10-Q

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

WASHINGTON, DC 20549

FORM 10-Q

(Mark One)

☒ QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended March 31, 2022

OR

☐ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the transition period from __________ to ____________

Commission File Number: 001-38958

Karuna Therapeutics, Inc.

(Exact Name of Registrant as Specified in its Charter)

Delaware	27-0605902
(State or other jurisdiction of incorporation or organization)	(I.R.S. Employer Identification No.)
99 High Street, 26th Floor Boston, Massachusetts	02110
(Address of principal executive offices)	(Zip Code)

Registrant’s telephone number, including area code: (857) 449-2244

Securities registered pursuant to Section 12(b) of the Act:

Title of each class	Trading Symbol(s)	Name of each exchange on which registered
Common Stock, $0.0001 par value per share	KRTX	Nasdaq Global Market

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes ☒ No ☐

Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files). Yes ☒ No ☐

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act.

Large accelerated filer	☒	Accelerated filer	☐
Non-accelerated filer	☐	Smaller reporting company	☐
Emerging growth company	☐

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ☐ No ☒

As of April 30, 2022, the registrant had 29,882,727 shares of common stock, $0.0001 par value per share, outstanding.

Table of Contents

		Page
PART I.	FINANCIAL INFORMATION	1
Item 1.	Consolidated Financial Statements (Unaudited)	1
	Consolidated Balance Sheets	1
	Consolidated Statements of Operations	2
	Consolidated Statements of Comprehensive Loss	3
	Consolidated Statements of Stockholders’ Equity	4
	Consolidated Statements of Cash Flows	5
	Notes to Consolidated Financial Statements (Unaudited)	6
Item 2.	Management’s Discussion and Analysis of Financial Condition and Results of Operations	17
Item 3.	Quantitative and Qualitative Disclosures About Market Risk	28
Item 4.	Controls and Procedures	28
PART II.	OTHER INFORMATION	29
Item 1.	Legal Proceedings	29
Item 1A.	Risk Factors	29
Item 2.	Unregistered Sales of Equity Securities and Use of Proceeds	29
Item 3.	Defaults Upon Senior Securities	29
Item 4.	Mine Safety Disclosures	29
Item 5.	Other Information	29
Item 6.	Exhibits	30
Signatures		31

i

PART I—FINANCIAL INFORMATION

Item 1. Consolidated Financial Statements.

KARUNA THERAPEUTICS, INC.

CONSOLIDATED BALANCE SHEETS

(In thousands, except share and per share data)

(Unaudited)

	March 31, 2022			December 31, 2021
Assets
Current assets:
Cash and cash equivalents	$	176,203		$	206,953
Investment securities, available-for-sale		266,984			287,038
Accounts receivable		—			1,750
Prepaid expenses and other current assets		20,972			21,138
Deferred offering costs		480			455
Total current assets		464,639			517,334
Restricted cash		261			261
Right-of-use lease assets - operating, net		6,021			6,453
Property and equipment, net		3,050			3,092
Other non-current assets		503			531
Total assets	$	474,474		$	527,671
Liabilities and Stockholders’ Equity
Current liabilities:
Accounts payable	$	1,478		$	1,939
Accrued expenses		12,226			16,099
Current portion of operating lease liability		2,219			2,175
Total current liabilities		15,923			20,213
Operating lease liability, net of current portion		4,759			5,328
Other non-current liabilities		104			104
Total liabilities		20,786			25,645
Commitments and Contingencies (Note 9)
Stockholders’ equity:
Preferred stock, $0.0001 par value; 10,000,000 shares authorized and 0     shares outstanding as of March 31, 2022 and December 31, 2021		—			—
Common stock, $0.0001 par value; 150,000,000 shares authorized at    March 31, 2022 and December 31, 2021; 29,831,258 and 29,770,558     shares issued and outstanding at March 31, 2022 and December 31,    2021, respectively		3			3
Additional paid-in capital		802,309			790,391
Accumulated deficit		(346,089	)		(287,871	)
Accumulated other comprehensive loss		(2,535	)		(497	)
Total stockholders’ equity		453,688			502,026
Total liabilities and stockholders’ equity	$	474,474		$	527,671

The accompanying notes are an integral part of these consolidated financial statements

1

Karuna Therapeutics, Inc.

CONSOLIDATED Statements of Operations

(In thousands, except share and per share data)

(Unaudited)

	Three Months Ended March 31,
	2022			2021
License revenue	$	—		$	—
Operating expenses:
Research and development		43,806			20,186
General and administrative		14,788			9,777
Total operating expenses		58,594			29,963
Loss from operations		(58,594	)		(29,963	)
Other income (loss), net:
Impairment loss on right-of-use assets		—			(677	)
Interest income		237			143
Sublease income		139			—
Total other income (loss), net		376			(534	)
Net loss before income taxes		(58,218	)		(30,497	)
Income tax provision		—			—
Net loss attributable to common stockholders	$	(58,218	)	$	(30,497	)
Net loss per share, basic and diluted (Note 6)	$	(1.95	)	$	(1.10	)
Weighted average common shares outstanding used in    computing net loss per share, basic and diluted		29,805,961			27,786,538

The accompanying notes are an integral part of these consolidated financial statements

2

Karuna Therapeutics, Inc.

CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS

(In thousands)

(Unaudited)

	Three Months Ended March 31,
	2022			2021
Net loss	$	(58,218	)	$	(30,497	)
Other comprehensive loss:
Unrealized losses on available-for-sale    investments		(2,038	)		(30	)
Comprehensive loss	$	(60,256	)	$	(30,527	)

The accompanying notes are an integral part of these consolidated financial statements

3

Karuna Therapeutics, Inc.

CONSOLIDATED Statements of Stockholders’ Equity

(In thousands, except share data)

(Unaudited)

	Common Stock				Additional Paid-in		Accumulated			Accumulated Other Comprehensive			Total Stockholders’
	Shares		Value		Capital		Deficit			Loss			Equity
Balance, December 31, 2021		29,770,558	$	3	$	790,391	$	(287,871	)	$	(497	)	$	502,026
Stock-based compensation expense		—		—		10,636		—			—			10,636
Exercise of common options		60,700		—		1,282		—			—			1,282
Other comprehensive loss		—		—		—		—			(2,038	)		(2,038	)
Net loss		—		—		—		(58,218	)		—			(58,218	)
Balance, March 31, 2022		29,831,258	$	3	$	802,309	$	(346,089	)	$	(2,535	)	$	453,688

	Common Stock				Additional Paid-in		Accumulated			Accumulated Other Comprehensive			Total Stockholders’
	Shares		Value		Capital		Deficit			Income			Equity
Balance, December 31, 2020		26,988,458	$	3	$	482,955	$	(144,066	)	$	39		$	338,931
Issuance of common stock upon public    offering, net of $17,250 in under-writing    discounts and commissions and $233 in    offering costs		2,395,834		—		270,017		—			—			270,017
Stock-based compensation expense		—		—		5,822		—			—			5,822
Exercise of common options		56,876		—		671		—			—			671
Other comprehensive loss		—		—		—		—			(30	)		(30	)
Net loss		—		—		—		(30,497	)		—			(30,497	)
Balance, March 31, 2021		29,441,168	$	3	$	759,465	$	(174,563	)	$	9		$	584,914

The accompanying notes are an integral part of these consolidated financial statements

4

Karuna Therapeutics, Inc.

CONSOLIDATED Statements of Cash Flows

(In thousands)

(Unaudited)

	Three Months Ended March 31,
	2022			2021
Cash flows from operating activities
Net loss	$	(58,218	)	$	(30,497	)
Adjustments to reconcile net loss to net cash used in operating activities:
Stock-based compensation expense		10,636			5,822
Impairment loss on right-of-use assets		—			677
Amortization of premiums and accretion of discounts on    investment securities		285			221
Depreciation and amortization expense		248			112
Changes in operating assets and liabilities:
Accrued interest on investment securities		(65	)		277
Accounts receivable		1,750			—
Prepaid expenses and other current assets		166			3,546
Right-of-use assets		432			167
Other non-current assets		28			(1,006	)
Accounts payable		(481	)		322
Accrued expenses		(4,059	)		(754	)
Operating lease liability		(525	)		(205	)
Deferred lease obligation		—			35
Other non-current liabilities		—			104
Net cash used in operating activities		(49,803	)		(21,179	)
Cash flows from investing activities
Purchases of investment securities		(48,303	)		(80,856	)
Maturities of investment securities		66,099			132,000
Acquisition of property and equipment		—			(47	)
Net cash provided by investing activities		17,796			51,097
Cash flows from financing activities
Proceeds from public offering, net of underwriting discounts    and commissions		—			270,250
Payment of offering costs		(25	)		(98	)
Proceeds from exercise of stock options		1,282			671
Net cash provided by financing activities		1,257			270,823
Net increase (decrease) in cash, cash equivalents and restricted cash		(30,750	)		300,741
Cash, cash equivalents and restricted cash at beginning of period		207,214			53,205
Cash, cash equivalents and restricted cash at end of period	$	176,464		$	353,946
Supplemental disclosures of cash flows information
Deferred offering costs included in accounts payable and accrued expenses	$	—		$	135
Purchases of property and equipment included in accounts payable    and accrued expenses	$	206		$	19

The accompanying notes are an integral part of these consolidated financial statements

5

NOTES TO CONSOLIDATED FINANCIAL STATEMENTS

(Unaudited)

Note 1. Nature of the Business and Basis of Presentation

Description of the Business

Karuna Therapeutics, Inc. (the “Company”) was incorporated under the laws of the State of Delaware in July 2009 as Karuna Pharmaceuticals, Inc. and is headquartered in Boston, Massachusetts. In March 2019, the Company changed its name to Karuna Therapeutics, Inc. The Company is an innovative clinical-stage biopharmaceutical company driven to create and deliver transformative medicines for people living with psychiatric and neurological conditions.

Since the Company’s inception, it has focused substantially all of its efforts and financial resources on organizing and staffing the Company, acquiring and developing its technology, raising capital, building its intellectual property portfolio, undertaking preclinical studies and clinical trials and providing general and administrative support for these activities. The Company has not generated any product revenue related to its primary business purpose to date and is subject to a number of risks similar to those of other early stage companies, including dependence on key individuals, regulatory approval of products, uncertainty of market acceptance of products, competition from substitute products and larger companies, compliance with government regulations, protection of proprietary technology, dependence on third parties, product liability, the impact of the ongoing and evolving COVID-19 coronavirus pandemic, and the need to obtain adequate additional financing to fund the development of its product candidates.

The Company’s consolidated financial statements have been prepared on the basis of continuity of operations, realization of assets and the satisfaction of liabilities in the ordinary course of business. The Company experienced negative operating cash flows of $49.8 million for the three months ended March 31, 2022 and had an accumulated deficit of $346.1 million as of March 31, 2022. The Company expects to continue to generate operating losses for the foreseeable future.

The Company expects that its cash, cash equivalents and available-for-sale investments of $443.2 million as of March 31, 2022 will be sufficient to fund its operating expenses and capital expenditure requirements through at least 12 months from the date of issuance of these consolidated financial statements.

Basis of Presentation

The accompanying consolidated financial statements have been prepared in conformity with accounting principles generally accepted in the United States of America (“U.S. GAAP”). Any reference in these notes to applicable guidance is meant to refer to the authoritative U.S. GAAP as found in the Accounting Standards Codification (“ASC”) and Accounting Standards Updates (“ASUs”) of the Financial Accounting Standards Board (“FASB”).

The consolidated financial statements include the accounts of the Company and its wholly owned subsidiary, Karuna Securities Corporation, a Massachusetts corporation. All inter-company transactions and balances have been eliminated in consolidation.

The accompanying consolidated balance sheet as of March 31, 2022 and the consolidated statements of operations, comprehensive loss, cash flows, and stockholders’ equity for the three months ended March 31, 2022 and 2021 are unaudited. The unaudited interim consolidated financial statements have been prepared on the same basis as the audited annual consolidated financial statements and, in the opinion of management, reflect all adjustments, which include only normal recurring adjustments, necessary for the fair statement of the Company’s financial position as of March 31, 2022 and the results of its operations and cash flows for the three months ended March 31, 2022 and 2021. Certain information and footnote disclosures typically included in annual financial statements prepared in accordance with U.S. GAAP have been condensed or omitted. Accordingly, these unaudited consolidated interim financial statements should be read in conjunction with the Company’s consolidated financial statements as of and for the year ended December 31, 2021. The results for the three months ended March 31, 2022 are not necessarily indicative of results to be expected for the year ending December 31, 2022, any other interim periods, or any future year or period.

Note 2. Summary of Significant Accounting Policies

The significant accounting policies and estimates used in preparation of the consolidated financial statements are described in the Company’s audited consolidated financial statements as of and for the year ended December 31, 2021, and the notes thereto, which are included in the Company’s Annual Report on Form 10-K. During the three months ended March 31, 2022, there were no material changes to the Company’s significant accounting policies.

6

Recently Issued Accounting Pronouncements

New pronouncements issued but not effective until after March 31, 2022 are not expected to have a material impact on the Company’s consolidated financial statements.

Note 3. Prepaid Expenses and Other Assets and Accrued Expenses

Prepaid expenses and other current assets consisted of the following (in thousands):

	March 31, 2022		December 31, 2021
Prepaid research and development expenses	$	17,854	$	18,066
Prepaid insurance		1,172		2,364
Other		1,946		708
Total prepaid expenses and other current assets	$	20,972	$	21,138

The Company also had other non-current assets of $0.5 million as of March 31, 2022 and December 31, 2021. As of March 31, 2022, other non-current assets consisted of a security deposit of $0.4 million and less than $0.1 million in prepaid research and development and other expenses, as well as less than $0.1 million in deferred rent. As of December 31, 2021, other non-current assets consisted of a security deposit of $0.4 million, $0.1 million in prepaid expenses, and less than $0.1 million in deferred rent.

Accrued expenses consisted of the following (in thousands):

	March 31, 2022		December 31, 2021
Accrued research and development expenses	$	8,765	$	8,316
Accrued payroll and related expenses		1,945		6,989
Professional fees		1,040		543
Other		476		251
Total accrued expenses	$	12,226	$	16,099

Note 4. Stockholders’ Equity

Preferred Stock

On July 2, 2019, in connection with the closing of the Company’s initial public offering of its common stock ("IPO"), the Company filed its amended and restated Certificate of Incorporation, which authorizes the Company to issue up to 10,000,000 shares of preferred stock, $0.0001 par value per share. Through March 31, 2022, no preferred stock has been issued.

Common Stock

As of March 31, 2022, the Company’s amended and restated Certificate of Incorporation authorized the Company to issue 150,000,000 shares of common stock, $0.0001 par value per share.

Holders of the common stock are entitled to one vote for each share of common stock held at all meetings of stockholders and written actions in lieu of meetings. The holders of common stock are entitled to receive dividends out of funds legally available, as declared by the board of directors. These dividends are subject to the preferential dividend rights of the holders of the Company’s preferred stock. Through March 31, 2022, no cash dividends have been declared or paid.

As of March 31, 2022, there were 29,831,258 shares of common stock outstanding.

7

Note 5. Zai License Agreement

Terms of Agreement

On November 8, 2021, the Company and Zai Lab (Shanghai) Co., Ltd. ("Zai") entered into a license agreement (the "Zai License Agreement"), pursuant to which the Company granted to Zai the right to exclusively develop, manufacture and commercialize KarXT in Greater China, including mainland China, Hong Kong, Macau, and Taiwan (the “Licensed Territory”). Zai will fund substantially all development, regulatory, and commercialization activities in the Licensed Territory.

Under the terms of the Zai License Agreement, the Company received a non-refundable $35 million upfront payment and payment of certain taxes on its behalf. The Company is eligible to receive up to an additional $80 million in development and regulatory milestone payments, up to $72 million in sales milestone payments and low double-digit to high-teens tiered royalties based on annual net sales of KarXT in the Licensed Territory, subject to reduction under specified circumstances. Receipt of sales milestone payments and royalties are not contingent on any further participation by Karuna in the development of KarXT in the Licensed Territory.

The Zai License Agreement will expire upon the latest of the following dates with respect to the last licensed product in any region in the Licensed Territory: (i) the date of expiration of the last valid claim covering such licensed product in such region, (ii) the date that is a specific period after the date of the first commercial sale of such licensed product in such region and (iii) the expiration date of any regulatory exclusivity for such licensed product in such region. Zai may terminate the Zai License Agreement for convenience, subject to the terms thereto, by providing written notice to Karuna, which termination will be effective following a prescribed notice period. In addition, the Company may terminate the Zai License Agreement under specified circumstances if Zai or certain other parties challenge the Company’s patent rights or if Zai or its affiliates fail to complete certain development activities with respect to the licensed product for a specified period of time, subject to specified exceptions. Either party may terminate the Zai License Agreement for the other party’s uncured material breach, with a customary notice and cure period, or insolvency.

After termination or expiration, the Company is entitled to retain a worldwide, exclusive, and perpetual license from Zai to exploit the licensed product, which license would be non-exclusive after expiration (but not termination), subject to a reasonable royalty to be agreed by the parties if terminated for the Company’s uncured material breach.

Revenue Recognition

The Company concluded that the distinct units of account within the agreement are reflective of a vendor-customer relationship and therefore within the scope of ASC 606.

Under the provisions of ASC 606, the Company identified one performance obligation. The Company provided an exclusive license to intellectual property, bundled with the associated know-how and certain professional services that are not substantive.

Under the terms of the Zai License Agreement, Zai has the sole right to manufacture, or have manufactured, KarXT for use in development and commercialization in the Licensed Territory. At the election of Zai, the Company may supply KarXT to Zai at the fully burdened manufacturing cost plus a specified margin, as defined within the agreement. This provision was determined to be an option to acquire additional goods or services at a price that approximates the stand-alone selling price for that good or service, and therefore does not represent a material right, or separate performance obligation, within the context of the Zai License Agreement.

The Company determined the transaction price was equal to $37.0 million, which includes the upfront fee of $35 million and payments to taxing authorities on the Company’s behalf. In estimating the stand-alone selling price, the Company determined that there were no significant financing components, noncash consideration or amounts that may be refunded to the customer, and as such the total unconstrained consideration of $37.0 million was included in the total transaction price.

8

License of Intellectual Property. The license to the Company's intellectual property, bundled with the associated know-how, represents a distinct performance obligation. The license and associated know-how was transferred to Zai in the fourth quarter of 2021 to satisfy this performance obligation. The Company allocated the full transaction price to the license of the Company's intellectual property, bundled with the associated know-how, and accordingly recognized revenue of $37.0 million as license revenue in its Consolidated Statement of Operations for the year ended December 31, 2021.

Milestone Payments. The potential development and regulatory milestone payments, as well as sales milestone payments, are paid upon achievement of certain milestones as defined in the Zai License Agreement. The Company evaluated whether or not the milestones are considered probable of being reached and determined that their achievement is highly dependent on factors outside of the Company's control. These payments have been fully constrained until the Company concludes that achievement of the milestone is probable, and that recognition of revenue related to the milestone will not result in a significant reversal in amounts recognized in future periods, and as such have been excluded from the transaction price. At the end of each subsequent reporting period, the Company will re-evaluate the probability of achievement of each milestone and any related constraint and, if necessary, adjust its estimate of the overall transaction price.

Royalties. Any consideration related to royalties will be recognized if and when the related sales occur, as they were determined to relate predominantly to the license granted to Zai and, therefore, have also been excluded from the transaction price.

The Company assessed the Zai License Agreement to determine whether a significant financing component exists and concluded that a significant financing component does not exist. The upfront payment received by the Company was subject to foreign tax withholdings of $3.7 million. The Company recorded this tax expense to general and administrative expense in the Consolidated Statement of Operations for the year ended December 31, 2021.

There was no revenue recorded for the three months ended March 31, 2022 and 2021, and no deferred revenue as of March 31, 2022 or December 31, 2021, related to the Zai License Agreement.

Note 6. Net Loss per Share

The following table sets forth the computation of basic and diluted net loss per share of common stock for the three months ended March 31, 2022 and 2021 (in thousands, except share and per share data):

	Three Months Ended March 31,
	2022			2021
Net Loss	$	(58,218	)	$	(30,497	)
Weighted-average shares used in computing net loss per share		29,805,961			27,786,538
Net loss per share, basic and diluted	$	(1.95	)	$	(1.10	)

The Company’s potentially dilutive securities, which consist of stock options, have been excluded from the computation of diluted net loss per share as the effect would be to reduce the net loss per share. Therefore, the weighted average number of common shares outstanding used to calculate both basic and diluted net loss per share attributable to common stockholders is the same.

Common Stock Equivalents

As of March 31, 2022 and 2021, stock options to purchase 5,923,147 and 5,171,914 shares of common stock, respectively, have been excluded from the calculation of diluted net loss per share because including them would have had an anti-dilutive impact.

9

Note 7. Stock-based Compensation

Stock Options

In September 2009, the Company’s board of directors approved the 2009 Stock Incentive Plan (the “2009 Plan”) which provided for the grant of incentive stock options to employees and non-statutory stock options to directors, consultants, and non-employees of the Company. The 2009 Plan terminated in July 2019 effective upon the completion of the Company’s IPO. No additional options will be granted under the 2009 Plan. As of March 31, 2022, there were 2,357,970 options outstanding under the 2009 Plan.

In May 2019, the Company’s board of directors approved the 2019 Stock Option and Incentive Plan (the “2019 Plan”) which became effective on June 26, 2019, the date immediately prior to the date on which the registration statement related to the IPO was declared effective by the Securities and Exchange Commission ("SEC"). The 2019 Plan will expire in May 2029. Under the 2019 Plan, the Company may grant incentive stock options, non-statutory stock options, restricted stock awards, restricted stock units ("RSUs") and other stock-based awards. There were 1,709,832 shares of the Company’s common stock initially reserved for issuance under the 2019 Plan. The number of shares of common stock underlying awards that expire, or are terminated, surrendered, canceled or forfeited without having been fully exercised under the 2009 Plan will be added to the shares of common stock available for issuance under the 2019 Plan. In addition, the number of shares of common stock that may be issued under the 2019 Plan automatically increases on January 1 of each calendar year, commencing on January 1, 2020, by 4% of the number of shares of common stock outstanding on the immediately preceding December 31 or such lesser amount determined by the Company’s board of directors or the compensation committee of the board of directors. As of March 31, 2022, there were 1,591,887 common shares available for issuance and 3,565,177 options outstanding under the 2019 Plan.

Options under the 2019 Plan generally vest based on the grantee’s continued service with the Company during a specified period following a grant as determined by the board of directors and expire ten years from the grant date. Awards typically vest in four years, but vesting conditions can vary based on the discretion of the Company’s board of directors.

A summary of the Company’s stock option activity and related information is as follows:

	Number of Shares			Weighted- Average Exercise Price Per Share		Weighted- Average Remaining Contractual Term (Years)		Aggregate Intrinsic Value (in thousands)
Outstanding as of December 31, 2021		5,323,162		$	50.04		7.7	$	431,456
Granted		703,685			112.16
Exercised		(60,700	)		21.13
Forfeited		(43,000	)		106.51
Outstanding as of March 31, 2022		5,923,147		$	57.31		7.7	$	414,748
Options vested and expected to vest as of    March 31, 2022		5,923,147		$	57.31		7.7	$	414,748
Options exercisable as of March 31, 2022		3,552,230		$	26.12		6.9	$	358,298

The aggregate intrinsic values of options outstanding, exercisable, vested and expected to vest were calculated as the difference between the exercise price of the options and the publicly traded stock price of the Company’s common stock as of March 31, 2022.

As of March 31, 2022, there was $131.0 million of unrecognized compensation cost, which is expected to be recognized over a weighted-average period of 3.17 years.

10

Stock-based Compensation Expense

Stock-based compensation expense is classified in the statements of operations for the three months ended March 31, 2022 and 2021 as follows (in thousands):

	Three Months Ended March 31,
	2022		2021
General and administrative	$	6,106	$	3,741
Research and development		4,530		2,081
Total stock-based compensation expense	$	10,636	$	5,822

Note 8. Fair Value of Financial Assets and Liabilities

The following tables present information about the Company’s assets as of March 31, 2022 and December 31, 2021 that are measured at fair value on a recurring basis and indicate the level of the fair value hierarchy utilized to determine such fair values (in thousands):

	Fair Value Measurement
	at March 31, 2022 Using
	Level 1		Level 2		Level 3		Total
Cash equivalents:
Money market fund	$	132,808	$	—	$	—	$	132,808
Commercial paper		26,878		—		—		26,878
US government agencies		9,287		—		—		9,287
Investment securities:
U.S. Treasuries		108,509		—		—		108,509
Corporate debt securities		—		49,227		—		49,227
Commercial paper		—		109,248		—		109,248
Total	$	277,482	$	158,475	$	—	$	435,957
	Fair Value Measurement
	at December 31, 2021 Using
	Level 1		Level 2		Level 3		Total
Cash equivalents:
Money market fund	$	199,019	$	—	$	—	$	199,019
Investment securities:
U.S. Treasuries		100,043		—		—		100,043
Corporate debt securities		—		55,744		—		55,744
Commercial paper		—		131,251		—		131,251
Total	$	299,062	$	186,995	$	—	$	486,057

The fair values of the Company’s commercial paper and corporate debt securities are based on prices obtained from independent pricing sources. Securities with validated quotes from pricing services are reflected within Level 2, as they are primarily based on observable pricing for similar assets or other market observable inputs. Typical inputs used by these pricing services include, but are not limited to, reported trades, benchmark yields, issuer spreads, bids, offers or estimates of cash flow, prepayment spreads and default rates.

The Company does not hold any securities classified as Level 3, which are securities valued using unobservable inputs. The Company has not transferred any investment securities between the classification levels.

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The estimated fair value and amortized cost of the Company’s available-for-sale investments, by contractual maturity and security type, are summarized as follows (in thousands):

	March 31, 2022
	Amortized Cost		Unrealized Gains		Unrealized Losses			Fair Value
U.S. Treasuries (due within one year)	$	45,286	$	—	$	(366	)	$	44,920
U.S. Treasuries (due after one year and less than    two years)		65,072		—		(1,483	)		63,589
Corporate debt securities (due within one year)		44,457		—		(263	)		44,194
Corporate debt securities (due after one year and    less than two years)		5,116		—		(83	)		5,033
Commercial paper (due within one year)		109,588		—		(340	)		109,248
Total	$	269,519	$	—	$	(2,535	)	$	266,984
	December 31, 2021
	Amortized Cost		Unrealized Gains		Unrealized Losses			Fair Value
U.S. Treasuries (due within one year)	$	15,137	$	—	$	(12	)	$	15,125
U.S. Treasuries (due after one year and less than    two years)	$	85,277	$	—	$	(359	)		84,918
Corporate debt securities (due within one year)	$	45,510	$	—	$	(57	)		45,453
Corporate debt securities (due after one year and    less than two years)		10,338		—		(47	)		10,291
Commercial paper (due within one year)		131,273		5		(27	)		131,251
Total	$	287,535	$	5	$	(502	)	$	287,038

The Company has classified all of its available-for-sale investment securities, including those with maturities beyond one year, as current assets on its condensed consolidated balance sheets based on the highly liquid nature of the investment securities and because these investment securities are considered available for use in current operations.

The Company is required to determine whether a decline in the fair value below the amortized cost basis of available-for-sale securities is due to credit-related factors. At each reporting date, the Company performs an evaluation of impairment to determine if any unrealized losses are the result of credit losses. Impairment is assessed at the individual security level. Factors considered in determining whether a loss resulted from a credit loss or other factors include the Company’s intent and ability to hold the investment until the recovery of its amortized cost basis, the extent to which the fair value is less than the amortized cost basis, the length of time and extent to which fair value has been less than the cost basis, the financial condition of the issuer, any historical failure of the issuer to make scheduled interest or principal payments, any changes to the rating of the security by a rating agency, any adverse legal or regulatory events affecting the issuer or issuer’s industry, and any significant deterioration in economic conditions.

Unrealized losses on available-for-sale securities presented in the previous table have not been recognized in the consolidated statements of operations because the securities are high credit quality, investment grade securities that the Company does not intend to sell and will not be required to sell prior to their anticipated recovery, and the decline in fair value is attributable to factors other than credit losses. Based on its evaluation, the Company determined its year-to-date credit losses related to its available-for-sale securities were immaterial at March 31, 2022 and December 31, 2021.

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Note 9. Commitments and Contingencies

Leases

The Company entered into an agreement to lease approximately 7,050 square feet of office space in Boston, Massachusetts (“Arch Street Original Premises”) that began in December 2018 and had an original expiry in February 2023. In January 2020, the Company entered into an amended agreement (“Amended Arch Street Lease Agreement”) to gain access to approximately 4,175 square feet of additional office space (“Arch Street Expansion Premises”) beginning in March 2020, and to extend the maturity of the agreement for the Arch Street Original Premises to December 2023. The Amended Arch Street Lease Agreement provides for future minimum annual rental payments as defined within the agreement. Under the terms of the Amended Arch Street Lease Agreement, the Company is required to maintain a cash balance of approximately $0.2 million to secure a letter of credit associated with this lease. The amount was classified as restricted cash in the consolidated balance sheets as of March 31, 2022 and December 31, 2021. The Amended Arch Street Lease Agreement also provides for approximately $0.1 million in leasehold incentives which may be applied to base rent or improvements to the Arch Street Expansion Premises, subject to limitations.

The Company determined the Amended Arch Street Lease Agreement represented a lease modification, and the Arch Street Original Premises and Arch Street Expansion Premises were identified as separate lease components. The extension of maturity with respect to the Arch Street Original Premises was treated as a modification not accounted for as a separate contract, in which the lease classification was reassessed, and the lease liability was remeasured. The effect of the remeasurement, in the amount of $0.4 million, was recorded as an adjustment to the right-of-use (“ROU”) lease asset as of February 1, 2020, the effective date of the modification. The addition of the Arch Street Expansion Premises was accounted for as a separate contract which granted the Company an additional right of use not included in the original lease, in which the lease payments increased commensurate with the standalone price for the additional right of use. As the leasehold incentives were not paid or payable at commencement, the Company will account for the incentives once the contingency is resolved.

In February 2020, the Company entered into an agreement to lease approximately 5,050 square feet of office space, and furniture within the office space, in Carmel, Indiana (“Indiana Lease Agreement”), which began in June 2020 and expires in July 2023, with the option to renew for an additional three-year term. In addition, the agreement provides an option to purchase the office furniture at the expiration of the agreement.

The office space and office furniture within the Indiana Lease Agreement were each determined to represent separate lease components. Consideration for the contract was allocated to each lease component based on their relative stand-alone selling price. The options to renew the lease for an additional three-year term as well as purchase the office furniture at the expiration of the agreement were excluded from the determination of lease liabilities arising from obtaining the ROU assets, as they were not considered probable of being exercised at commencement.

In March 2021, the Company entered into an agreement (“High Street Lease”) to sublease from a third party approximately 25,445 square feet of office space in Boston, Massachusetts, beginning on April 1, 2021 and expiring December 31, 2025. The initial fixed rental rate is $60 per rentable square foot of the premises per annum and will increase at a rate of $1 per rentable square foot each year, with base rent first becoming due on July 1, 2021. Upon signing of the High Street Lease, the Company was also required to pay the first full monthly installment of base rent of $0.1 million and a security deposit of $0.4 million. The security deposit was recorded within other non-current assets on the consolidated balance sheets as of March 31, 2022 and December 31, 2021. The first monthly installment was included as an adjustment to the ROU asset recognized upon commencement of the lease. The Company recognized an ROU asset and corresponding lease liability of approximately $6.2 million and $6.0 million, respectively, on its consolidated balance sheet as of April 1, 2021, upon commencement of the High Street Lease.

For each of the lease agreements entered into or modified, the Company identified certain non-lease components. Lease and non-lease components were combined into a single lease component. In addition, all identified leases were assessed as operating leases.

As the Company’s leases do not provide an implicit rate, the Company used its incremental borrowing rate, which is the rate incurred to borrow on a collateralized basis over a term equal to the lease payments in a similar economic environment, in determining the present value of lease payments for each identified lease at the lease commencement date.

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Simultaneous with the High Street Lease, the Company entered into an agreement (“Arch Street Original Premises Sublease”) to sublease approximately 7,050 square feet of its former Arch Street Boston headquarters to a third party from July 1, 2021 through the remainder of its current lease term, which ends on December 31, 2023. The initial fixed rental rate is $59 per rentable square foot of the premises per annum, and will increase at a rate of 2% per year, with base rent first becoming due on October 1, 2021. Upon signing of the Arch Street Original Premises Sublease, the agreement required a security deposit of $0.1 million which has been recorded within restricted cash on the consolidated balance sheet as of March 31, 2022.

On April 30, 2021, the Company entered into an agreement ("First Expansion Premises Sublease") to sublease approximately 1,751 square feet of the Arch Street Expansion Premises to another third party from June 1, 2021 through the remainder of its current lease term, which ends on December 31, 2023. The initial fixed rental rate is $61 per rentable square foot per annum and will increase at a rate of 2% per year, with base rent commencing on June 1, 2021.

On January 21, 2022, the Company entered into an agreement ("Second Expansion Premises Sublease") to sublease approximately 2,422 square feet of its Arch Street Expansion Premises to a third party from February 7, 2022 through the remainder of its current lease term, which ends on December 31, 2023. The fixed rental rate is $45 per rentable square foot per annum, with base rent commencing on April 7, 2022.

The components of lease cost were as follows (dollar amounts in thousands):

	Three Months Ended March 31,
	2022			2021
Lease Cost
Operating lease cost	$	538		$	207
Short-term lease cost		—			—
Sublease income		(139	)		—
Total lease cost	$	399		$	207
Other Information
Cash paid for amounts included in the measurement of lease liabilities	$	631		$	244
Weighted-average remaining lease term	3.28 years			2.69 years
Weighted-average discount rate		5.89	%		6.21	%

The following is a maturity analysis of the annual undiscounted cash flows of the operating lease liabilities and a reconciliation to present value of lease liabilities as of March 31, 2022 (in thousands):

Year ended:
December 31, 2022	$	1,916
December 31, 2023		2,520
December 31, 2024		1,597
December 31, 2025		1,622
Total future minimum lease payments		7,655
Less imputed interest		(677	)
Present value of lease liabilities	$	6,978

The following summarizes the annual undiscounted cash flows to be received from subleases (in thousands):

Year ended:
December 31, 2022	$	477
December 31, 2023		648
Total future sublease payments to be received	$	1,125

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Historically, all Company assets and liabilities belonged to a single corporate office asset group. The circumstances described above triggered a reassessment of asset grouping, such that the ROU assets associated with the Arch Street Original Premises and Arch Street Expansion Premises had their own separately identifiable cash flows and therefore their own separate asset grouping. Further, sublease income associated with the Arch Street office space is projected to be lower than lease payments owed by the Company for this space, and therefore impairment was indicated for this new asset group.

The carrying value of these ROU assets immediately before impairment was $2.0 million, and the fair value of these operating lease ROU assets immediately subsequent to the impairment, calculated as the present value of the estimated future cash flows attributable to the assets, was $1.3 million. The Company recognized approximately $0.7 million in impairment losses on ROU assets within other income (loss) on the statement of operations for the three months ended March 31, 2021.

Intellectual Property License with Eli Lilly and Company

In May 2012, the Company entered into an exclusive license agreement (the “Lilly License Agreement”), with Eli Lilly and Company (“Eli Lilly”), pursuant to which Eli Lilly assigned to the Company all of its rights to certain patents (now expired), regulatory documentation, data records and materials related to xanomeline. The Company is also entitled to sublicense or otherwise transfer the rights granted in connection with the Lilly License Agreement.

Under the Lilly License Agreement, the Company is obligated to use commercially reasonable efforts to develop, manufacture, commercialize and seek and maintain regulatory approval for xanomeline, in any formulation, for use in humans.

The Company paid Eli Lilly an upfront payment of $0.1 million and has agreed to make milestone payments to Eli Lilly of up to an aggregate of $16 million upon the achievement of specified regulatory milestones and up to an aggregate of $54 million in commercial milestones. In addition, the Company is obligated to pay Eli Lilly tiered royalties, at rates in the low to mid single-digit percentages, on the worldwide net sales of any commercialized product on a country-by-country basis until the expiration of the applicable royalty term, which is the longer of six years from the date of first commercial sale of each licensed product within a country or data package exclusivity in such country. During the royalty term, Eli Lilly is prohibited from granting any third party rights to the patents, regulatory documentation, data records and materials that have been licensed to the Company under the Lilly License Agreement.

The Lilly License Agreement will expire on the later of (i) the expiration of the last-to-expire royalty term on a licensed product-by-licensed product basis or (ii) the date on which the Company has made all milestone payments pursuant to the terms of the Lilly License Agreement, unless terminated earlier by the parties. In no event will the term of the Lilly License Agreement exceed 15 years past the anniversary of the first commercial sale of a xanomeline product. The Company may terminate the Lilly License Agreement for any reason with proper prior notice to Eli Lilly. Either party may terminate the Lilly License Agreement upon an uncured material breach by the other party.

The initial upfront payment of $0.1 million was expensed when incurred in May 2012. As of March 31, 2022, no milestones have been reached and, accordingly, no milestone payments have been made.

Intellectual Property License with PureTech Health

In March 2011, the Company entered into an exclusive license agreement (the “Patent License Agreement”) with PureTech Health, pursuant to which PureTech Health granted the Company an exclusive license to patent rights relating to combinations of a muscarinic activator with a muscarinic inhibitor for the treatment of central nervous system disorders.

In connection with the Patent License Agreement, the Company has agreed to make milestone payments to PureTech Health of up to an aggregate of $10 million upon the achievement of specified development and regulatory milestones. In addition, the Company is obligated to pay PureTech Health low single-digit royalties on the worldwide net sales of any commercialized product covered by the licenses granted under the Patent License Agreement.

In the event that the Company sublicenses any of the patent rights granted under the Patent License Agreement, the Company will be obligated to pay PureTech Health royalties within the range of 15% to 25% on any income the Company receives from the sublicensee, excluding royalties.

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The Company may terminate the Patent License Agreement for any reason with proper prior notice to PureTech Health. Either party may terminate the Patent License Agreement upon an uncured material breach by the other party.

The Company incurred no expenses related to the Patent License Agreement provided by PureTech Health during the three months ended March 31, 2022 and 2021. During the year ended December 31, 2021, the Company paid less than $0.1 million in sublicense income associated with the Zai License Agreement to PureTech Health. In December 2020, the Company paid $2.0 million to PureTech Health, having reached the milestone of Phase 3 clinical trial commencement. The Company had no outstanding liabilities to PureTech Health related to the Patent License Agreement as of March 31, 2022 and December 31, 2021.

Indemnification

In the normal course of business, the Company enters into contracts and agreements that contain a variety of representations and warranties and provide for general indemnifications. The Company’s exposure under these agreements is unknown because it involves claims that may be made against the Company in the future but have not yet been made. To date, the Company has not paid any claims or been required to defend any action related to its indemnification obligations. However, the Company may incur charges in the future as a result of these indemnification obligations.

Contingencies

From time to time, the Company may have certain contingent liabilities that arise in the ordinary course of its business activities. The Company accrues a liability for such matters when it is probable that future expenditures will be made, and such expenditures can be reasonably estimated.

Litigation

The Company is not a party to any litigation and does not have contingency reserves established for any litigation liabilities as of March 31, 2022.

Note 10. 401(k) Savings Plan

The Company has a 401(k) retirement plan in which substantially all U.S. employees are eligible to participate. Eligible employees may elect to contribute up to the maximum limits, as set by the Internal Revenue Service, of their eligible compensation. The total contribution expense for the Company was $0.4 million and $0.2 million for the three months ended March 31, 2022 and 2021, respectively.

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Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations.

The following discussion and analysis of our financial condition and results of operations should be read in conjunction with our unaudited consolidated financial statements and related notes appearing elsewhere in this Quarterly Report on Form 10‑Q and our audited consolidated financial statements and related notes for the year ended December 31, 2021 included in our Annual Report on Form 10-K, or the Annual Report, filed with the Securities and Exchange Commission, or the SEC, on February 24, 2022. This Quarterly Report on Form 10-Q contains “forward-looking statements” within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended, or the Exchange Act. These statements are often identified by the use of words such as “anticipate,” “believe,” “continue,” “could,” “estimate,” “expect,” “intend,” “may,” “plan,” “project,” “will,” “would” or the negative or plural of these words or similar expressions or variations. Such forward-looking statements are subject to a number of risks, uncertainties, assumptions and other factors that could cause actual results and the timing of certain events to differ materially from future results expressed or implied by the forward-looking statements. Factors that could cause or contribute to such differences include, but are not limited to, those identified and discussed in the section titled “Risk Factors,” set forth in Part II, Item 1A of this Quarterly Report on form 10Q, Part I, Item 1A of our Annual Report, and in subsequent SEC filings. You should not rely upon forward-looking statements as predictions of future events. Furthermore, such forward-looking statements speak only as of the date of this report. Except as required by law, we undertake no obligation to update any forward-looking statements to reflect events or circumstances after the date of such statements.

Overview

We are a clinical-stage biopharmaceutical company driven to create and deliver transformative medicines for people living with psychiatric and neurological conditions. Our pipeline is built on the broad therapeutic potential of our lead product candidate, KarXT, an oral modulator of muscarinic receptors that are located both in the central nervous system, or CNS, and various peripheral tissues. KarXT is our proprietary product candidate that combines xanomeline, a novel muscarinic agonist, with trospium, an approved muscarinic antagonist, to preferentially stimulate muscarinic receptors in the CNS.

We are initially developing KarXT for the treatment of acute psychosis in adults with schizophrenia. KarXT combines xanomeline, a muscarinic receptor agonist that preferentially stimulates M1 and M4 muscarinic receptors, and trospium, an approved muscarinic receptor antagonist that does not measurably cross the blood-brain barrier, confining its effects to peripheral tissues. M1 and M4 muscarinic receptors are the receptor subtypes believed to mediate the antipsychotic and procognitive effects of xanomeline and other muscarinic agonists. Results from preclinical studies and clinical trials conducted by third parties support the hypothesis that xanomeline can reduce psychosis and improve cognition. To our knowledge, xanomeline is the only muscarinic orthosteric agonist that has demonstrated therapeutic benefit in schizophrenia and Alzheimer's Disease, or AD. Like all muscarinic orthosteric agonists studied to date, however, xanomeline’s tolerability has been limited by side effects arising from muscarinic receptor stimulation in peripheral tissues, leading to nausea, vomiting, diarrhea and increased salivation and sweating, collectively referred to as cholinergic adverse events. Trospium is a muscarinic receptor antagonist approved in the United States and Europe for the treatment of overactive bladder that inhibits all five muscarinic receptor subtypes in peripheral tissues. We believe that the combination xanomeline and trospium in KarXT has the potential to preferentially stimulate M1 and M4 muscarinic receptors in the brain without stimulating muscarinic receptors in peripheral tissues in order to achieve meaningful therapeutic benefit in patients with psychotic and cognitive disorders.

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The EMERGENT program is our clinical program evaluating KarXT for the treatment of schizophrenia, and includes the completed positive Phase 2 EMERGENT-1 trial and four ongoing Phase 3 trials. In November 2019, we announced positive results from our EMERGENT-1 trial, a Phase 2 clinical trial evaluating KarXT for the treatment of acute psychosis in adults with schizophrenia. In this trial, KarXT met the trial’s primary endpoint with a statistically significant (p<0.0001) and clinically meaningful 11.6 point mean reduction in Positive and Negative Syndrome Scale, or PANSS, total scores over placebo at week 5 (-17.4 KarXT vs. -5.9 placebo). We also observed a statistically significant 3.2 point mean reduction from baseline in the PANSS-positive subscale (-5.6 KarXT v. -2.4 placebo) and a statistically significant 2.3 point mean reduction from baseline in the PANSS-negative subscale (-3.2 KarXT v. -0.9 placebo) at week five (p<0.0001 and p<0.001, respectively). The PANSS total score, PANSS-positive subscale, and the PANSS-negative subscale had statistically significant separation at every assessment throughout the trial. Following the positive results of our Phase 2 EMERGENT-1 trial, we had an End-of-Phase 2 meeting with the U.S. Food and Drug Administration, or FDA, in which the FDA indicated that our completed Phase 2 EMERGENT-1 trial, along with one successful Phase 3 efficacy and safety trial, and additional safety data to meet regulatory requirements, would be acceptable to support a New Drug Application, or NDA, filing in schizophrenia.
 

In addition to our completed positive Phase 2 EMERGENT-1 trial, our EMERGENT program includes two Phase 3 trials evaluating the efficacy and safety of KarXT compared to placebo (EMERGENT-2 and EMERGENT-3, which are similar in design to EMERGENT-1), and two Phase 3 trials evaluating the long-term safety of KarXT (EMERGENT-4 and EMERGENT-5). All Phase 3 trials within our EMERGENT program are currently enrolling, with details as follows:
 

•EMERGENT-2: A five-week inpatient trial evaluating the efficacy and safety of KarXT compared to placebo in 246 adults with schizophrenia in the U.S. We completed enrollment of EMERGENT-2 in the second quarter of 2022 and anticipate topline data from the trial in the third quarter of 2022.

•EMERGENT-3: A five-week inpatient trial evaluating the efficacy and safety of KarXT compared to placebo in 246 adults with schizophrenia in the U.S. and Ukraine. We anticipate topline data in the first quarter of 2023. We continue to enroll patients at clinical trial sites in the U.S., and are not enrolling patients at clinical trial sites in Ukraine at this time due to the Ukraine-Russia conflict.

•EMERGENT-4: A 52-week outpatient, open-label extension trial evaluating the long-term safety and tolerability of KarXT in adults with schizophrenia who completed EMERGENT-2 or EMERGENT-3.

•EMERGENT-5: A 52-week outpatient, open-label trial evaluating the long-term safety and tolerability of KarXT in adults with schizophrenia in the U.S. and Puerto Rico who were not enrolled in EMERGENT-2 or EMERGENT-3.

Given the unique mechanism of action of KarXT in comparison to existing standard of care therapies, we believe there is the potential for therapeutic benefit as both a monotherapy and as an adjunctive therapy for the treatment of schizophrenia. In November 2021, we initiated our Phase 3 ARISE trial evaluating the safety and efficacy of KarXT compared to placebo as an adjunctive treatment in adults with schizophrenia who have an inadequate response to their current antipsychotic therapy. This six-week, 1:1 randomized, double-blind, placebo-controlled Phase 3 trial will enroll approximately 400 adults with schizophrenia who have not achieved an adequate response to their current atypical antipsychotic treatment. The primary outcome measure of the trial is change in Positive and Negative Syndrome Scale (PANSS) total score of KarXT compared to placebo at week 6. Upon completion of the trial at week 6, participants will have the opportunity to enroll in a 52-week outpatient, open-label extension trial evaluating the long-term safety and tolerability of KarXT when dosed with atypical antipsychotic treatment.

We are also developing KarXT as a potential treatment for dementia-related psychosis, or DRP, with an initial focus on psychosis in AD. In June 2021 we announced results from our multi-cohort, placebo-controlled Phase 1b trial evaluating the safety and tolerability of KarXT in healthy elderly volunteers. Results from the trial suggest that potentially therapeutic doses of KarXT can be administered to elderly adults while maintaining a favorable tolerability profile, and support the advancement of KarXT into a Phase 3 program. Our initial focus on the AD dementia subtype reflects various strategic development, regulatory and commercial considerations, and we remain interested in exploring KarXT in other dementia subtypes in future development programs. We plan to share details of our Phase 3 program evaluating KarXT for the treatment of AD psychosis in the first half of 2022 prior to the program’s initiation in mid-2022.
 

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Since our inception in 2009, we have focused substantially all of our efforts and financial resources on organizing and staffing our company, acquiring and developing our technology, raising capital, building our intellectual property portfolio, undertaking preclinical studies and clinical trials and providing general and administrative support for these activities.

We have never generated revenue from product sales and have incurred significant net losses since inception. Our net losses were $58.2 million and $30.5 million for the three months ended March 31, 2022 and 2021, respectively. As of March 31, 2022, we had an accumulated deficit of $346.1 million. Our net losses may fluctuate significantly from quarter to quarter and year to year. We expect to incur significant expenses and increasing operating losses for the foreseeable future. We anticipate that our operating expenses and capital expenditures will increase substantially, particularly as we:

•invest significantly to further develop KarXT for our current and future indications;

•advance additional product candidates into preclinical and clinical development;

•seek regulatory approvals for any product candidates that successfully complete clinical trials;

•require the manufacture of larger quantities of our product candidates for clinical development and potential commercialization;

•hire additional clinical, scientific, management and administrative personnel;

•maintain, expand and protect our intellectual property portfolio;

•acquire or in-license other assets and technologies; and

•add additional operational, financial and management information systems and processes to support our ongoing development efforts, any future manufacturing or commercialization efforts and our ongoing operations as a public company.

We do not expect to generate revenue from product sales unless and until we successfully complete development and obtain regulatory approval for a product candidate, which we expect will take a number of years, if ever, and the outcome of which is subject to significant uncertainty. Additionally, we currently use third parties such as contract research organizations, or CROs, and contract manufacturing organizations, or CMOs, to carry out our preclinical and clinical development activities, and we do not yet have a sales organization. If we obtain regulatory approval for any product candidates, we expect to incur significant commercialization expenses related to product sales, marketing, manufacturing and distribution.

As a result, we will need substantial additional funding to support our continuing operations and pursue our growth strategy. Until such time as we can generate significant revenue from product sales, if ever, we expect to finance our operations through a combination of private and public equity offerings, debt financings, collaborations, strategic alliances and marketing, distribution, or licensing arrangements with third parties. We may be unable to raise additional funds or enter into such other agreements or arrangements when needed on favorable terms, or at all. If we fail to raise capital or enter into such agreements as and when needed, we may have to significantly delay, scale back or discontinue the development and commercialization of one or more of our product candidates.

As of March 31, 2022, we had cash, cash equivalents and available-for-sale investments of $443.2 million. We believe that our existing cash, cash equivalents and available-for-sale investments will be sufficient to meet our anticipated operating and capital expenditure requirements for at least twelve months following the potential submission of a new drug application, or NDA, with the U.S. Food and Drug Administration for KarXT for the treatment of acute psychosis in patients with schizophrenia. We have based this estimate on assumptions that may prove to be wrong, and we could exhaust our available capital resources sooner than we expect. See “Liquidity and Capital Resources.”

Components of Our Results of Operations

Revenue

To date, we have not generated any revenue from product sales. If our development efforts for our product candidates are successful and result in regulatory approval, we may generate revenue in the future from product sales. We cannot predict if, when, or to what extent we will generate revenue from the commercialization and sale of our product candidates. We may never succeed in obtaining regulatory approval for any of our product candidates.
 

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We may also generate revenue in the future from payments as a result of license or collaboration agreements for any of our product candidates or intellectual property, such as our License Agreement, or the Zai License Agreement, with Zai Lab (Shanghai) Co., Ltd., or Zai. Under the Zai License Agreement, we recognized revenue of $37.0 million in the year ended December 31, 2021. We cannot provide assurance as to the timing of future milestone or royalty payments under the Zai License Agreement, or that we will receive any of these payments at all. We generated no revenue from license or collaboration agreements in the three months ended March 31, 2022 and 2021.


Operating Expenses

Research and Development Expenses

Research and development expenses consist primarily of costs incurred for the development of our product candidates and our drug discovery efforts, which include:

•personnel costs, including salaries and the related costs, and stock-based compensation expense for employees engaged in research and development functions;

•expenses incurred in connection with the preclinical and clinical development of our product candidates, including under agreements with CROs;

•expenses incurred in connection with CMOs that manufacture drug products for use in our preclinical and clinical trials;

•formulation costs and chemistry, manufacturing and controls, or CMC, costs; and

•expenses incurred under agreements with consultants who supplement our internal capabilities.

We expense all research and development costs in the periods in which they are incurred. Costs for certain development activities are recognized based on an evaluation of the progress to completion of specific tasks using information and data provided to us by our vendors and third-party service providers.

Research and development costs directly related to our clinical development activities, such as fees paid to consultants, central laboratories, contractors, CMOs and CROs are tracked on an indication-by-indication basis. Other costs that are indirectly related to our clinical development activities, such as formulation and CMC, preclinical, discovery and unallocated expenses in the table below are not allocated on an indication-by-indication basis due to the overlap of the potential benefit of those efforts across multiple indications that utilize KarXT and future product and development candidates. Unallocated expenses primarily relate to personnel or other consulting costs which are deployed across multiple projects under development. The following table summarizes our research and development expenses:

	Three Months Ended March 31,
	2022		2021
	(in thousands)
Schizophrenia clinical trials	$	20,804	$	7,162
Dementia-related psychosis clinical trials		686		186
Pain clinical trial		—		131
Formulation and CMC		5,553		3,334
Preclinical		177		524
Discovery		4,710		3,091
Unallocated expenses		11,876		5,758
Total research and development expense	$	43,806	$	20,186

We expect our research and development expenses to increase substantially for the foreseeable future as we continue to invest in research and development activities related to developing our product candidates, as our programs advance into later stages of development and we continue to conduct clinical trials. The process of conducting the necessary clinical research to obtain regulatory approval is costly and time-consuming, and the successful development of our product candidates is highly uncertain.

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Because of the numerous risks and uncertainties associated with conducting product development, we cannot determine with certainty the duration and completion costs of our current or future preclinical studies and clinical trials or if, when, or to what extent we will generate revenues from the commercialization and sale of our product candidates. We may never succeed in achieving regulatory approval for our product candidates. The duration, costs and timing of preclinical studies and clinical trials and development of our product candidates will depend on a variety of factors, if and as we:

•continue to develop and conduct clinical trials for KarXT for our current and future indications;

•initiate and continue research, preclinical and clinical development efforts for future product candidates;

•seek to identify additional product candidates;

•seek regulatory approvals for KarXT for our current and future indications as well as any other product candidates that successfully complete clinical development;

•add operational, financial and management information systems and personnel, including personnel to support our product development;

•hire and retain additional personnel, such as clinical, quality control, scientific, commercial and administrative personnel;

•maintain, expand and protect our intellectual property portfolio;

•establish sales, marketing, distribution, manufacturing, supply chain and other commercial infrastructure in the future to commercialize various products for which we may obtain regulatory approval, if any;

•continue to assess the impact of the ongoing and evolving COVID-19 pandemic on the ability to execute research and development activities;

•add equipment and physical infrastructure to support our research and development; and

•acquire or in-license other product candidates and technologies.

A change in the outcome of any of these variables with respect to the development of any of our product candidates would significantly change the costs and timing associated with the development of that product candidate. We may never succeed in obtaining regulatory approval for any of our product candidates.

We do not believe that it is possible at this time to accurately project total indication-specific expenses through commercialization. There are numerous factors associated with the successful commercialization of any of our product candidates, including future trial design and various regulatory requirements, many of which cannot be determined with accuracy at this time based on our stage of development. Additionally, future commercial and regulatory factors beyond our control will impact our clinical development programs and plans.

General and Administrative Expenses

General and administrative expenses consist primarily of employee-related costs for personnel in executive, finance, commercial, and administrative functions, costs related to maintenance and filing of intellectual property, facility-related costs, insurance costs, and other expenses for outside professional services, including legal, human resources, data management, audit and accounting services, and costs incurred as we prepare for commercialization. Personnel costs consist of salaries, short-term incentive compensation, benefits, travel expense and stock-based compensation expense.

We anticipate that our general and administrative expenses will increase in the future as we increase our headcount to support our continued research activities and development of our product candidates, and as we commercialize. We will also continue to incur increased accounting, audit, legal, regulatory, compliance and director and officer insurance costs as well as investor and public relations expenses associated with operating as a public company.

Other Income (Loss), Net

Other income (loss), net, consists of interest income from our cash equivalents and available-for-sale investments and sublease income recognized in connection with the sublease of office space, offset by impairment loss on our right-of-use lease assets at our Arch Street facility, due to their carrying value exceeding their estimated fair value.

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Results of Operations

Comparison of the three months ended March 31, 2022 and 2021

	Three Months Ended March 31,
	2022			2021			Change
				(in thousands)
License revenue	$	—		$	—		$	—
Operating expenses:
Research and development		43,806			20,186			23,620
General and administrative		14,788			9,777			5,011
Total operating expenses		58,594			29,963			28,631
Loss from operations		(58,594	)		(29,963	)		(28,631	)
Total other income (loss), net		376			(534	)		910
Net loss attributable to common stockholders	$	(58,218	)	$	(30,497	)	$	(27,721	)

Research and Development Expenses

	Three Months Ended March 31,
	2022		2021		Change
			(in thousands)
Direct research and development expenses:
Schizophrenia clinical trials	$	20,804	$	7,162	$	13,642
Dementia-related psychosis clinical trials		686		186		500
Pain clinical trial		—		131		(131	)
Formulation and CMC		5,553		3,334		2,219
Preclinical		177		524		(347	)
Discovery		4,710		3,091		1,619
Unallocated expenses:
Personnel related expenses (including stock-based compensation)		10,952		5,280		5,672
Consultant fees and other expenses		924		478		446
Total research and development expense	$	43,806	$	20,186	$	23,620

Expenses related to our schizophrenia clinical trials increased by $13.6 million, primarily due to expenses related to ongoing enrollment of our EMERGENT and ARISE Phase 3 trials. The increase of $0.5 million in expenses related to our DRP clinical trials is primarily driven by start-up costs for our Phase 3 program evaluating KarXT for the treatment of AD psychosis in advance of the program’s planned initiation in mid-2022. The decrease of $0.1 million in expenses related to our pain clinical trial is due to unrepeated costs of closing out the Phase 1b trial in the second half of 2021. The increase of $2.2 million in formulation and CMC expenses is primarily due to an increase in manufacturing activities in 2022 to obtain sufficient supply to support current and future clinical trial activities as well as activities to support a potential future NDA filing and commercialization. The decrease of $0.3 million in expenses related to preclinical activities is primarily due to the execution of studies in early 2021 that were not repeated in 2022. The increase of $1.6 million in discovery costs is due to an increase in costs associated with our portfolio of discovery programs, including ongoing collaborations with Charles River Labs and Psychogenics, Inc. The increase of $5.7 million in personnel related costs was primarily a result of an increase in headcount and an increase of $2.4 million related to stock-based compensation expense. The increase of $0.4 million in consultant fees and other expenses was due to an increase in consulting costs not specifically allocated to discovery, preclinical, clinical, formulation and CMC activities.

General and Administrative Expenses

	Three Months Ended March 31,
	2022		2021		Change
			(in thousands)
Personnel related expenses (including stock-based compensation)	$	10,169	$	5,699	$	4,470
Professional and consultant fees		1,876		2,333		(457	)
Other		2,743		1,745		998
Total general and administrative expense	$	14,788	$	9,777	$	5,011

22

The increase of $4.5 million in personnel related costs was primarily a result of an increase in headcount and an increase of $2.4 million related to stock-based compensation expense. The decrease of $0.5 million in professional and consultant fees was primarily due to timing of accounting fees, pre-commercial costs, legal costs and consulting fees related to our ongoing business activities. The increase of $1.0 million in other costs was primarily due to increased lease costs relating to the addition of the High Street Lease in Boston, Massachusetts in March 2021 as well as other infrastructure and administrative related costs to support increased headcount.

Other Income (Loss), Net

	Three Months Ended March 31,
	2022		2021			Change
			(in thousands)
Impairment loss on right-of-use assets	$	—	$	(677	)	$	677
Interest income		237		143			94
Sublease income		139		—			139
Total other income (loss), net	$	376	$	(534	)	$	910

Impairment loss on right-of-use assets for the three months ended March 31, 2021 represents impairment recognized on our right-of-use lease assets to the extent their carrying value exceeded their estimated fair value for our Arch Street facility leases in Boston, Massachusetts. See Note 9 to our consolidated financial statements appearing elsewhere in this Quarterly Report on Form 10-Q.

Interest income is attributable to interest earned on our cash equivalents and available-for-sale investments. The increase of $0.1 million in interest income is primarily due to an increase in the average balance of investment securities held during the three months ended March 31, 2022 compared to the three months ended March 31, 2021 as a result of our March 4, 2021 sale of common stock in our follow-on public offering.

Sublease income is due to the sublease of our Arch Street office space in Boston, Massachusetts, which had not yet commenced as of March 31, 2021.

Liquidity and Capital Resources

Since our inception, we have incurred significant operating losses. We have not yet commercialized any of our product candidates and we do not expect to generate revenue from sales of any product candidates for several years, if at all. To date, we have funded our operations primarily with proceeds from the sale of redeemable convertible preferred stock, issuance of convertible notes, sales of our common stock and revenue from a license agreement. Through March 31, 2022, our operations have been financed by net proceeds of $25.7 million from the issuance of convertible notes, $91.0 million from the sale of shares of our redeemable convertible preferred stock, $93.0 million from the sale of our common stock in our initial public offering in June 2019, $234.2 million from the sale of our common stock in a follow-on public offering in November 2019, $270.0 million from the sale of our common stock in a follow-on public offering in March 2021 and $35.0 million from the Zai License Agreement in December 2021. As of March 31, 2022, we had $443.2 million in cash, cash equivalents and available-for-sale investments, and an accumulated deficit of $346.1 million.

On July 2, 2020, we filed an automatically effective registration statement on Form S-3, or the Registration Statement, with the SEC which registers the offering, issuance and sale of an unspecified amount of common stock, preferred stock, debt securities, warrants and/or units of any combination thereof. We simultaneously entered into an equity distribution agreement with Goldman Sachs & Co. LLC, as sales agent, to provide for the issuance and sale by the Company of up to $150.0 million of common stock from time to time in “at-the-market” offerings under the Registration Statement and related prospectus filed with the Registration Statement, or the ATM Program. As of March 31, 2022, no sales had been made pursuant to the ATM Program.

Our primary use of cash has been to fund operating expenses, which consist of research and development and general and administrative expenditures. Cash used to fund operating expenses is impacted by the timing of when we pay these expenses, as reflected in the change in our outstanding prepaid expenses, accounts payable and accrued expenses.

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Cash Flows

The following table summarizes our sources and uses of cash for each of the periods presented:

	Three Months Ended March 31,
	2022			2021
	(in thousands)
Net cash used in operating activities	$	(49,803	)	$	(21,179	)
Net cash provided by investing activities		17,796			51,097
Net cash provided by financing activities		1,257			270,823
Net increase (decrease) in cash, cash equivalents and restricted cash	$	(30,750	)	$	300,741

Cash Flows from Operating Activities

Cash used in operating activities for the three months ended March 31, 2022 was $49.8 million, consisting of a net loss of $58.2 million, partially offset by non-cash items, including stock-based compensation expense of $10.6 million and interest expense resulting from the amortization of premiums and accretion of discounts on our available-for-sale investments of $0.3 million. The change in our net operating assets and liabilities was mainly due to a decrease in accrued expenses of $4.1 million, primarily driven by timing of payments made to CROs and CMOs in connection with our clinical trials, partially offset by a decrease in accounts receivable of $1.8 million pursuant to revenue earned under the Zai License Agreement.

Cash used in operating activities for the three months ended March 31, 2021 was $21.2 million, consisting of a net loss of $30.5 million, partially offset by non-cash items, including stock-based compensation expense of $5.8 million, and impairment loss on right-of-use assets of $0.7 million. The change in our net operating assets and liabilities was mainly due to a decrease in prepaid expenses and other current assets of $3.5 million, which was primarily driven by timing of upfront payments made to CROs and CMOs in connection with our clinical trials.

Cash Flows from Investing Activities

Cash provided by investing activities for the three months ended March 31, 2022 was $17.8 million, primarily attributable to maturities of investment securities of $66.1 million, which were partially offset by purchases of investment securities of $48.3 million.

Cash used in investing activities for the three months ended March 31, 2021 was $51.1 million, primarily attributable to the maturities of investment securities of $132.0 million, which were partially offset by purchases of investment securities of $80.9 million.

Cash Flows from Financing Activities

Cash provided by financing activities for the three months ended March 31, 2022 was $1.3 million, which was primarily attributable to proceeds received from the exercise of stock options.

Cash provided by financing activities for the three months ended March 31, 2021 was $270.8 million, which was primarily attributable to $270.0 million in net proceeds received from the sale of common stock in our follow-on public offering.

Future Funding Requirements

We expect our expenses to increase substantially in connection with our ongoing activities, in particular as we continue to advance our product candidates through clinical trials and prepare for commercialization. In addition, we expect to incur additional costs associated with our ongoing operations as a public company.

As of March 31, 2022, we had cash and cash equivalents and available-for-sale investments of $443.2 million. Based on our current plans, we believe that our existing cash, cash equivalents and available-for-sale investments will be sufficient to meet our anticipated operating and capital expenditure requirements for at least twelve months following the submission of an NDA for KarXT for the treatment of acute psychosis in patients with schizophrenia.

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We have based this estimate on assumptions that may prove to be wrong, and we could utilize our available capital resources sooner than we currently expect. Because of the numerous risks and uncertainties associated with research, development and commercialization of pharmaceutical product candidates, we are unable to estimate the exact amount of our working capital requirements. Our future funding requirements will depend on and could increase significantly as a result of many factors, including:

•the scope, progress, results and costs of researching and developing KarXT for our current and future indications as well as other product candidates we may develop;

•the timing of, and the costs involved in, obtaining marketing approvals for KarXT for our current and future indications as well as future product candidates we may develop and pursue;

•the number of future indications and product candidates that we pursue and their development requirements;

•if approved, the costs of commercialization activities for KarXT for the approved indication, or any other product candidate that receives regulatory approval to the extent such costs are not the responsibility of any future collaborators, including the costs and timing of establishing product sales, marketing, distribution and manufacturing capabilities;

•subject to receipt of regulatory approval, revenue, if any, received from commercial sales of KarXT for any indication or revenue received from any future product candidates;

•the extent to which we in-license or acquire rights to other products, product candidates or technologies;

•our headcount growth and associated costs as we expand our research and development and establish a commercial infrastructure;

•the costs of preparing, filing and prosecuting patent applications, and maintaining and protecting our intellectual property rights, including enforcing and defending intellectual property related claims; and

•the ongoing costs of operating as a public company.

A change in the outcome of any of these or other variables with respect to the development of any of our product candidates could significantly change the costs and timing associated with the development of that product candidate. Further, our operating plans may change in the future, and we may need additional funds to meet operational needs and capital requirements associated with such operating plans.

Until such time, if ever, as we can generate substantial product revenue, we expect to finance our operations through a combination of equity financings, debt financings, collaborations with other companies or other strategic transactions. We do not currently have any committed external source of funds. To the extent that we raise additional capital through the sale of equity or convertible debt securities, our stockholders’ ownership interest will be diluted, and the terms of these securities may include liquidation or other preferences that adversely affect their rights as common stockholders. Debt financing and preferred equity financing, if available, may involve agreements that include covenants limiting or restricting our ability to take specific actions, such as incurring additional debt, making acquisitions or capital expenditures or declaring dividends. If we raise additional funds through collaborations, strategic alliances or marketing, distribution or licensing arrangements with third parties, we may have to relinquish valuable rights to our technologies, future revenue streams, research programs or product candidates or grant licenses on terms that may not be favorable to us. If we are unable to raise additional funds through equity or debt financings or other arrangements when needed, we may be required to delay, limit, reduce or terminate our research, product development or future commercialization efforts or grant rights to develop and market product candidates that we would otherwise prefer to develop and market ourselves.

Further, our operating plans may change, and we may need additional funds to meet operational needs and capital requirements for clinical trials and other research and development activities. We currently have no credit facility or committed sources of capital. Because of the numerous risks and uncertainties associated with the development and commercialization of our product candidates, we are unable to estimate the amounts of increased capital outlays and operating expenditures associated with our current and anticipated product development programs.

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Cash Requirements due to Contractual Obligations and Other Commitments

In January 2020, we amended our current lease for 7,050 square feet of office space in Boston, Massachusetts, or the Arch Street Original Premises, to acquire approximately 4,175 in additional square feet, or the Arch Street Expansion Premises, and to extend the original lease term through December 2023. Remaining lease payments from April 1, 2022 through the end of the lease term total $1.5 million for both the Arch Street Original Premises and the Arch Street Expansion Premises, of which we took possession of 2,424 square feet and 1,751 square feet in March 2020 and August 2020, respectively.

In February 2020, we entered into an agreement to lease approximately 5,050 square feet of office space in Carmel, Indiana. The term of the lease commenced in June 2020 and expires in July 2023. Remaining lease payments total approximately $0.2 million through the end of the lease term.

In March 2021, we entered into an agreement to sublease approximately 25,445 square feet of office space, or the High Street Premises, from a third party in Boston, Massachusetts as part of the relocation of our corporate headquarters. The term of the sublease extends from April 1, 2021 through December 31, 2025 and provides for escalating annualized base rent payments starting at approximately $1.5 million and increasing to $1.6 million in the final year of the sublease. Remaining lease payments from April 1, 2022 through the end of the lease term total $6.0 million.

Simultaneously, in March 2021, we entered into an agreement to sublease the Arch Street Original Premises to a third party. The term of the sublease extends from July 1, 2021 through December 31, 2023.

In April 2021, we entered into an agreement, or the First Expansion Premises Sublease, to sublease approximately 1,751 square feet of the Arch Street Expansion Premises to a third party from June 1, 2021 through December 31, 2023.

In January 2022, we entered into an agreement, or the Second Expansion Premises Sublease, to sublease approximately 2,422 square feet of the Arch Street Expansion Premises to a third party from February 7, 2022 through December 31, 2023.

During the three months ended March 31, 2022, there were no other material changes to our contractual obligations and commitments described in our Annual Report, as filed with the SEC.

We enter into contracts in the normal course of business with CROs, CMOs and other third parties for clinical trials, preclinical research studies and testing and manufacturing services. These contracts are generally cancelable by us upon prior written notice. Payments due upon cancellation consist of payments for services provided or expenses incurred, including noncancelable obligations of our service providers, up to the date of cancellation, and may also include termination penalties. As of March 31, 2022 the timing, amount or likelihood of such payments are not known.

We are also party to certain license and collaboration agreements with PureTech Health and Eli Lilly and Company. We may be obligated to make certain future payments which are contingent upon future events such as our achievement of specified regulatory and commercial milestones, or royalties on net product sales under these agreements. As of March 31, 2022, we were unable to estimate the timing or likelihood of achieving these milestones or generating future product sales.

Critical Accounting Polices and Estimates

Our consolidated financial statements are prepared in accordance with generally accepted accounting principles in the United States. The preparation of our consolidated financial statements and related disclosures requires us to make estimates, assumptions and judgments that affect the reported amount of assets, liabilities, revenue, costs and expenses, and related disclosures. We believe that of our critical accounting policies described under the heading “Management’s Discussion and Analysis of Financial Condition and Results of Operations—Critical Accounting Policies and Estimates” in our Annual Report, the following involves the most judgment and complexity:

•Revenue

•Research and development contract costs and accruals

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Accordingly, we believe the policies set forth above are critical to fully understand and evaluate our financial condition and results of operations. If actual results or events differ materially from the estimates, judgments and assumptions used by us in applying these policies, our reported financial condition and results of operations could be materially affected.

Recently Issued or Adopted Accounting Pronouncements

A description of recently issued accounting pronouncements that may potentially impact our financial position and results of operations is disclosed in Note 2 to our consolidated financial statements appearing elsewhere in this Quarterly Report on Form 10-Q.

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Item 3. Quantitative and Qualitative Disclosures About Market Risk.

We are exposed to market risk related to changes in interest rates. We had cash, cash equivalents and available-for-sale investment securities of $443.2 million as of March 31, 2022, which consisted primarily of money market funds and investment securities, largely composed of U.S. Treasuries and investment grade, short to intermediate term fixed income securities.

The primary objective of our investment activities is to preserve capital to fund our operations. We also seek to maximize income from our investments without assuming significant risk. To achieve our objectives, we maintain a portfolio of investments in a variety of securities of high credit quality and short-term duration, according to our board-approved investment policy. Our investments are subject to interest rate risk and could fall in value if market interest rates increase. A hypothetical 10% relative change in interest rates during any of the periods presented would not have had a material impact on our condensed consolidated financial statements.

We are not currently exposed to significant market risk related to changes in foreign currency exchange rates; however, we have contracted with and may continue to contract with vendors that are located outside of the United States. As a result, our operations may be subject to fluctuations in foreign currency exchange rates in the future.

Inflation generally affects us by increasing our cost of labor. We do not believe that inflation had a material effect on our business, financial condition, or results of operations during the three months ended March 31, 2022 and 2021.

Item 4. Limitations on Effectiveness of Controls and Procedures.

The term “disclosure controls and procedures,” as defined in Rules 13a-15(e) and 15d-15(e) under the Exchange Act, refers to controls and procedures that are designed to ensure that information required to be disclosed by a company in the reports that it files or submits under the Exchange Act is recorded, processed, summarized and reported, within the time periods specified in the SEC’s rules and forms. Disclosure controls and procedures include, without limitation, controls and procedures designed to ensure that information required to be disclosed by a company in the reports that it files or submits under the Exchange Act is accumulated and communicated to the company’s management, including its principal executive and principal financial officers, or persons performing similar functions, as appropriate, to allow timely decisions regarding required disclosure.

In designing and evaluating our disclosure controls and procedures, management recognizes that any controls and procedures, no matter how well designed and operated, can provide only reasonable assurance of achieving the desired control objectives. In addition, the design of disclosure controls and procedures must reflect the fact that there are resource constraints and that management is required to apply judgment in evaluating the benefits of possible controls and procedures relative to their costs.

Evaluation of Disclosure Controls and Procedures

Our management, with the participation of our principal executive officer and principal financial officer, evaluated, as of the end of the period covered by this Quarterly Report on Form 10-Q, the effectiveness of our disclosure controls and procedures (as defined in Rules 13a-15(e) and 15d-15(e) under the Exchange Act of 1934). Based on that evaluation, our principal executive officer and principal financial officer concluded that our disclosure controls and procedures were effective at the reasonable assurance level as of March 31, 2022.

Changes in Internal Control Over Financial Reporting

No change in our internal control over financial reporting (as defined in Rules 13a-15(f) and 15d-15(f) under the Exchange Act) has occurred during the three months ended March 31, 2022 that has materially affected, or is reasonably likely to materially affect, our internal control over financial reporting.

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PART II—OTHER INFORMATION

Item 1. Legal Proceedings.

We are not currently subject to any material legal proceedings.

Item 1A. Risk Factors.

In addition to the risks described in our Annual Report, you should carefully consider the other information set forth in this Form 10-Q and the information in our other filings with the SEC, as they could materially affect our business, financial condition or future results of operations. There have been no material changes to the risk factors previously disclosed in Part I, Item 1A (Risk Factors) of our Annual Report.

Item 2. Unregistered Sales of Equity Securities and Use of Proceeds.

None.

Item 3. Defaults Upon Senior Securities.

None.

Item 4. Mine Safety Disclosures.

Not applicable.

Item 5. Other Information.

None.

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Item 6. Exhibits.

The exhibits listed on the Exhibit Index immediately preceding such exhibits, which is incorporated herein by reference, are filed or furnished as part of this Quarterly Report on Form 10‑Q.

Exhibit Number	Description
31.1	Certification of Principal Executive Officer Pursuant to Rules 13a-14(a) and 15d-14(a) under the Securities Exchange Act of 1934, as Adopted Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.
31.2	Certification of Principal Financial Officer Pursuant to Rules 13a-14(a) and 15d-14(a) under the Securities Exchange Act of 1934, as Adopted Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.
32.1+	Certification of Principal Executive Officer and Principal Financial Officer Pursuant to 18 U.S.C. Section 1350, as Adopted Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
101.INS	Inline XBRL Instance Document – the instance document does not appear in the Interactive Data File because XBRL tags are embedded within the Inline XBRL document.
101.SCH	Inline XBRL Taxonomy Extension Schema Document
101.CAL	Inline XBRL Taxonomy Extension Calculation Linkbase Document
101.DEF	Inline XBRL Taxonomy Extension Definition Linkbase Document
101.LAB	Inline XBRL Taxonomy Extension Label Linkbase Document
101.PRE	Inline XBRL Taxonomy Extension Presentation Linkbase Document
104	Cover Page Interactive Data File (embedded within the Inline XBRL document)

+ The certification furnished in Exhibit 32.1 hereto is deemed to accompany this Quarterly Report on Form 10‑Q and will not be deemed “filed” for purposes of Section 18 of the Securities Exchange Act of 1934, as amended, except to the extent that the Registrant specifically incorporates it by reference. Such certification will not be deemed to be incorporated by reference into any filings under the Securities Act of 1933, as amended, or the Securities Exchange Act of 1934, as amended, except to the extent that the Registrant specifically incorporates it by reference.

30

SIGNATURES

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.

	KARUNA THERAPEUTICS, INC.
Date: May 5, 2022	By:	/s/ Steven Paul, M.D.
		Steven Paul, M.D.
		Chief Executive Officer, President and Chairman (Principal Executive Officer)
Date: May 5, 2022	By:	/s/ Troy Ignelzi
		Troy Ignelzi
		Chief Financial Officer (Principal Financial and Accounting Officer)

31

EX-31.1

Exhibit 31.1

CERTIFICATION OF PRINCIPAL EXECUTIVE OFFICER PURSUANT TO RULES 13A-14(A) AND 15D-14(A) UNDER THE SECURITIES EXCHANGE ACT OF 1934, AS ADOPTED PURSUANT TO SECTION 302 OF SARBANES-OXLEY ACT OF 2002

I, Steven Paul, certify that:

1. I have reviewed this Quarterly Report on Form 10-Q of Karuna Therapeutics, Inc.;

2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4. The registrant’s other certifying officer(s) and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

a) Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

b) Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

c) Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

d) Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report), that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and

5. The registrant’s other certifying officer(s) and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

a) All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

b) Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Dated: May 5, 2022	/s/ Steven Paul, M.D.
	Steven Paul, M.D.
	Chief Executive Officer
	(Principal Executive Officer)

EX-31.2

Exhibit 31.2

CERTIFICATION OF PRINCIPAL FINANCIAL OFFICER PURSUANT TO RULES 13A-14(A) AND 15D-14(A) UNDER THE SECURITIES EXCHANGE ACT OF 1934, AS ADOPTED PURSUANT TO SECTION 302 OF SARBANES-OXLEY ACT OF 2002

I, Troy Ignelzi, certify that:

1. I have reviewed this Quarterly Report on Form 10-Q of Karuna Therapeutics, Inc.;

2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4. The registrant’s other certifying officer(s) and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

a) Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

b) Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

c) Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

d) Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report), that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and

5. The registrant’s other certifying officer(s) and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

a) All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

b) Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Dated: May 5, 2022	/s/ Troy Ignelzi
	Troy Ignelzi
	Chief Financial Officer
	(Principal Financial Officer)

EX-32.1

Exhibit 32.1

CERTIFICATION OF PRINCIPAL EXECUTIVE OFFICER AND PRINCIPAL FINANCIAL OFFICER

PURSUANT TO18 U.S.C. SECTION 1350, AS ADOPTED PURSUANT TO

SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

In connection with the Quarterly Report on Form 10-Q of Karuna Therapeutics, Inc. (the “Company”) for the quarterly period ended March 31, 2022, as filed with the Securities and Exchange Commission on the date hereof (the “Report”), the undersigned, Steven Paul and Troy Ignelzi, Chief Executive Officer of the Company and Chief Financial Officer of the Company, respectively, hereby certify, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that to their knowledge:

(1) the Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934, as amended; and

(2) the information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company.

Dated: May 5, 2022	/s/ Steven Paul, M.D.
	Steven Paul, M.D.
	Chief Executive Officer
	(Principal Executive Officer)
Dated: May 5, 2022	/s/ Troy Ignelzi
	Troy Ignelzi
	Chief Financial Officer
	(Principal Financial Officer)

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Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2022	Apr. 30, 2022
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2022
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	Q1
Trading Symbol	KRTX
Entity Registrant Name	Karuna Therapeutics, Inc.
Entity Central Index Key	0001771917
Current Fiscal Year End Date	--12-31
Entity File Number	001-38958
Entity Tax Identification Number	27-0605902
Entity Address, Address Line One	99 High Street
Entity Address, Address Line Two	26th Floor
Entity Address, City or Town	Boston
Entity Address, State or Province	MA
Entity Address, Postal Zip Code	02110
City Area Code	857
Local Phone Number	449-2244
Entity Current Reporting Status	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Common Stock, Shares Outstanding		29,882,727
Entity Shell Company	false
Document Quarterly Report	true
Document Transition Report	false
Entity Interactive Data Current	Yes
Title of 12(b) Security	Common Stock, $0.0001 par value per share
Security Exchange Name	NASDAQ
Entity Incorporation, State or Country Code	DE

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CONSOLIDATED BALANCE SHEETS (Unaudited) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Current assets:
Cash and cash equivalents	$ 176,203	$ 206,953
Investment securities, available-for-sale	266,984	287,038
Accounts receivable	0	1,750
Prepaid expenses and other current assets	20,972	21,138
Deferred offering costs	480	455
Total current assets	464,639	517,334
Restricted cash	261	261
Right-of-use lease assets - operating, net	6,021	6,453
Property and equipment, net	3,050	3,092
Other non-current assets	503	531
Total assets	474,474	527,671
Current liabilities:
Accounts payable	1,478	1,939
Accrued expenses	12,226	16,099
Current portion of operating lease liability	2,219	2,175
Total current liabilities	15,923	20,213
Operating lease liability, net of current portion	4,759	5,328
Other non-current liabilities	104	104
Total liabilities	20,786	25,645
Commitments and Contingencies (Note 9)
Stockholders’ equity:
Preferred stock, $0.0001 par value; 10,000,000 shares authorized and 0 shares outstanding as of March 31, 202 and December 31, 2021	0	0
Common stock, $0.0001 par value; 150,000,000 shares authorized at March 31, 2022 and December 31, 2021; XXX and 29,770,558 shares issued and outstanding at March 31, 2022 and December 31, 2021, respectively	3	3
Additional paid-in capital	802,309	790,391
Accumulated deficit	(346,089)	(287,871)
Accumulated other comprehensive loss	(2,535)	(497)
Total stockholders’ equity	453,688	502,026
Total liabilities and stockholders’ equity	$ 474,474	$ 527,671

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CONSOLIDATED BALANCE SHEETS (Unaudited) (Parenthetical) - $ / shares	Mar. 31, 2022	Dec. 31, 2021
Statement of Financial Position [Abstract]
Preferred stock, par value	$ 0.0001	$ 0.0001
Preferred stock, shares authorized	10,000,000	10,000,000
Preferred stock, shares outstanding	0	0
Common stock, par value	$ 0.0001	$ 0.0001
Common stock, shares authorized	150,000,000	150,000,000
Common stock, shares issued	29,831,258	29,770,558
Common stock, shares outstanding	29,831,258	29,770,558

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CONSOLIDATED STATEMENTS OF OPERATIONS (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Income Statement [Abstract]
License revenue	$ 0	$ 0
Operating expenses:
Research and development	43,806	20,186
General and administrative	14,788	9,777
Total operating expenses	58,594	29,963
Loss from operations	(58,594)	(29,963)
Other income (loss), net:
Impairment loss on right-of-use assets	0	(677)
Interest income	237	143
Sublease income	139	0
Total other income (loss), net	376	(534)
Net loss before income taxes	(58,218)	(30,497)
Income tax provision	0	0
Net loss attributable to common stockholders	$ (58,218)	$ (30,497)
Net loss per share, basic and diluted (Note 6)	$ (1.95)	$ (1.10)
Weighted average common shares outstanding used in computing net loss per share, basic and diluted	29,805,961	27,786,538

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CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Statement of Comprehensive Income [Abstract]
Net loss	$ (58,218)	$ (30,497)
Other comprehensive loss:
Unrealized losses on available-for-sale investments	(2,038)	(30)
Comprehensive loss	$ (60,256)	$ (30,527)

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CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY (Unaudited) - USD ($)	Total	Common Stock	Additional Paid In Capital	Accumulated Deficit	Accumulated Other Comprehensive Income (Loss)
Beginning balance at Dec. 31, 2020	$ 338,931,000	$ 3,000	$ 482,955,000	$ (144,066,000)	$ 39,000
Beginning balance, shares at Dec. 31, 2020		26,988,458
Issuance of common stock	270,017,000
Issuance of common stock, shares		2,395,834
Stock-based compensation expense	5,822,000		5,822,000
Exercise of common options	671,000		671,000
Exercise of common options, shares		56,876
Other comprehensive income (loss)	(30,000)				(30,000)
Net loss	(30,497,000)			(30,497,000)
Ending balance at Mar. 31, 2021	584,914,000	$ 3,000	759,465,000	(174,563,000)	9,000
Ending balance, shares at Mar. 31, 2021		29,441,168
Beginning balance at Dec. 31, 2021	502,026,000	$ 3,000	790,391,000	(287,871,000)	(497,000)
Beginning balance, shares at Dec. 31, 2021		29,770,558
Stock-based compensation expense	10,636,000		10,636,000
Exercise of common options	$ 1,282,000		1,282,000
Exercise of common options, shares	60,700	60,700
Other comprehensive income (loss)	$ 2,038,000				2,038,000
Net loss	(58,218,000)			(58,218,000)
Ending balance at Mar. 31, 2022	$ 453,688,000	$ 3,000	$ 802,309,000	$ (346,089,000)	$ (2,535,000)
Ending balance, shares at Mar. 31, 2022		29,831,258

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CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY (Unaudited) (Parenthetical) - Public Offering $ in Thousands	3 Months Ended
	Mar. 31, 2021 USD ($)
Underwriting discounts and commissions	$ 17,250
Offering cost	$ 233

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CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Cash flows from operating activities
Net loss	$ (58,218)	$ (30,497)
Adjustments to reconcile net loss to net cash used in operating activities:
Stock-based compensation expense	10,636	5,822
Impairment loss on right-of-use assets	0	677
Amortization of premiums and accretion of discounts on investment securities	285	221
Depreciation and amortization expense	248	112
Changes in operating assets and liabilities:
Accrued interest on investment securities	(65)	277
Accounts receivable	1,750	0
Prepaid expenses and other current assets	166	3,546
Right-of-use assets	432	167
Other non-current assets	28	(1,006)
Accounts payable	(481)	322
Accrued expenses	(4,059)	(754)
Operating lease liability	(525)	(205)
Deferred lease obligation	0	35
Other non-current liabilities	0	104
Net cash used in operating activities	(49,803)	(21,179)
Cash flows from investing activities
Purchases of investment securities	(48,303)	(80,856)
Maturities of investment securities	66,099	132,000
Acquisition of property and equipment		(47)
Net cash provided by investing activities	17,796	51,097
Cash flows from financing activities
Proceeds from public offering, net of underwriting discounts and commissions		270,250
Payment of offering costs	(25)	(98)
Proceeds from exercise of stock options	1,282	671
Net cash provided by financing activities	1,257	270,823
Net increase (decrease) in cash, cash equivalents and restricted cash	(30,750)	300,741
Cash, cash equivalents and restricted cash at beginning of period	207,214	53,205
Cash, cash equivalents and restricted cash at end of period	176,464	353,946
Supplemental disclosures of cash flows information
Deferred offering costs included in accounts payable and accrued expenses	0	135
Purchases of property and equipment included in accounts payable and accrued expenses	$ 206	$ 19

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Nature of the Business and Basis of Presentation

3 Months Ended

Mar. 31, 2022

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Nature of the Business

Note 1. Nature of the Business and Basis of Presentation

Description of the Business

Karuna Therapeutics, Inc. (the “Company”) was incorporated under the laws of the State of Delaware in July 2009 as Karuna Pharmaceuticals, Inc. and is headquartered in Boston, Massachusetts. In March 2019, the Company changed its name to Karuna Therapeutics, Inc. The Company is an innovative clinical-stage biopharmaceutical company driven to create and deliver transformative medicines for people living with psychiatric and neurological conditions.

Since the Company’s inception, it has focused substantially all of its efforts and financial resources on organizing and staffing the Company, acquiring and developing its technology, raising capital, building its intellectual property portfolio, undertaking preclinical studies and clinical trials and providing general and administrative support for these activities. The Company has not generated any product revenue related to its primary business purpose to date and is subject to a number of risks similar to those of other early stage companies, including dependence on key individuals, regulatory approval of products, uncertainty of market acceptance of products, competition from substitute products and larger companies, compliance with government regulations, protection of proprietary technology, dependence on third parties, product liability, the impact of the ongoing and evolving COVID-19 coronavirus pandemic, and the need to obtain adequate additional financing to fund the development of its product candidates.

The Company’s consolidated financial statements have been prepared on the basis of continuity of operations, realization of assets and the satisfaction of liabilities in the ordinary course of business. The Company experienced negative operating cash flows of $49.8 million for the three months ended March 31, 2022 and had an accumulated deficit of $346.1 million as of March 31, 2022. The Company expects to continue to generate operating losses for the foreseeable future.

The Company expects that its cash, cash equivalents and available-for-sale investments of $443.2 million as of March 31, 2022 will be sufficient to fund its operating expenses and capital expenditure requirements through at least 12 months from the date of issuance of these consolidated financial statements.

Basis of Presentation

The accompanying consolidated financial statements have been prepared in conformity with accounting principles generally accepted in the United States of America (“U.S. GAAP”). Any reference in these notes to applicable guidance is meant to refer to the authoritative U.S. GAAP as found in the Accounting Standards Codification (“ASC”) and Accounting Standards Updates (“ASUs”) of the Financial Accounting Standards Board (“FASB”).

The consolidated financial statements include the accounts of the Company and its wholly owned subsidiary, Karuna Securities Corporation, a Massachusetts corporation. All inter-company transactions and balances have been eliminated in consolidation.

The accompanying consolidated balance sheet as of March 31, 2022 and the consolidated statements of operations, comprehensive loss, cash flows, and stockholders’ equity for the three months ended March 31, 2022 and 2021 are unaudited. The unaudited interim consolidated financial statements have been prepared on the same basis as the audited annual consolidated financial statements and, in the opinion of management, reflect all adjustments, which include only normal recurring adjustments, necessary for the fair statement of the Company’s financial position as of March 31, 2022 and the results of its operations and cash flows for the three months ended March 31, 2022 and 2021. Certain information and footnote disclosures typically included in annual financial statements prepared in accordance with U.S. GAAP have been condensed or omitted. Accordingly, these unaudited consolidated interim financial statements should be read in conjunction with the Company’s consolidated financial statements as of and for the year ended December 31, 2021. The results for the three months ended March 31, 2022 are not necessarily indicative of results to be expected for the year ending December 31, 2022, any other interim periods, or any future year or period.

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Summary of Significant Accounting Policies

3 Months Ended

Mar. 31, 2022

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

Note 2. Summary of Significant Accounting Policies

The significant accounting policies and estimates used in preparation of the consolidated financial statements are described in the Company’s audited consolidated financial statements as of and for the year ended December 31, 2021, and the notes thereto, which are included in the Company’s Annual Report on Form 10-K. During the three months ended March 31, 2022, there were no material changes to the Company’s significant accounting policies.

Recently Issued Accounting Pronouncements

New pronouncements issued but not effective until after March 31, 2022 are not expected to have a material impact on the Company’s consolidated financial statements.

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Prepaid Expenses and Other Assets and Accrued Expenses

3 Months Ended

Mar. 31, 2022

Prepaid Expenses And Other Assets And Accrued Expenses [Abstract]

Prepaid Expenses and Other Assets and Accrued Expenses

Note 3. Prepaid Expenses and Other Assets and Accrued Expenses

Prepaid expenses and other current assets consisted of the following (in thousands):

	March 31, 2022		December 31, 2021
Prepaid research and development expenses	$	17,854	$	18,066
Prepaid insurance		1,172		2,364
Other		1,946		708
Total prepaid expenses and other current assets	$	20,972	$	21,138

The Company also had other non-current assets of $0.5 million as of March 31, 2022 and December 31, 2021. As of March 31, 2022, other non-current assets consisted of a security deposit of $0.4 million and less than $0.1 million in prepaid research and development and other expenses, as well as less than $0.1 million in deferred rent. As of December 31, 2021, other non-current assets consisted of a security deposit of $0.4 million, $0.1 million in prepaid expenses, and less than $0.1 million in deferred rent.

Accrued expenses consisted of the following (in thousands):

	March 31, 2022		December 31, 2021
Accrued research and development expenses	$	8,765	$	8,316
Accrued payroll and related expenses		1,945		6,989
Professional fees		1,040		543
Other		476		251
Total accrued expenses	$	12,226	$	16,099

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Stockholders' Equity

3 Months Ended

Mar. 31, 2022

Equity [Abstract]

Stockholders' Equity

Note 4. Stockholders’ Equity

Preferred Stock

On July 2, 2019, in connection with the closing of the Company’s initial public offering of its common stock ("IPO"), the Company filed its amended and restated Certificate of Incorporation, which authorizes the Company to issue up to 10,000,000 shares of preferred stock, $0.0001 par value per share. Through March 31, 2022, no preferred stock has been issued.

Common Stock

As of March 31, 2022, the Company’s amended and restated Certificate of Incorporation authorized the Company to issue 150,000,000 shares of common stock, $0.0001 par value per share.

Holders of the common stock are entitled to one vote for each share of common stock held at all meetings of stockholders and written actions in lieu of meetings. The holders of common stock are entitled to receive dividends out of funds legally available, as declared by the board of directors. These dividends are subject to the preferential dividend rights of the holders of the Company’s preferred stock. Through March 31, 2022, no cash dividends have been declared or paid.

As of March 31, 2022, there were 29,831,258 shares of common stock outstanding.

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Zai License Agreement

3 Months Ended

Mar. 31, 2022

Research and Development [Abstract]

Zai License Agreement

Note 5. Zai License Agreement

Terms of Agreement

On November 8, 2021, the Company and Zai Lab (Shanghai) Co., Ltd. ("Zai") entered into a license agreement (the "Zai License Agreement"), pursuant to which the Company granted to Zai the right to exclusively develop, manufacture and commercialize KarXT in Greater China, including mainland China, Hong Kong, Macau, and Taiwan (the “Licensed Territory”). Zai will fund substantially all development, regulatory, and commercialization activities in the Licensed Territory.

Under the terms of the Zai License Agreement, the Company received a non-refundable $35 million upfront payment and payment of certain taxes on its behalf. The Company is eligible to receive up to an additional $80 million in development and regulatory milestone payments, up to $72 million in sales milestone payments and low double-digit to high-teens tiered royalties based on annual net sales of KarXT in the Licensed Territory, subject to reduction under specified circumstances. Receipt of sales milestone payments and royalties are not contingent on any further participation by Karuna in the development of KarXT in the Licensed Territory.

The Zai License Agreement will expire upon the latest of the following dates with respect to the last licensed product in any region in the Licensed Territory: (i) the date of expiration of the last valid claim covering such licensed product in such region, (ii) the date that is a specific period after the date of the first commercial sale of such licensed product in such region and (iii) the expiration date of any regulatory exclusivity for such licensed product in such region. Zai may terminate the Zai License Agreement for convenience, subject to the terms thereto, by providing written notice to Karuna, which termination will be effective following a prescribed notice period. In addition, the Company may terminate the Zai License Agreement under specified circumstances if Zai or certain other parties challenge the Company’s patent rights or if Zai or its affiliates fail to complete certain development activities with respect to the licensed product for a specified period of time, subject to specified exceptions. Either party may terminate the Zai License Agreement for the other party’s uncured material breach, with a customary notice and cure period, or insolvency.

After termination or expiration, the Company is entitled to retain a worldwide, exclusive, and perpetual license from Zai to exploit the licensed product, which license would be non-exclusive after expiration (but not termination), subject to a reasonable royalty to be agreed by the parties if terminated for the Company’s uncured material breach.

Revenue Recognition

The Company concluded that the distinct units of account within the agreement are reflective of a vendor-customer relationship and therefore within the scope of ASC 606.

Under the provisions of ASC 606, the Company identified one performance obligation. The Company provided an exclusive license to intellectual property, bundled with the associated know-how and certain professional services that are not substantive.

Under the terms of the Zai License Agreement, Zai has the sole right to manufacture, or have manufactured, KarXT for use in development and commercialization in the Licensed Territory. At the election of Zai, the Company may supply KarXT to Zai at the fully burdened manufacturing cost plus a specified margin, as defined within the agreement. This provision was determined to be an option to acquire additional goods or services at a price that approximates the stand-alone selling price for that good or service, and therefore does not represent a material right, or separate performance obligation, within the context of the Zai License Agreement.

The Company determined the transaction price was equal to $37.0 million, which includes the upfront fee of $35 million and payments to taxing authorities on the Company’s behalf. In estimating the stand-alone selling price, the Company determined that there were no significant financing components, noncash consideration or amounts that may be refunded to the customer, and as such the total unconstrained consideration of $37.0 million was included in the total transaction price.

License of Intellectual Property. The license to the Company's intellectual property, bundled with the associated know-how, represents a distinct performance obligation. The license and associated know-how was transferred to Zai in the fourth quarter of 2021 to satisfy this performance obligation. The Company allocated the full transaction price to the license of the Company's intellectual property, bundled with the associated know-how, and accordingly recognized revenue of $37.0 million as license revenue in its Consolidated Statement of Operations for the year ended December 31, 2021.

Milestone Payments. The potential development and regulatory milestone payments, as well as sales milestone payments, are paid upon achievement of certain milestones as defined in the Zai License Agreement. The Company evaluated whether or not the milestones are considered probable of being reached and determined that their achievement is highly dependent on factors outside of the Company's control. These payments have been fully constrained until the Company concludes that achievement of the milestone is probable, and that recognition of revenue related to the milestone will not result in a significant reversal in amounts recognized in future periods, and as such have been excluded from the transaction price. At the end of each subsequent reporting period, the Company will re-evaluate the probability of achievement of each milestone and any related constraint and, if necessary, adjust its estimate of the overall transaction price.

Royalties. Any consideration related to royalties will be recognized if and when the related sales occur, as they were determined to relate predominantly to the license granted to Zai and, therefore, have also been excluded from the transaction price.

The Company assessed the Zai License Agreement to determine whether a significant financing component exists and concluded that a significant financing component does not exist. The upfront payment received by the Company was subject to foreign tax withholdings of $3.7 million. The Company recorded this tax expense to general and administrative expense in the Consolidated Statement of Operations for the year ended December 31, 2021.

There was no revenue recorded for the three months ended March 31, 2022 and 2021, and no deferred revenue as of March 31, 2022 or December 31, 2021, related to the Zai License Agreement.

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Net Loss per Share

3 Months Ended

Mar. 31, 2022

Earnings Per Share [Abstract]

Net Loss per Share

Note 6. Net Loss per Share

The following table sets forth the computation of basic and diluted net loss per share of common stock for the three months ended March 31, 2022 and 2021 (in thousands, except share and per share data):

	Three Months Ended March 31,
	2022			2021
Net Loss	$	(58,218	)	$	(30,497	)
Weighted-average shares used in computing net loss per share		29,805,961			27,786,538
Net loss per share, basic and diluted	$	(1.95	)	$	(1.10	)

The Company’s potentially dilutive securities, which consist of stock options, have been excluded from the computation of diluted net loss per share as the effect would be to reduce the net loss per share. Therefore, the weighted average number of common shares outstanding used to calculate both basic and diluted net loss per share attributable to common stockholders is the same.

Common Stock Equivalents

As of March 31, 2022 and 2021, stock options to purchase 5,923,147 and 5,171,914 shares of common stock, respectively, have been excluded from the calculation of diluted net loss per share because including them would have had an anti-dilutive impact.

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Stock-based Compensation

3 Months Ended

Mar. 31, 2022

Share-based Payment Arrangement [Abstract]

Stock-based Compensation

Note 7. Stock-based Compensation

Stock Options

In September 2009, the Company’s board of directors approved the 2009 Stock Incentive Plan (the “2009 Plan”) which provided for the grant of incentive stock options to employees and non-statutory stock options to directors, consultants, and non-employees of the Company. The 2009 Plan terminated in July 2019 effective upon the completion of the Company’s IPO. No additional options will be granted under the 2009 Plan. As of March 31, 2022, there were 2,357,970 options outstanding under the 2009 Plan.

In May 2019, the Company’s board of directors approved the 2019 Stock Option and Incentive Plan (the “2019 Plan”) which became effective on June 26, 2019, the date immediately prior to the date on which the registration statement related to the IPO was declared effective by the Securities and Exchange Commission ("SEC"). The 2019 Plan will expire in May 2029. Under the 2019 Plan, the Company may grant incentive stock options, non-statutory stock options, restricted stock awards, restricted stock units ("RSUs") and other stock-based awards. There were 1,709,832 shares of the Company’s common stock initially reserved for issuance under the 2019 Plan. The number of shares of common stock underlying awards that expire, or are terminated, surrendered, canceled or forfeited without having been fully exercised under the 2009 Plan will be added to the shares of common stock available for issuance under the 2019 Plan. In addition, the number of shares of common stock that may be issued under the 2019 Plan automatically increases on January 1 of each calendar year, commencing on January 1, 2020, by 4% of the number of shares of common stock outstanding on the immediately preceding December 31 or such lesser amount determined by the Company’s board of directors or the compensation committee of the board of directors. As of March 31, 2022, there were 1,591,887 common shares available for issuance and 3,565,177 options outstanding under the 2019 Plan.

Options under the 2019 Plan generally vest based on the grantee’s continued service with the Company during a specified period following a grant as determined by the board of directors and expire ten years from the grant date. Awards typically vest in four years, but vesting conditions can vary based on the discretion of the Company’s board of directors.

A summary of the Company’s stock option activity and related information is as follows:

	Number of Shares			Weighted- Average Exercise Price Per Share		Weighted- Average Remaining Contractual Term (Years)		Aggregate Intrinsic Value (in thousands)
Outstanding as of December 31, 2021		5,323,162		$	50.04		7.7	$	431,456
Granted		703,685			112.16
Exercised		(60,700	)		21.13
Forfeited		(43,000	)		106.51
Outstanding as of March 31, 2022		5,923,147		$	57.31		7.7	$	414,748
Options vested and expected to vest as of    March 31, 2022		5,923,147		$	57.31		7.7	$	414,748
Options exercisable as of March 31, 2022		3,552,230		$	26.12		6.9	$	358,298

The aggregate intrinsic values of options outstanding, exercisable, vested and expected to vest were calculated as the difference between the exercise price of the options and the publicly traded stock price of the Company’s common stock as of March 31, 2022.

As of March 31, 2022, there was $131.0 million of unrecognized compensation cost, which is expected to be recognized over a weighted-average period of 3.17 years.

Stock-based Compensation Expense

Stock-based compensation expense is classified in the statements of operations for the three months ended March 31, 2022 and 2021 as follows (in thousands):

	Three Months Ended March 31,
	2022		2021
General and administrative	$	6,106	$	3,741
Research and development		4,530		2,081
Total stock-based compensation expense	$	10,636	$	5,822

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Fair Value of Financial Assets and Liabilities

3 Months Ended

Mar. 31, 2022

Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Abstract]

Fair Value of Financial Assets and Liabilities

Note 8. Fair Value of Financial Assets and Liabilities

The following tables present information about the Company’s assets as of March 31, 2022 and December 31, 2021 that are measured at fair value on a recurring basis and indicate the level of the fair value hierarchy utilized to determine such fair values (in thousands):

	Fair Value Measurement
	at March 31, 2022 Using
	Level 1		Level 2		Level 3		Total
Cash equivalents:
Money market fund	$	132,808	$	—	$	—	$	132,808
Commercial paper		26,878		—		—		26,878
US government agencies		9,287		—		—		9,287
Investment securities:
U.S. Treasuries		108,509		—		—		108,509
Corporate debt securities		—		49,227		—		49,227
Commercial paper		—		109,248		—		109,248
Total	$	277,482	$	158,475	$	—	$	435,957
	Fair Value Measurement
	at December 31, 2021 Using
	Level 1		Level 2		Level 3		Total
Cash equivalents:
Money market fund	$	199,019	$	—	$	—	$	199,019
Investment securities:
U.S. Treasuries		100,043		—		—		100,043
Corporate debt securities		—		55,744		—		55,744
Commercial paper		—		131,251		—		131,251
Total	$	299,062	$	186,995	$	—	$	486,057

The fair values of the Company’s commercial paper and corporate debt securities are based on prices obtained from independent pricing sources. Securities with validated quotes from pricing services are reflected within Level 2, as they are primarily based on observable pricing for similar assets or other market observable inputs. Typical inputs used by these pricing services include, but are not limited to, reported trades, benchmark yields, issuer spreads, bids, offers or estimates of cash flow, prepayment spreads and default rates.

The Company does not hold any securities classified as Level 3, which are securities valued using unobservable inputs. The Company has not transferred any investment securities between the classification levels.

The estimated fair value and amortized cost of the Company’s available-for-sale investments, by contractual maturity and security type, are summarized as follows (in thousands):

	March 31, 2022
	Amortized Cost		Unrealized Gains		Unrealized Losses			Fair Value
U.S. Treasuries (due within one year)	$	45,286	$	—	$	(366	)	$	44,920
U.S. Treasuries (due after one year and less than    two years)		65,072		—		(1,483	)		63,589
Corporate debt securities (due within one year)		44,457		—		(263	)		44,194
Corporate debt securities (due after one year and    less than two years)		5,116		—		(83	)		5,033
Commercial paper (due within one year)		109,588		—		(340	)		109,248
Total	$	269,519	$	—	$	(2,535	)	$	266,984
	December 31, 2021
	Amortized Cost		Unrealized Gains		Unrealized Losses			Fair Value
U.S. Treasuries (due within one year)	$	15,137	$	—	$	(12	)	$	15,125
U.S. Treasuries (due after one year and less than    two years)	$	85,277	$	—	$	(359	)		84,918
Corporate debt securities (due within one year)	$	45,510	$	—	$	(57	)		45,453
Corporate debt securities (due after one year and    less than two years)		10,338		—		(47	)		10,291
Commercial paper (due within one year)		131,273		5		(27	)		131,251
Total	$	287,535	$	5	$	(502	)	$	287,038

The Company has classified all of its available-for-sale investment securities, including those with maturities beyond one year, as current assets on its condensed consolidated balance sheets based on the highly liquid nature of the investment securities and because these investment securities are considered available for use in current operations.

The Company is required to determine whether a decline in the fair value below the amortized cost basis of available-for-sale securities is due to credit-related factors. At each reporting date, the Company performs an evaluation of impairment to determine if any unrealized losses are the result of credit losses. Impairment is assessed at the individual security level. Factors considered in determining whether a loss resulted from a credit loss or other factors include the Company’s intent and ability to hold the investment until the recovery of its amortized cost basis, the extent to which the fair value is less than the amortized cost basis, the length of time and extent to which fair value has been less than the cost basis, the financial condition of the issuer, any historical failure of the issuer to make scheduled interest or principal payments, any changes to the rating of the security by a rating agency, any adverse legal or regulatory events affecting the issuer or issuer’s industry, and any significant deterioration in economic conditions.

Unrealized losses on available-for-sale securities presented in the previous table have not been recognized in the consolidated statements of operations because the securities are high credit quality, investment grade securities that the Company does not intend to sell and will not be required to sell prior to their anticipated recovery, and the decline in fair value is attributable to factors other than credit losses. Based on its evaluation, the Company determined its year-to-date credit losses related to its available-for-sale securities were immaterial at March 31, 2022 and December 31, 2021.

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Commitments and Contingencies

3 Months Ended

Mar. 31, 2022

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

Note 9. Commitments and Contingencies

Leases

The Company entered into an agreement to lease approximately 7,050 square feet of office space in Boston, Massachusetts (“Arch Street Original Premises”) that began in December 2018 and had an original expiry in February 2023. In January 2020, the Company entered into an amended agreement (“Amended Arch Street Lease Agreement”) to gain access to approximately 4,175 square feet of additional office space (“Arch Street Expansion Premises”) beginning in March 2020, and to extend the maturity of the agreement for the Arch Street Original Premises to December 2023. The Amended Arch Street Lease Agreement provides for future minimum annual rental payments as defined within the agreement. Under the terms of the Amended Arch Street Lease Agreement, the Company is required to maintain a cash balance of approximately $0.2 million to secure a letter of credit associated with this lease. The amount was classified as restricted cash in the consolidated balance sheets as of March 31, 2022 and December 31, 2021. The Amended Arch Street Lease Agreement also provides for approximately $0.1 million in leasehold incentives which may be applied to base rent or improvements to the Arch Street Expansion Premises, subject to limitations.

The Company determined the Amended Arch Street Lease Agreement represented a lease modification, and the Arch Street Original Premises and Arch Street Expansion Premises were identified as separate lease components. The extension of maturity with respect to the Arch Street Original Premises was treated as a modification not accounted for as a separate contract, in which the lease classification was reassessed, and the lease liability was remeasured. The effect of the remeasurement, in the amount of $0.4 million, was recorded as an adjustment to the right-of-use (“ROU”) lease asset as of February 1, 2020, the effective date of the modification. The addition of the Arch Street Expansion Premises was accounted for as a separate contract which granted the Company an additional right of use not included in the original lease, in which the lease payments increased commensurate with the standalone price for the additional right of use. As the leasehold incentives were not paid or payable at commencement, the Company will account for the incentives once the contingency is resolved.

In February 2020, the Company entered into an agreement to lease approximately 5,050 square feet of office space, and furniture within the office space, in Carmel, Indiana (“Indiana Lease Agreement”), which began in June 2020 and expires in July 2023, with the option to renew for an additional three-year term. In addition, the agreement provides an option to purchase the office furniture at the expiration of the agreement.

The office space and office furniture within the Indiana Lease Agreement were each determined to represent separate lease components. Consideration for the contract was allocated to each lease component based on their relative stand-alone selling price. The options to renew the lease for an additional three-year term as well as purchase the office furniture at the expiration of the agreement were excluded from the determination of lease liabilities arising from obtaining the ROU assets, as they were not considered probable of being exercised at commencement.

In March 2021, the Company entered into an agreement (“High Street Lease”) to sublease from a third party approximately 25,445 square feet of office space in Boston, Massachusetts, beginning on April 1, 2021 and expiring December 31, 2025. The initial fixed rental rate is $60 per rentable square foot of the premises per annum and will increase at a rate of $1 per rentable square foot each year, with base rent first becoming due on July 1, 2021. Upon signing of the High Street Lease, the Company was also required to pay the first full monthly installment of base rent of $0.1 million and a security deposit of $0.4 million. The security deposit was recorded within other non-current assets on the consolidated balance sheets as of March 31, 2022 and December 31, 2021. The first monthly installment was included as an adjustment to the ROU asset recognized upon commencement of the lease. The Company recognized an ROU asset and corresponding lease liability of approximately $6.2 million and $6.0 million, respectively, on its consolidated balance sheet as of April 1, 2021, upon commencement of the High Street Lease.

For each of the lease agreements entered into or modified, the Company identified certain non-lease components. Lease and non-lease components were combined into a single lease component. In addition, all identified leases were assessed as operating leases.

As the Company’s leases do not provide an implicit rate, the Company used its incremental borrowing rate, which is the rate incurred to borrow on a collateralized basis over a term equal to the lease payments in a similar economic environment, in determining the present value of lease payments for each identified lease at the lease commencement date.

Simultaneous with the High Street Lease, the Company entered into an agreement (“Arch Street Original Premises Sublease”) to sublease approximately 7,050 square feet of its former Arch Street Boston headquarters to a third party from July 1, 2021 through the remainder of its current lease term, which ends on December 31, 2023. The initial fixed rental rate is $59 per rentable square foot of the premises per annum, and will increase at a rate of 2% per year, with base rent first becoming due on October 1, 2021. Upon signing of the Arch Street Original Premises Sublease, the agreement required a security deposit of $0.1 million which has been recorded within restricted cash on the consolidated balance sheet as of March 31, 2022.

On April 30, 2021, the Company entered into an agreement ("First Expansion Premises Sublease") to sublease approximately 1,751 square feet of the Arch Street Expansion Premises to another third party from June 1, 2021 through the remainder of its current lease term, which ends on December 31, 2023. The initial fixed rental rate is $61 per rentable square foot per annum and will increase at a rate of 2% per year, with base rent commencing on June 1, 2021.

On January 21, 2022, the Company entered into an agreement ("Second Expansion Premises Sublease") to sublease approximately 2,422 square feet of its Arch Street Expansion Premises to a third party from February 7, 2022 through the remainder of its current lease term, which ends on December 31, 2023. The fixed rental rate is $45 per rentable square foot per annum, with base rent commencing on April 7, 2022.

The components of lease cost were as follows (dollar amounts in thousands):

	Three Months Ended March 31,
	2022			2021
Lease Cost
Operating lease cost	$	538		$	207
Short-term lease cost		—			—
Sublease income		(139	)		—
Total lease cost	$	399		$	207
Other Information
Cash paid for amounts included in the measurement of lease liabilities	$	631		$	244
Weighted-average remaining lease term	3.28 years			2.69 years
Weighted-average discount rate		5.89	%		6.21	%

The following is a maturity analysis of the annual undiscounted cash flows of the operating lease liabilities and a reconciliation to present value of lease liabilities as of March 31, 2022 (in thousands):

Year ended:
December 31, 2022	$	1,916
December 31, 2023		2,520
December 31, 2024		1,597
December 31, 2025		1,622
Total future minimum lease payments		7,655
Less imputed interest		(677	)
Present value of lease liabilities	$	6,978

The following summarizes the annual undiscounted cash flows to be received from subleases (in thousands):

Year ended:
December 31, 2022	$	477
December 31, 2023		648
Total future sublease payments to be received	$	1,125

Historically, all Company assets and liabilities belonged to a single corporate office asset group. The circumstances described above triggered a reassessment of asset grouping, such that the ROU assets associated with the Arch Street Original Premises and Arch Street Expansion Premises had their own separately identifiable cash flows and therefore their own separate asset grouping. Further, sublease income associated with the Arch Street office space is projected to be lower than lease payments owed by the Company for this space, and therefore impairment was indicated for this new asset group.

The carrying value of these ROU assets immediately before impairment was $2.0 million, and the fair value of these operating lease ROU assets immediately subsequent to the impairment, calculated as the present value of the estimated future cash flows attributable to the assets, was $1.3 million. The Company recognized approximately $0.7 million in impairment losses on ROU assets within other income (loss) on the statement of operations for the three months ended March 31, 2021.

Intellectual Property License with Eli Lilly and Company

In May 2012, the Company entered into an exclusive license agreement (the “Lilly License Agreement”), with Eli Lilly and Company (“Eli Lilly”), pursuant to which Eli Lilly assigned to the Company all of its rights to certain patents (now expired), regulatory documentation, data records and materials related to xanomeline. The Company is also entitled to sublicense or otherwise transfer the rights granted in connection with the Lilly License Agreement.

Under the Lilly License Agreement, the Company is obligated to use commercially reasonable efforts to develop, manufacture, commercialize and seek and maintain regulatory approval for xanomeline, in any formulation, for use in humans.

The Company paid Eli Lilly an upfront payment of $0.1 million and has agreed to make milestone payments to Eli Lilly of up to an aggregate of $16 million upon the achievement of specified regulatory milestones and up to an aggregate of $54 million in commercial milestones. In addition, the Company is obligated to pay Eli Lilly tiered royalties, at rates in the low to mid single-digit percentages, on the worldwide net sales of any commercialized product on a country-by-country basis until the expiration of the applicable royalty term, which is the longer of six years from the date of first commercial sale of each licensed product within a country or data package exclusivity in such country. During the royalty term, Eli Lilly is prohibited from granting any third party rights to the patents, regulatory documentation, data records and materials that have been licensed to the Company under the Lilly License Agreement.

The Lilly License Agreement will expire on the later of (i) the expiration of the last-to-expire royalty term on a licensed product-by-licensed product basis or (ii) the date on which the Company has made all milestone payments pursuant to the terms of the Lilly License Agreement, unless terminated earlier by the parties. In no event will the term of the Lilly License Agreement exceed 15 years past the anniversary of the first commercial sale of a xanomeline product. The Company may terminate the Lilly License Agreement for any reason with proper prior notice to Eli Lilly. Either party may terminate the Lilly License Agreement upon an uncured material breach by the other party.

The initial upfront payment of $0.1 million was expensed when incurred in May 2012. As of March 31, 2022, no milestones have been reached and, accordingly, no milestone payments have been made.

Intellectual Property License with PureTech Health

In March 2011, the Company entered into an exclusive license agreement (the “Patent License Agreement”) with PureTech Health, pursuant to which PureTech Health granted the Company an exclusive license to patent rights relating to combinations of a muscarinic activator with a muscarinic inhibitor for the treatment of central nervous system disorders.

In connection with the Patent License Agreement, the Company has agreed to make milestone payments to PureTech Health of up to an aggregate of $10 million upon the achievement of specified development and regulatory milestones. In addition, the Company is obligated to pay PureTech Health low single-digit royalties on the worldwide net sales of any commercialized product covered by the licenses granted under the Patent License Agreement.

In the event that the Company sublicenses any of the patent rights granted under the Patent License Agreement, the Company will be obligated to pay PureTech Health royalties within the range of 15% to 25% on any income the Company receives from the sublicensee, excluding royalties.

The Company may terminate the Patent License Agreement for any reason with proper prior notice to PureTech Health. Either party may terminate the Patent License Agreement upon an uncured material breach by the other party.

The Company incurred no expenses related to the Patent License Agreement provided by PureTech Health during the three months ended March 31, 2022 and 2021. During the year ended December 31, 2021, the Company paid less than $0.1 million in sublicense income associated with the Zai License Agreement to PureTech Health. In December 2020, the Company paid $2.0 million to PureTech Health, having reached the milestone of Phase 3 clinical trial commencement. The Company had no outstanding liabilities to PureTech Health related to the Patent License Agreement as of March 31, 2022 and December 31, 2021.

Indemnification

In the normal course of business, the Company enters into contracts and agreements that contain a variety of representations and warranties and provide for general indemnifications. The Company’s exposure under these agreements is unknown because it involves claims that may be made against the Company in the future but have not yet been made. To date, the Company has not paid any claims or been required to defend any action related to its indemnification obligations. However, the Company may incur charges in the future as a result of these indemnification obligations.

Contingencies

From time to time, the Company may have certain contingent liabilities that arise in the ordinary course of its business activities. The Company accrues a liability for such matters when it is probable that future expenditures will be made, and such expenditures can be reasonably estimated.

Litigation

The Company is not a party to any litigation and does not have contingency reserves established for any litigation liabilities as of March 31, 2022.

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401(k) Savings Plan

3 Months Ended

Mar. 31, 2022

Retirement Benefits [Abstract]

401(k) Savings Plan

Note 10. 401(k) Savings Plan

The Company has a 401(k) retirement plan in which substantially all U.S. employees are eligible to participate. Eligible employees may elect to contribute up to the maximum limits, as set by the Internal Revenue Service, of their eligible compensation. The total contribution expense for the Company was $0.4 million and $0.2 million for the three months ended March 31, 2022 and 2021, respectively.

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Summary of Significant Accounting Policies (Policies)

3 Months Ended

Mar. 31, 2022

Accounting Policies [Abstract]

Basis of Presentation

Basis of Presentation

The accompanying consolidated financial statements have been prepared in conformity with accounting principles generally accepted in the United States of America (“U.S. GAAP”). Any reference in these notes to applicable guidance is meant to refer to the authoritative U.S. GAAP as found in the Accounting Standards Codification (“ASC”) and Accounting Standards Updates (“ASUs”) of the Financial Accounting Standards Board (“FASB”).

The consolidated financial statements include the accounts of the Company and its wholly owned subsidiary, Karuna Securities Corporation, a Massachusetts corporation. All inter-company transactions and balances have been eliminated in consolidation.

The accompanying consolidated balance sheet as of March 31, 2022 and the consolidated statements of operations, comprehensive loss, cash flows, and stockholders’ equity for the three months ended March 31, 2022 and 2021 are unaudited. The unaudited interim consolidated financial statements have been prepared on the same basis as the audited annual consolidated financial statements and, in the opinion of management, reflect all adjustments, which include only normal recurring adjustments, necessary for the fair statement of the Company’s financial position as of March 31, 2022 and the results of its operations and cash flows for the three months ended March 31, 2022 and 2021. Certain information and footnote disclosures typically included in annual financial statements prepared in accordance with U.S. GAAP have been condensed or omitted. Accordingly, these unaudited consolidated interim financial statements should be read in conjunction with the Company’s consolidated financial statements as of and for the year ended December 31, 2021. The results for the three months ended March 31, 2022 are not necessarily indicative of results to be expected for the year ending December 31, 2022, any other interim periods, or any future year or period.

Recently Issued Accounting Pronouncements

Recently Issued Accounting Pronouncements

New pronouncements issued but not effective until after March 31, 2022 are not expected to have a material impact on the Company’s consolidated financial statements.

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Prepaid Expenses and Other Assets and Accrued Expenses (Tables)

3 Months Ended

Mar. 31, 2022

Prepaid Expenses And Other Assets And Accrued Expenses [Abstract]

Schedule of Prepaid Expenses and Other Current Assets

Prepaid expenses and other current assets consisted of the following (in thousands):

	March 31, 2022		December 31, 2021
Prepaid research and development expenses	$	17,854	$	18,066
Prepaid insurance		1,172		2,364
Other		1,946		708
Total prepaid expenses and other current assets	$	20,972	$	21,138

Schedule of Accrued Expenses

Accrued expenses consisted of the following (in thousands):

	March 31, 2022		December 31, 2021
Accrued research and development expenses	$	8,765	$	8,316
Accrued payroll and related expenses		1,945		6,989
Professional fees		1,040		543
Other		476		251
Total accrued expenses	$	12,226	$	16,099

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Net Loss per Share (Tables)

3 Months Ended

Mar. 31, 2022

Earnings Per Share [Abstract]

Schedule of Computation of Basic and Diluted Net Loss Per Share of Common Stock

The following table sets forth the computation of basic and diluted net loss per share of common stock for the three months ended March 31, 2022 and 2021 (in thousands, except share and per share data):

	Three Months Ended March 31,
	2022			2021
Net Loss	$	(58,218	)	$	(30,497	)
Weighted-average shares used in computing net loss per share		29,805,961			27,786,538
Net loss per share, basic and diluted	$	(1.95	)	$	(1.10	)

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Stock-based Compensation (Tables)

3 Months Ended

Mar. 31, 2022

Share-based Payment Arrangement [Abstract]

Summary of Stock Option Activity

A summary of the Company’s stock option activity and related information is as follows:

	Number of Shares			Weighted- Average Exercise Price Per Share		Weighted- Average Remaining Contractual Term (Years)		Aggregate Intrinsic Value (in thousands)
Outstanding as of December 31, 2021		5,323,162		$	50.04		7.7	$	431,456
Granted		703,685			112.16
Exercised		(60,700	)		21.13
Forfeited		(43,000	)		106.51
Outstanding as of March 31, 2022		5,923,147		$	57.31		7.7	$	414,748
Options vested and expected to vest as of    March 31, 2022		5,923,147		$	57.31		7.7	$	414,748
Options exercisable as of March 31, 2022		3,552,230		$	26.12		6.9	$	358,298

Summary of Stock-based Compensation Expense

Stock-based compensation expense is classified in the statements of operations for the three months ended March 31, 2022 and 2021 as follows (in thousands):

	Three Months Ended March 31,
	2022		2021
General and administrative	$	6,106	$	3,741
Research and development		4,530		2,081
Total stock-based compensation expense	$	10,636	$	5,822

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Fair Value of Financial Assets and Liabilities (Tables)

3 Months Ended

Mar. 31, 2022

Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Abstract]

Schedule of Fair Value Measurement on Recurring Basis and Indicates the level of Fair Value Hierarchy Utilized

The following tables present information about the Company’s assets as of March 31, 2022 and December 31, 2021 that are measured at fair value on a recurring basis and indicate the level of the fair value hierarchy utilized to determine such fair values (in thousands):

	Fair Value Measurement
	at March 31, 2022 Using
	Level 1		Level 2		Level 3		Total
Cash equivalents:
Money market fund	$	132,808	$	—	$	—	$	132,808
Commercial paper		26,878		—		—		26,878
US government agencies		9,287		—		—		9,287
Investment securities:
U.S. Treasuries		108,509		—		—		108,509
Corporate debt securities		—		49,227		—		49,227
Commercial paper		—		109,248		—		109,248
Total	$	277,482	$	158,475	$	—	$	435,957
	Fair Value Measurement
	at December 31, 2021 Using
	Level 1		Level 2		Level 3		Total
Cash equivalents:
Money market fund	$	199,019	$	—	$	—	$	199,019
Investment securities:
U.S. Treasuries		100,043		—		—		100,043
Corporate debt securities		—		55,744		—		55,744
Commercial paper		—		131,251		—		131,251
Total	$	299,062	$	186,995	$	—	$	486,057

Summary of Estimated Fair Value and Amortized Cost of Available-for-Sale Investments by Contractual Maturity

The estimated fair value and amortized cost of the Company’s available-for-sale investments, by contractual maturity and security type, are summarized as follows (in thousands):

	March 31, 2022
	Amortized Cost		Unrealized Gains		Unrealized Losses			Fair Value
U.S. Treasuries (due within one year)	$	45,286	$	—	$	(366	)	$	44,920
U.S. Treasuries (due after one year and less than    two years)		65,072		—		(1,483	)		63,589
Corporate debt securities (due within one year)		44,457		—		(263	)		44,194
Corporate debt securities (due after one year and    less than two years)		5,116		—		(83	)		5,033
Commercial paper (due within one year)		109,588		—		(340	)		109,248
Total	$	269,519	$	—	$	(2,535	)	$	266,984
	December 31, 2021
	Amortized Cost		Unrealized Gains		Unrealized Losses			Fair Value
U.S. Treasuries (due within one year)	$	15,137	$	—	$	(12	)	$	15,125
U.S. Treasuries (due after one year and less than    two years)	$	85,277	$	—	$	(359	)		84,918
Corporate debt securities (due within one year)	$	45,510	$	—	$	(57	)		45,453
Corporate debt securities (due after one year and    less than two years)		10,338		—		(47	)		10,291
Commercial paper (due within one year)		131,273		5		(27	)		131,251
Total	$	287,535	$	5	$	(502	)	$	287,038

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Commitments and Contingencies (Tables)

3 Months Ended

Mar. 31, 2022

Commitments and Contingencies Disclosure [Abstract]

Components of Lease Cost

The components of lease cost were as follows (dollar amounts in thousands):

	Three Months Ended March 31,
	2022			2021
Lease Cost
Operating lease cost	$	538		$	207
Short-term lease cost		—			—
Sublease income		(139	)		—
Total lease cost	$	399		$	207
Other Information
Cash paid for amounts included in the measurement of lease liabilities	$	631		$	244
Weighted-average remaining lease term	3.28 years			2.69 years
Weighted-average discount rate		5.89	%		6.21	%

Schedule of Maturity Analysis of Annual Undiscounted Cash Flows of Operating Lease Liabilities and Reconciliation to Present Value of Lease Liabilities

The following is a maturity analysis of the annual undiscounted cash flows of the operating lease liabilities and a reconciliation to present value of lease liabilities as of March 31, 2022 (in thousands):

Year ended:
December 31, 2022	$	1,916
December 31, 2023		2,520
December 31, 2024		1,597
December 31, 2025		1,622
Total future minimum lease payments		7,655
Less imputed interest		(677	)
Present value of lease liabilities	$	6,978

Summary of Annual Undiscounted Cash Flows To Be Received from Subleases

The following summarizes the annual undiscounted cash flows to be received from subleases (in thousands):

Year ended:
December 31, 2022	$	477
December 31, 2023		648
Total future sublease payments to be received	$	1,125

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Nature of the Business and Basis of Presentation - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021	Dec. 31, 2021
Subsidiary Sale Of Stock [Line Items]
Payment of offering costs	$ 25	$ 98
Common stock value	3		$ 3
Deferred offering costs	480		455
Cash flows from operating activities	49,803	$ 21,179
Accumulated deficit	346,089		$ 287,871
Cash and cash equivalents and available-for-sale investments	$ 443,200
Common Stock
Subsidiary Sale Of Stock [Line Items]
Shares issued and sold		2,395,834

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Prepaid Expenses and Other Assets and Accrued Expenses - Schedule of Prepaid Expenses and Other Current Assets (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Prepaid research and development expenses	$ 17,854	$ 18,066
Prepaid insurance	1,172	2,364
Other	1,946	708
Total prepaid expenses and other current assets	$ 20,972	$ 21,138

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Prepaid Expenses and Other Assets and Accrued Expenses - Additional Information (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Other non-current assets	$ 503	$ 531
Prepaid research and development expenses	100	100
Security deposit	400	400
Deferred rent	$ 100	$ 100

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Prepaid Expenses and Other Assets and Accrued Expenses - Schedule of Accrued Expenses (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Payables and Accruals [Abstract]
Accrued research and development expenses	$ 8,765	$ 8,316
Accrued payroll and related expenses	1,945	6,989
Professional fees	1,040	543
Other	476	251
Total accrued expenses	$ 12,226	$ 16,099

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Stockholders' Equity - Additional Information (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2022	Dec. 31, 2021	Jul. 02, 2019
Class Of Stock [Line Items]
Preferred stock, shares authorized	10,000,000	10,000,000
Preferred stock, par value	$ 0.0001	$ 0.0001
Preferred stock, shares outstanding	0	0
Common Stock, Shares, Outstanding	29,831,258	29,770,558
Common stock, shares authorized	150,000,000	150,000,000
Common stock, par value	$ 0.0001	$ 0.0001
Dividends declared	$ 0
Initial Public Offering
Class Of Stock [Line Items]
Preferred stock, shares authorized			10,000,000
Preferred stock, par value			$ 0.0001
Preferred Stock, Shares Issued	0

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Zai License Agreement (Additional Information) (Details) - USD ($) $ in Thousands		3 Months Ended		12 Months Ended
	Nov. 08, 2021	Mar. 31, 2022	Mar. 31, 2021	Dec. 31, 2021
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
License revenue		$ 0	$ 0
Zai License Agreement [Member]
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Upfront Payment for License Agreement	$ 35,000
Development and Regulatory Milestone Payments Under License Agreement	80,000
Sales Milestone Payments Under License Agreement	72,000
Transaction Price of License Agreement	37,000
Initial payment	$ 35,000
License revenue		0	$ 0
Foreign tax general and administrative expense				$ 3,700
Deferred revenue		$ 0		0
Zai License Agreement [Member] | Intellectual Property License Agreement [Member]
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
License revenue				$ 37,000

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Net Loss Per Share - Schedule of Computation of Basic and Diluted Net Loss Per Share of Common Stock (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Earnings Per Share, Basic and Diluted [Abstract]
Net Loss	$ (58,218)	$ (30,497)
Weighted-average shares used in computing net loss per share	29,805,961	27,786,538
Net loss per share, basic and diluted	$ (1.95)	$ (1.10)

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Net Loss Per Share - Additional Information (Details) - shares	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Stock Options to Purchase Common Stock
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive securities excluded from computation of earnings per share, amount	5,923,147	5,171,914

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Stock-based Compensation - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended	12 Months Ended
	Mar. 31, 2022	Dec. 31, 2020	Dec. 31, 2021	May 30, 2019
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Number of shares outstanding	5,923,147		5,323,162
Unrecognized compensation cost	$ 131.0
Employee Stock Option
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Unrecognized compensation costs, weighted average recognition period	3 years 2 months 1 day
2009 Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Number of shares outstanding	2,357,970
Share based compensation arrangement by share based payment award termination date	Jul. 02, 2019
2019 Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Aggregate common shares issuable	1,591,887
Number of shares outstanding	3,565,177
Common stock reserved for future issuance				1,709,832
Automatic increase in stock issuance as percentage on outstanding stock		4.00%
Stock option and incentive plan expiration month and year		2029-05
Expiration period	10 years
Vesting period	4 years

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Stock-based Compensation - Summary of Stock Option Activity (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2022	Dec. 31, 2021
Compensation Related Costs [Abstract]
Number of Shares, Outstanding, beginning of period	5,323,162
Number of Shares, Granted	703,685
Number of Shares, Exercised	(60,700)
Number of Shares, Forfeited	(43,000)
Number of Shares, Outstanding, end of period	5,923,147	5,323,162
Number of Shares, Options vested and expected to vest	5,923,147
Number of Shares, Options exercisable	3,552,230
Weighted-Average Exercise Price Per Share, Outstanding, beginning of period	$ 50.04
Weighted-Average Exercise Price Per Share, Outstanding, Granted	112.16
Weighted-Average Exercise Price Per Share, Outstanding, Exercised	21.13
Weighted-Average Exercise Price Per Share, Outstanding, Forfeited	106.51
Weighted-Average Exercise Price Per Share, Outstanding, end of period	57.31	$ 50.04
Weighted-Average Exercise Price Per Share, Options vested and expected to vest	57.31
Weighted-Average Exercise Price Per Share, Options exercisable	$ 26.12
Weighted-Average Remaining Contractual Term, Outstanding (Years)	7 years 8 months 12 days	7 years 8 months 12 days
Weighted-Average Remaining Contractual Term, Options vested and expected to vest	7 years 8 months 12 days
Weighted-Average Remaining Contractual Term, Options exercisable	6 years 10 months 24 days
Aggregate Intrinsic Value, Outstanding	$ 414,748	$ 431,456
Aggregate Intrinsic Value, Options vested and expected to vest	414,748
Aggregate Intrinsic Value, Options exercisable	$ 358,298

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Stock-based Compensation - Summary of Stock-based Compensation Expense (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Total stock based compensation expense	$ 10,636	$ 5,822
Research and Development
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Total stock based compensation expense	4,530	2,081
General and Administrative
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Total stock based compensation expense	$ 6,106	$ 3,741

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Fair Value of Financial Assets and Liabilities - Schedule of Fair Value Measurement on Recurring Basis and Indicates the level of Fair Value Hierarchy Utilized (Details) - Recurring - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Investment securities	$ 109,248	$ 131,251
Total fair value assets	435,957	486,057
Corporate Debt Securities
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Investment securities	49,227	55,744
Money Market Funds
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Cash equivalents	132,808	199,019
US Treasury Securities
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Investment securities	108,509	100,043
Commercial Paper
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Cash equivalents	26,878
US Government Agencies
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Cash equivalents	9,287
Fair Value, Inputs, Level 1
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Investment securities
Total fair value assets	277,482	299,062
Fair Value, Inputs, Level 1 | Corporate Debt Securities
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Investment securities
Fair Value, Inputs, Level 1 | Money Market Funds
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Cash equivalents	132,808	199,019
Fair Value, Inputs, Level 1 | US Treasury Securities
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Investment securities	108,509	100,043
Fair Value, Inputs, Level 1 | Commercial Paper
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Cash equivalents	26,878
Fair Value, Inputs, Level 1 | US Government Agencies
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Cash equivalents	9,287
Fair Value, Inputs, Level 2
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Investment securities	109,248	131,251
Total fair value assets	158,475	186,995
Fair Value, Inputs, Level 2 | Corporate Debt Securities
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Investment securities	49,227	55,744
Fair Value, Inputs, Level 2 | Money Market Funds
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Cash equivalents
Fair Value, Inputs, Level 2 | US Treasury Securities
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Investment securities
Fair Value, Inputs, Level 2 | Commercial Paper
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Cash equivalents
Fair Value, Inputs, Level 2 | US Government Agencies
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Cash equivalents
Fair Value, Inputs, Level 3
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Investment securities
Total fair value assets
Fair Value, Inputs, Level 3 | Corporate Debt Securities
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Investment securities
Fair Value, Inputs, Level 3 | Money Market Funds
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Cash equivalents
Fair Value, Inputs, Level 3 | US Treasury Securities
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Investment securities
Fair Value, Inputs, Level 3 | Commercial Paper
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Cash equivalents
Fair Value, Inputs, Level 3 | US Government Agencies
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Cash equivalents

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Fair Value of Financial Assets and Liabilities - Summary of Estimated Fair Value and Amortized Cost of Available-for-Sale Investments by Contractual Maturity (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Amortized Cost	$ 269,519	$ 287,535
Available For Sale Securities Accumulated Gross Unrealized Gains Before Tax	0	5
Available For Sale Securities Accumulated Gross Unrealized Losses Before Tax	(2,535)	(502)
Fair Value	266,984	287,038
Corporate Debt Securities
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Due within in one year, Amortized cost	44,457	45,510
Due within one year, Amortized cost, Unrealized gains	0	0
Due within one year , Amortized cost, Unrealized losses	(263)	(57)
Due in one year or less, Fair value	44,194	45,453
Due after one year and less than two years, Amortized cost	5,116	10,338
Due after one year and less than two years, Amortized cost, Unrealized gains	0	0
Due after one year and less than two years, Amortized cost, Unrealized losses	83	47
Due after one year and less than two years, Fair value	5,033	10,291
US Treasury Securities
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Due after one year and less than two years, Amortized cost	65,072	85,277
Due after one year and less than two years, Amortized cost, Unrealized losses	(1,483)	(359)
Due after one year and less than two years, Fair value	63,589	84,918
Due within in one year, Amortized cost	45,286	15,137
Due within one year, Amortized cost, Unrealized gains	0	0
Due within one year, Amortized cost, Unrealized losses	(366)	(12)
Due in one year or less, Fair value	44,920	15,125
Due after one year and less than two years, Amortized cost, Unrealized gains	0	0
Commercial Paper
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Due within in one year, Amortized cost	109,588	131,273
Due within one year, Amortized cost, Unrealized gains	0	5
Due within one year , Amortized cost, Unrealized losses	(340)	(27)
Due in one year or less, Fair value	$ 109,248	$ 131,251

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Commitments and Contingencies - Additional Information (Details) $ in Thousands			1 Months Ended					3 Months Ended		12 Months Ended
	Jan. 21, 2022 ft² $ / ft²	Apr. 30, 2021 ft² $ / ft²	Mar. 31, 2021 USD ($) ft² $ / ft²	Feb. 29, 2020 Milestone	Jan. 31, 2020 Milestone	May 31, 2012 USD ($)	Mar. 31, 2011 USD ($)	Mar. 31, 2022 USD ($) ft² Milestone $ / ft²	Mar. 31, 2021 USD ($) ft²	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)	Dec. 31, 2019	Apr. 01, 2021 USD ($)	Feb. 01, 2020 USD ($)
Commitments And Contingencies [Line Items]
Restricted cash								$ 261		$ 261
Operating lease liability remeasurement amount														$ 400
Security deposit								400		400
Right of use assets, net								6,021		6,453
Present value of lease liabilities								6,978
Sublicense income								0	$ 0
Impairment loss on right-of-use assets								0	677
Contingency reserves for litigation								$ 0
PureTech Health
Commitments And Contingencies [Line Items]
Sublicense payment										100
Milestone payments											$ 2,000
Intellectual Property License Agreement | Eli Lilly and Company
Commitments And Contingencies [Line Items]
Upfront payment						$ 100
Royalty expiration term						6 years
Number of milestones reached | Milestone								0
Milestone payments								$ 0
License agreement term								15 years
Patent License | PureTech Health
Commitments And Contingencies [Line Items]
Expenses incurred								$ 0	0
Outstanding liabilities								$ 0		0
Maximum | Intellectual Property License Agreement | Eli Lilly and Company
Commitments And Contingencies [Line Items]
Contingent milestone payments payable						$ 16,000
Commercial milestone payments payable						$ 54,000
Maximum | Patent License | PureTech Health
Commitments And Contingencies [Line Items]
Contingent milestone payments payable							$ 10,000
Percentage of royalties payable on income from sublicensee, excluding royalties							25.00%
Minimum | Patent License | PureTech Health
Commitments And Contingencies [Line Items]
Percentage of royalties payable on income from sublicensee, excluding royalties							15.00%
Office Space
Commitments And Contingencies [Line Items]
Right of use assets, net			$ 1,300						1,300
Right of use assets, gross			$ 2,000						2,000
Impairment loss on right-of-use assets									$ 700
Office Space | Massachusetts
Commitments And Contingencies [Line Items]
No. of square feet acquired | Milestone					4,175			7,050
Lease commencement period								2018-12
Lease expiration period								2023-12				2023-02
Restricted cash								$ 200		$ 200
Leasehold incentives								100
Office Space | Boston, Massachusetts
Commitments And Contingencies [Line Items]
Sublease area of office space | ft²			25,445						25,445
Sublease commencement date			Apr. 01, 2021
Sublease Expiring Date			Dec. 31, 2025
Sublease, initial fixed rental amount per rentable square foot of premises per annum | $ / ft²			60
Sublease, initial fixed rental increase amount per rentable square foot each year | $ / ft²			1
Base rent, first rent due date			Jul. 01, 2021
Monthly installment of base rental								100
Security deposit								400
Right of use assets, net													$ 6,200
Present value of lease liabilities													$ 6,000
Office Space And Furniture | Carmel, Indiana
Commitments And Contingencies [Line Items]
No. of square feet acquired | Milestone				5,050
Lease commencement period				2020-06
Lease expiration period				2023-07
Headquarters | Boston, Massachusetts | Other Non-Current Liabilities
Commitments And Contingencies [Line Items]
Security deposit liability								$ 100
Headquarters | Arch Street Boston
Commitments And Contingencies [Line Items]
Sublease commencement date								Jul. 01, 2021
Sublease square feet | ft²								7,050
Lease expiration date								Dec. 31, 2023
Sublease, initial fixed rental income per rentable square foot of premises per annum | $ / ft²								59
Sublease, initial fixed rental income increase rate per rentable square foot each year								2.00%
Premises
Commitments And Contingencies [Line Items]
Sublease commencement date	Feb. 07, 2022	Jun. 01, 2021
Sublease square feet | ft²	2,422	1,751
Lease expiration date	Dec. 31, 2023	Dec. 31, 2023
Sublease, initial fixed rental income per rentable square foot of premises per annum | $ / ft²	45	61
Sublease, initial fixed rental income increase rate per rentable square foot each year		2.00%

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Commitments and Contingencies - Components of Lease Cost (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Lease Cost
Operating lease cost	$ 538	$ 207
Short-term lease cost	0	0
Sublease income	(139)	0
Total lease cost	399	207
Cash paid for amounts included in the measurement of lease liabilities	$ 631	$ 244
Weighted-average remaining lease term	3 years 3 months 10 days	2 years 8 months 8 days
Weighted-average discount rate	5.89%	6.21%

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Commitments and Contingencies - Schedule of Maturity Analysis of Annual Undiscounted Cash Flows of Operating Lease Liabilities and Reconciliation to Present Value of Lease Liabilities (Details) $ in Thousands	Mar. 31, 2022 USD ($)
Commitments and Contingencies Disclosure [Abstract]
December 31, 2022	$ 1,916
December 31, 2023	2,520
December 31, 2024	1,597
December 31, 2025	1,622
Total future minimum lease payments	7,655
Less imputed interest	(677)
Present value of lease liabilities	$ 6,978

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Commitments and Contingencies - Summary of Annual Undiscounted Cash Flows To Be Received from Subleases (Details) $ in Thousands	Mar. 31, 2022 USD ($)
Commitments and Contingencies Disclosure [Abstract]
December 31, 2022	$ 477
December 31, 2023	648
Total future sublease payments to be received	$ 1,125

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401(k) Savings Plan - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Retirement Benefits [Abstract]
Defined contribution plan, plan name	401(k)
Total contribution expense	$ 0.4	$ 0.2