exercise of options	1,478	507
Net cash provided by financing activities	22,252	139,171
Effect of exchange rate changes on cash and cash equivalents	(2,429)	(1,947)
Net (decrease) increase in cash and cash equivalents	(21,219)	120,371
Cash and cash equivalents - beginning of period	163,885	53,231
Cash and cash equivalents - end of period	142,666	$ 173,602
Supplemental disclosures of cash and non-cash activities:
Purchase of property, plant and equipment in accounts payable	17
Right of use assets obtained in exchange for operating lease obligation	$ 4,665