SCHEDULE 13D/A 0001527166 XXXXXXXX LIVE 3 Common Stock, par value $0.0001 per share 02/18/2026 false 0001683553 85209E208 Spruce Biosciences, Inc.

611 Gateway Boulevard Suite 740 South San Francisco CA 94080

Jeffrey Ferguson (202) 729-5626 The Carlyle Group 1001 Pennsylvania Avenue, NW, Suite 220S Washington DC 20004 0001527166 N The Carlyle Group Inc. OO N DE 0.00 50893.00 0.00 50893.00 50893.00 N 4.7 CO 0001548626 N Carlyle Holdings I GP Inc. OO N DE 0.00 50893.00 0.00 50893.00 50893.00 N 4.7 CO 0001548627 N Carlyle Holdings I GP Sub L.L.C. OO N DE 0.00 50893.00 0.00 50893.00 50893.00 N 4.7 OO Limited Liability Company 0001548628 N Carlyle Holdings I L.P. OO N DE 0.00 50893.00 0.00 50893.00 50893.00 N 4.7 PN 0001790577 N CG Subsidiary Holdings L.L.C. OO N DE 0.00 50893.00 0.00 50893.00 50893.00 N 4.7 OO Limited Liability Company 0000933790 N TC Group, L.L.C. OO N DE 0.00 50893.00 0.00 50893.00 50893.00 N 4.7 OO Limited Liability Company 0001354120 N Carlyle Investment Management L.L.C. OO N DE 0.00 50893.00 0.00 50893.00 50893.00 N 4.7 OO Limited Liability Company 0001941860 N Carlyle Genesis UK LLC OO N DE 0.00 50893.00 0.00 50893.00 50893.00 N 4.7 OO Limited Liability Company 0001397144 N Abingworth LLP OO N X0 0.00 50893.00 0.00 50893.00 50893.00 N 4.7 PN 0001688313 N Abingworth Bioventures VII LP OO N X0 0.00 50893.00 0.00 50893.00 50893.00 N 4.7 PN Common Stock, par value $0.0001 per share Spruce Biosciences, Inc. 611 Gateway Boulevard Suite 740 South San Francisco CA 94080 Explanatory Note This Amendment No. 3 to Schedule 13D ("Amendment No. 3") amends and supplements the Schedule 13D originally filed with the United States Securities and Exchange Commission (the "SEC") on October 16, 2020 (as amended to date, the "Schedule 13D"), relating to the shares of common stock, par value $0.0001 per share (the "Common Stock"), of Spruce Biosciences, Inc., a Delaware corporation (the "Issuer"). Capitalized terms used herein without definition shall have the meanings set forth in the Schedule 13D. Item 4 of the Schedule 13D is hereby amended as follows: Bali Muralidhar, who represented Abingworth Bioventures VII LP on the Issuer's board of directors, resigned as a director in October 2025. Item 5 of the Schedule 13D is hereby amended and restated in its entirety as follows: The following sets forth, as of the date of this Schedule 13D, the aggregate number of shares of Common Stock and percentage of Common Stock beneficially owned by each of the Reporting Persons, based on 1,070,370 shares of Common Stock outstanding as of November 7, 2025, as disclosed in the Issuer's Quarterly Report on Form 10-Q filed with the SEC on November 10, 2025. The amount of Common Stock reported herein reflects a 1-for-75 reverse stock split effected by the Issuer on August 4, 2025. The Reporting Persons beneficially own 50,893 shares of Common Stock, or approximately 4.7% of the shares of Common Stock outstanding, which include (i) 38,620 shares of Common Stock held of record by Abingworth Bioventures VII LP, (ii) 1,233 shares of Common Stock underlying stock options exercisable within 60 days of the date hereof held for the benefit of Abingworth Bioventures VII LP and (iii) 11,040 shares of Common Stock underlying the Standard Warrants exercisable within 60 days of the date hereof. The Carlyle Group Inc., which is a publicly traded entity listed on Nasdaq, is the sole shareholder of Carlyle Holdings I GP Inc., which is the sole member of Carlyle Holdings I GP Sub L.L.C., which is the general partner of Carlyle Holdings I L.P., which, with respect to the securities reported herein, is the managing member of CG Subsidiary Holdings L.L.C., which is the managing member of TC Group, L.L.C., which is the managing member of Carlyle Investment Management, L.L.C., which is the sole member of Carlyle Genesis UK LLC, which is the principal member of Abingworth LLP. Abingworth Bioventures VII LP has delegated to Abingworth LLP all investment and dispositive power over the securities held of record by Abingworth Bioventures VII LP. Accordingly, each of the foregoing entities may be deemed to share beneficial ownership of the securities held of record by Abingworth Bioventures VII LP, but each disclaims beneficial ownership of such securities. Sole power to vote or to direct the vote: 0 Shared power to vote or to direct the vote: 50,893 Sole power to dispose or to direct the disposition: 0 Shared power to dispose or to direct the disposition: 50,893 During the past 60 days, the Reporting Persons have not effected any transactions with respect to the Common Stock. None. As of the date hereof, the Reporting Persons ceased to be the beneficial owners of more than five percent of the outstanding shares of Common Stock. The Carlyle Group Inc. /s/ Anne K. Frederick 02/18/2026 Carlyle Holdings I GP Inc. /s/ Anne K. Frederick 02/18/2026 Carlyle Holdings I GP Sub L.L.C. By: Carlyle Holdings I GP Inc., its sole member, /s/ Anne K. Frederick 02/18/2026 Carlyle Holdings I L.P. /s/ Anne K. Frederick 02/18/2026 CG Subsidiary Holdings L.L.C. /s/ Anne K. Frederick 02/18/2026 TC Group, L.L.C. /s/ Anne K. Frederick 02/18/2026 Carlyle Investment Management L.L.C. /s/ Anne K. Frederick 02/18/2026 Carlyle Genesis UK LLC By: Carlyle Investment Management L.L.C., its sole member, /s/ Anne K. Frederick 02/18/2026 Abingworth LLP /s/ Emma O'Reilly 02/18/2026 Abingworth Bioventures VII LP /s/ Emma O'Reilly 02/18/2026