Here are 1-3 brief analogies for Spruce Biosciences:

• Think of them as a Vertex Pharmaceuticals, but focused on rare endocrine disorders like CAH instead of cystic fibrosis.
• Like an early-stage Amgen or Gilead Sciences, but hyper-focused on developing novel treatments for specific hormonal imbalances.

• Tildacerfont: A non-steroidal therapy in clinical trials for multiple rare endocrine disorders, including congenital adrenal hyperplasia (CAH) in adult and pediatric patients, and polycystic ovary syndrome (PCOS) in females.

Spruce Biosciences (SPRB) is a biopharmaceutical company primarily engaged in the research and development of novel therapies for rare endocrine disorders. Its main drug candidate, tildacerfont, is currently in Phase 2b and Phase 2 clinical trials. As the company's product is still in clinical development and has not yet received regulatory approval for commercialization, Spruce Biosciences does not currently have major customers for its therapeutic products.

While the company has a license agreement with Eli Lilly and Company for research, development, and commercialization of other compounds, this represents a partnership or collaboration for intellectual property and development rather than Eli Lilly being a direct customer for Spruce Biosciences' primary commercial products.

Javier Szwarcberg, M.D., M.P.H. Chief Executive Officer

Dr. Szwarcberg was appointed Chief Executive Officer in January 2022. He brings over 18 years of leadership experience in the biotechnology and pharmaceutical industries. Dr. Szwarcberg previously served as Group Vice President and Head of Program and Portfolio Development for BioMarin Pharmaceuticals. His prior roles also include Senior Vice President, Head of Program and Portfolio Management at Ultragenyx Pharmaceutical, and Vice President of R&D and Business Development at Horizon Pharma. He is currently a scientific advisor to Abalone Bio.

Samir Gharib, M.B.A. President and Chief Financial Officer

Mr. Gharib has served as Chief Financial Officer since May 2020 and was promoted to President in January 2022. He has been instrumental in the company's capital raises, having raised nearly $1 billion from private and public capital markets, including two IPOs. Prior to joining Spruce Biosciences, Mr. Gharib was the Chief Financial Officer of Stemedica Cell Technologies, Inc. He also held executive finance roles at Revance Therapeutics, Inc. and Talon Therapeutics, Inc. Mr. Gharib began his career in the Audit and Advisory practice at KPMG LLP.

Michael Grey Executive Chairman of the Board

Mr. Grey possesses over 45 years of experience in the pharmaceutical and biotechnology industries. He has served as Executive Chairman of the Spruce Board since 2017 and as Interim Chief Executive Officer from November 2021 to January 2022. Mr. Grey has founded several biotechnology companies, including Lumena Pharmaceuticals, Inc., where he was President and CEO until its acquisition by Shire Plc. He also previously served as President and CEO of Auspex Pharmaceuticals, Inc., and was President and CEO of SGX Pharmaceuticals, Inc. until its acquisition by Eli Lilly in 2008. Additionally, he was President and CEO of Trega Biosciences, Inc. until its acquisition by Lion Bioscience in 2001. Mr. Grey is a venture partner at Pappas Capital and currently serves as chairman or executive chair of Mirum Pharmaceuticals, Inc., Plexium, Inc., Reneo Pharmaceuticals, Inc., and Theolytics Ltd.

Kirk Ways, M.D., Ph.D. Chief Medical Officer

Dr. Ways is an experienced endocrinologist with more than 30 years of pharmaceutical drug discovery and development experience. He serves as the Chief Medical Officer and is also a member of the company's Board of Directors.

Dasharatha Reddy, Ph.D. Vice President, Pharmaceutical Development and Manufacturing

Dr. Reddy was appointed Vice President, Pharmaceutical Development and Manufacturing in May 2020. Before joining Spruce Biosciences, he was the Head of CMC at Landos Biopharma. His career also includes positions in product and pharmaceutical development and manufacturing at Reviva Pharmaceuticals, Teikoku Pharma USA, Spectrum Pharmaceuticals, and Relypsa Inc.

1. Clinical Development and Product Pipeline Concentration Risk: Spruce Biosciences faces substantial risk associated with its drug development pipeline. The company's previous lead product candidate, tildacerfont, which was in Phase 2b clinical trials for congenital adrenal hyperplasia (CAH), failed to meet its primary efficacy endpoints in both adult and pediatric studies in 2024 and has since been trimmed from the pipeline, leaving its future direction uncertain. This highlights the high risk inherent in clinical trials. The company's current prospects are now heavily concentrated on tralesinidase alfa (TA-ERT) for Sanfilippo Syndrome Type B (MPS IIIB). While TA-ERT has received FDA Breakthrough Therapy Designation and shows promising long-term data for biomarker normalization and cognitive stabilization, its Biologics License Application (BLA) submission has been delayed to late 2026. The success or failure of this single, critical program will largely determine the company's future.
2. Significant Financial Distress and Going Concern Risk: Spruce Biosciences is in a challenging financial position, characterized by negative margins, substantial losses (EPS of -85.91), and a low Piotroski F-Score of 1, indicating poor business operations. The company's Altman Z-Score of -23.26 places it within the distress zone, suggesting a high risk of bankruptcy. As of March 2026, the company has explicitly stated substantial doubt about its ability to continue as a going concern and acknowledges that it lacks sufficient working capital for the next twelve months without securing new funding. The need to raise additional capital to fund manufacturing and commercialization plans is a critical and immediate risk.
3. Regulatory Approval and Commercialization Risk for TA-ERT: Despite TA-ERT receiving Breakthrough Therapy Designation, which is intended to expedite development and review, there is no guarantee of regulatory approval. Even if approved, Spruce Biosciences will face significant challenges in successfully commercializing a therapy for an ultra-rare disease like MPS IIIB, particularly given its precarious financial situation and the need for specialized market access and distribution strategies. Any further delays in the BLA submission or unforeseen hurdles in the approval process could severely impact the company's viability.

Polycystic Ovary Syndrome (PCOS)

Congenital Adrenal Hyperplasia (CAH) (Adult and Pediatric Classic)

Spruce Biosciences (SPRB) is expected to drive future revenue growth over the next 2-3 years through the following key areas:

1. Advancement of Tildacerfont for Polycystic Ovary Syndrome (PCOS): Following positive Phase 2 POWER study results for tildacerfont in PCOS, which demonstrated significant reductions in DHEAS and increases in SHBG, Spruce Biosciences is evaluating strategic collaboration opportunities. A successful collaboration or further internal development of tildacerfont for PCOS could lead to upfront payments, development milestones, and eventual commercialization revenue from a market with significant unmet medical need.

2. Milestone Payments and Royalties from Kaken Pharmaceutical Collaboration: Spruce Biosciences has an exclusive licensing agreement with Kaken Pharmaceutical for the development and commercialization of tildacerfont for congenital adrenal hyperplasia (CAH) in Japan. This agreement includes an upfront payment received by Spruce, and potential future revenue from development and commercial milestones, as well as tiered double-digit royalties on net sales in Japan.

3. Progression of Tildacerfont for Major Depressive Disorder (MDD) through Strategic Collaboration: Spruce Biosciences has partnered with HMNC Brain Health GmbH to develop tildacerfont for MDD, utilizing HMNC's companion diagnostic. HMNC will fund and conduct a Phase 2 proof-of-concept study. The advancement of this program, including potential milestone payments from the collaboration, could contribute to future revenue growth.

Share Repurchases

• Spruce Biosciences has not engaged in any share repurchases, with the share buybacks for SPRB stock reported as $0.00.

Share Issuance

• In October 2025, Spruce Biosciences completed a private placement, issuing approximately 502,181 shares of common stock at $68.00 per share and pre-funded warrants for up to 233,144 shares at $67.99 each, resulting in gross proceeds of approximately $50.0 million.
• On March 9, 2026, the company entered into a new Open Market Sale Agreement with Jefferies for at-the-market issuances of common stock, replacing a previous agreement from 2022.
• The number of issued and outstanding shares increased significantly, from 563,042 as of December 31, 2024, to 1,372,043 as of December 31, 2025.

Inbound Investments

• In October 2025, Spruce Biosciences secured $50.0 million through a private placement financing aimed at advancing its tralesinidase alfa enzyme replacement therapy (TA-ERT) program.
• In January 2026, the company established a loan facility of up to $50 million in growth capital with Avenue Capital Group, with an initial tranche of $15 million fully funded in January 2026. This capital is intended to support the development and potential commercial launch of TA-ERT.

Capital Expenditures

• Research and development (R&D) expenses were $19.5 million for the year ended December 31, 2025, a decrease from $46.4 million in 2024. This reduction was primarily due to the cessation of tildacerfont development activities, offset by increased activities for TA-ERT and the acquisition of SPR202.
• Total operating expenses for the year ended December 31, 2025, were $36.5 million, down from $61.1 million in 2024.