X0202 SCHEDULE 13G 0001855655 XXXXXXXX LIVE Common Stock, $0.001 par value per share 04/17/2026 0000949858 Achieve Life Sciences, Inc. 004468500 22722 29th Drive SE, Suite 100 Bothell WA 98021 Rule 13d-1(c) Paradigm BioCapital Advisors LP b DE 9903712.00 0.00 9903712.00 0.00 9903712.00 N 9.2 PN Paradigm BioCapital Advisors GP LLC b DE 9903712.00 0.00 9903712.00 0.00 9903712.00 N 9.2 OO limited liability company Senai Asefaw, M.D. b X1 9903712.00 0.00 9903712.00 0.00 9903712.00 N 9.2 IN Paradigm BioCapital International Fund Ltd. b E9 8687536.00 0.00 8687536.00 0.00 8687536.00 N 8.1 CO Achieve Life Sciences, Inc. 22722 29th Drive SE, Suite 100, Bothell, WA 98021 This Schedule 13G is filed by the following (the "Reporting Persons"): (1) Paradigm BioCapital Advisors LP (the "Adviser"); (2) Paradigm BioCapital Advisors GP LLC (the "Adviser GP"); (3) Senai Asefaw, M.D. ("Senai Asefaw"); and (4) Paradigm BioCapital International Fund Ltd. (the "Fund"). The Fund is a private investment vehicle. The Fund and one or more separately managed accounts managed by the Adviser (the "Account") directly beneficially own the Common Stock reported in this statement. The Adviser is the investment manager of the Fund and the Account. The Adviser GP is the general partner of the Adviser. Senai Asefaw is the managing member of the Adviser GP. The Adviser, the Adviser GP and Senai Asefaw may be deemed to beneficially own the Common Stock directly beneficially owned by the Fund and the Account. Each Reporting Person disclaims beneficial ownership with respect to any Common Stock other than the Common Stock directly beneficially owned by such Reporting Person. The principal business office of the Fund is c/o Walkers, 190 Elgin Avenue, George Town, Grand Cayman KY1-9001, Cayman Islands. The principal business office of the Adviser, the Adviser GP and Senai Asefaw is 767 Third Avenue, 17th Floor, New York, NY 10017. For citizenship or place of organization see Item 4 of the cover page of each Reporting Person. Y See Item 9 on the cover page for each Reporting Person, and Item 2, which information is given as of the close of business on April 17, 2026. The Fund beneficially owns 4,343,768 shares of Common Stock and an additional 4,343,768 shares of Common Stock underlying warrants that are exercisable within 60 days. The Account beneficially owns 608,088 shares of Common Stock and an additional 608,088 shares of Common Stock underlying warrants that are exercisable within 60 days. See Item 11 on the cover page for each Reporting Person. The percentages of beneficial ownership contained herein are based on: (i) 53,239,988 shares of Common Stock outstanding as of March 24, 2026, as reported by the Issuer in its Form 10-K filed with the SEC on March 24, 2026; plus (ii) an additional 49,418,069 shares of Common Stock issued on April 17, 2026, as reported by the Issuer in its Form 8-K filed with the SEC on April 16, 2026; plus (iii) an additional 4,951,856 shares of Common Stock underlying the warrants disclosed in Item 4(a). See Item 5 on the cover page for each Reporting Person. See Item 6 on the cover page for each Reporting Person. See Item 7 on the cover page for each Reporting Person. See Item 8 on the cover page for each Reporting Person. Y Y Y Y Y N By signing below I certify that, to the best of my knowledge and belief, the securities referred to above were not acquired and are not held for the purpose of or with the effect of changing or influencing the control of the issuer of the securities and were not acquired and are not held in connection with or as a participant in any transaction having that purpose or effect, other than activities solely in connection with a nomination under ?? 240.14a-11. Exhibit 99.1 - Joint Filing Agreement Paradigm BioCapital Advisors LP /s/ David K. Kim 04/24/2026 Paradigm BioCapital Advisors GP LLC /s/ David K. Kim 04/24/2026 Senai Asefaw, M.D. /s/ Senai Asefaw, M.D. 04/24/2026 Paradigm BioCapital International Fund Ltd. /s/ David K. Kim 04/24/2026