Milestone Pharmaceuticals (MIST) 10-Q 10 Aug 22 2022 Q2 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	6 Months Ended
	Jun. 30, 2022	Aug. 10, 2022
Document and Entity Information
Document Type	10-Q
Document Period End Date	Jun. 30, 2022
Document Quarterly Report	true
Document Transition Report	false
Entity File Number	001-38899
Entity Registrant Name	Milestone Pharmaceuticals Inc.
Entity Incorporation, State or Country Code	A8
Entity Tax Identification Number	00-0000000
Entity Address, Address Line One	1111 Dr. Frederik-Philips Boulevard
Entity Address, Address Line Two	Suite 420
Entity Address, City or Town	Montréal
Entity Address, State or Province	QC
Entity Address, Postal Zip Code	H4M 2X6
City Area Code	514
Local Phone Number	336-0444
Title of 12(b) Security	Common Shares
Trading Symbol	MIST
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	true
Entity Ex Transition Period	true
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		30,010,873
Entity Central Index Key	0001408443
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	Q2
Amendment Flag	false

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Jun. 30, 2022	Dec. 31, 2021
Current assets
Cash and cash equivalents	$ 63,237	$ 114,141
Short-term investments	23,000
Research and development tax credits receivable	539	356
Prepaid expenses	3,465	4,299
Other receivables	261	127
Total current assets	90,502	118,923
Operating lease assets	570	711
Property and equipment	227	215
Total assets	91,299	119,849
Current liabilities
Accounts payable and accrued liabilities	4,087	6,551
Operating lease liabilities	169	224
Total current liabilities	4,256	6,775
Operating lease liabilities (net of current portion)	384	474
Total liabilities	4,640	7,249
Shareholders' Equity
Common shares, no par value, unlimited shares authorized 30,005,884 shares issued and outstanding as of June 30, 2022, 29,897,559 shares issued and outstanding as of December 31, 2021	252,236	251,901
Pre-funded warrants - 12,327,780 issued and outstanding as of June 30, 2022 and 12,327,780 as of December 31, 2021	52,941	52,941
Additional paid-in capital	20,090	15,711
Cumulative translation adjustment	(1,634)	(1,634)
Accumulated deficit	(236,974)	(206,319)
Total shareholders' equity	86,659	112,600
Total liabilities and shareholders' equity	$ 91,299	$ 119,849

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares	6 Months Ended	12 Months Ended
	Jun. 30, 2022	Dec. 31, 2021
Condensed Consolidated Balance Sheets
Common shares, par value (in dollars per share)	$ 0	$ 0
Common shares, Shares authorized (in shares)	Unlimited	Unlimited
Common shares, Shares issued (in shares)	30,005,884	29,897,559
Common shares, Shares outstanding (in shares)	30,005,884	29,897,559
Warrants issued	12,327,780	12,327,780
Warrants outstanding	12,327,780	12,327,780

Condensed Consolidated Statemen

Condensed Consolidated Statements of Earnings (Loss) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Condensed Consolidated Statements of Earnings (Loss)
Revenue		$ 15,000		$ 15,000
Operating expenses
Research and development, net of tax credits	$ 10,657	9,427	$ 19,425	18,022
General and administrative	3,918	3,018	7,561	5,651
Commercial	2,231	1,843	3,867	3,209
Earnings (loss) from operations	(16,806)	712	(30,853)	(11,882)
Interest income, net	158	58	198	138
Net earnings (loss)	$ (16,648)	$ 770	$ (30,655)	$ (11,744)
Weighted average number of shares and pre-funded warrants outstanding, basic	42,278,563	41,673,370	42,260,682	41,465,961
Net earnings (loss) per share, basic	$ (0.39)	$ 0.02	$ (0.73)	$ (0.28)
Weighted average number of shares and pre-funded warrants outstanding, diluted	42,278,563	44,530,121	42,260,682	41,465,961
Net earnings (loss) per share, diluted	$ (0.39)	$ 0.02	$ (0.73)	$ (0.28)

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Shareholders' Equity - USD ($) $ in Thousands	Common Shares	Pre-funded warrants	Additional paid-in capital	Cumulative translation adjustment	Accumulated deficit	Total
Increase (Decrease) in Stockholders' Equity and Temporary Equity
Number of warrants		11,417,034
Beginning balance at Dec. 31, 2020	$ 251,682	$ 48,007	$ 8,530	$ (1,634)	$ (163,466)	$ 143,119
Balance at the beginning of period (in shares) at Dec. 31, 2020	29,827,997
Increase (Decrease) in Stockholders' Equity and Temporary Equity
Net (loss) earnings					(11,744)	(11,744)
Exercise of stock options	$ 34		(15)			19
Exercise of stock options (in shares)	18,003
Private placement		$ 4,920				4,920
Private placement (in shares)		910,746
Share-based compensation			3,280			3,280
Ending balance at Jun. 30, 2021	$ 251,716	$ 52,927	11,795	(1,634)	(175,210)	139,594
Balance at the end of period (in shares) at Jun. 30, 2021	29,846,000
Increase (Decrease) in Stockholders' Equity and Temporary Equity
Number of warrants		11,417,034
Beginning balance at Mar. 31, 2021	$ 251,716	$ 48,007	9,883	(1,634)	(175,980)	131,992
Balance at the beginning of period (in shares) at Mar. 31, 2021	29,846,000
Increase (Decrease) in Stockholders' Equity and Temporary Equity
Net (loss) earnings					770	770
Private placement		$ 4,920				4,920
Private placement (in shares)		910,746
Share-based compensation			1,912			1,912
Ending balance at Jun. 30, 2021	$ 251,716	$ 52,927	11,795	(1,634)	(175,210)	$ 139,594
Balance at the end of period (in shares) at Jun. 30, 2021	29,846,000
Increase (Decrease) in Stockholders' Equity and Temporary Equity
Number of warrants		12,327,780
Number of warrants		12,327,780				12,327,780
Beginning balance at Dec. 31, 2021	$ 251,901	$ 52,941	15,711	(1,634)	(206,319)	$ 112,600
Balance at the beginning of period (in shares) at Dec. 31, 2021	29,897,559					29,897,559
Increase (Decrease) in Stockholders' Equity and Temporary Equity
Net (loss) earnings					(30,655)	$ (30,655)
Exercise of stock options	$ 335		(146)			189
Exercise of stock options (in shares)	108,325
Share-based compensation			4,525			4,525
Ending balance at Jun. 30, 2022	$ 252,236	$ 52,941	20,090	(1,634)	(236,974)	$ 86,659
Balance at the end of period (in shares) at Jun. 30, 2022	30,005,884					30,005,884
Increase (Decrease) in Stockholders' Equity and Temporary Equity
Number of warrants		12,327,780
Beginning balance at Mar. 31, 2022	$ 251,990	$ 52,941	17,785	(1,634)	(220,326)	$ 100,756
Balance at the beginning of period (in shares) at Mar. 31, 2022	29,917,326
Increase (Decrease) in Stockholders' Equity and Temporary Equity
Net (loss) earnings					(16,648)	(16,648)
Exercise of stock options	$ 246		(106)			140
Exercise of stock options (in shares)	88,558
Share-based compensation			2,411			2,411
Ending balance at Jun. 30, 2022	$ 252,236	$ 52,941	$ 20,090	$ (1,634)	$ (236,974)	$ 86,659
Balance at the end of period (in shares) at Jun. 30, 2022	30,005,884					30,005,884
Increase (Decrease) in Stockholders' Equity and Temporary Equity
Number of warrants		12,327,780				12,327,780

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021
Cash flows used in operating activities
Net loss	$ (30,655)	$ (11,744)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation of property and equipment	47	46
Share-based compensation expense	4,525	3,280
Changes in operating assets and liabilities:
Other receivables	(134)	(19)
Research and development tax credits receivable	(183)	(178)
Prepaid expenses	834	(2,019)
Operating lease assets and liabilities	(4)	24
Accounts payable and accrued liabilities	(2,464)	(845)
Net cash used in operating activities	(28,034)	(11,455)
Cash provided by (used in) investing activities
Acquisition of property and equipment	(59)
Acquisition of short-term investments	(23,000)
Redemption of short-term investments		32,000
Net cash provided by (used in) investing activities	(23,059)	32,000
Cash provided by financing activities
Proceeds from exercise of options	189	19
Net Proceeds from issuance of pre-funded warrants in a private placement		4,920
Cash provided by financing activities	189	4,939
Net decrease in cash and cash equivalents	(50,904)	25,484
Cash and cash equivalents - Beginning of period	114,141	72,310
Cash and cash equivalents - End of period	$ 63,237	$ 97,794

Organization and Nature of Oper

Organization and Nature of Operations	6 Months Ended
	Jun. 30, 2022
Organization and Nature of Operations
Organization and Nature of Operations	1 Organization and Nature of Operations Milestone Pharmaceuticals Inc. (Milestone or the Company) is a biopharmaceutical company incorporated under the Business Corporations Act

Summary of Significant Accounti

Summary of Significant Accounting Policies	6 Months Ended
	Jun. 30, 2022
Summary of Significant Accounting Policies
Summary of Significant Accounting Policies	2 Summary of Significant Accounting Policies a) Basis of Consolidation The consolidated financial statements include the accounts of the Company and Milestone Pharmaceuticals USA, Inc. All intercompany transactions and balances have been eliminated. b) Basis of presentation and use of accounting estimates and significant accounting policies These unaudited interim condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (US GAAP) and on a basis consistent with those accounting principles followed by the Company and disclosed in Note 2 of its most recent annual consolidated financial statements. Certain information, in particular the accompanying notes normally included in the annual financial statements prepared in accordance with US GAAP have been omitted or condensed. Accordingly, the unaudited interim condensed consolidated financial statements do not include all the information required for full annual financial statements, and therefore, should be read in conjunction with the annual consolidated financial statements and the notes thereto for the year ended December 31, 2021. In the opinion of the Company's management, the accompanying unaudited interim condensed consolidated financial statements contain all adjustments, consisting of only normal recurring adjustments, necessary for a fair statement of its balance sheet as of June 30, 2022, and its statements of earnings (loss), shareholders’ equity for the three and six months ended June 30, 2022 and 2021 and its statement of cash flows for the six months ended June 30, 2022 and 2021. The condensed consolidated balance sheet as of December 31, 2021, was derived from audited annual consolidated financial statements, but does not contain all the footnote disclosures required by accounting principles generally accepted in the United States of America. These unaudited interim condensed consolidated financial statements are presented in US dollars, which is the Company’s functional currency. The preparation of unaudited interim condensed consolidated financial statements in conformity with US GAAP requires the Company to make estimates and judgments that affect certain reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the consolidated financial statements and the reported amounts of revenue and expenses during the period. The Company bases its estimates and assumptions on current facts, historical experience and various other factors that it believes are reasonable under the circumstances, to determine the carrying values of assets and liabilities that are not readily apparent from other sources. Significant estimates and judgments include, but are not limited to, ● Estimates of the percentage of work completed of the total work over the life of an individual clinical trial in accordance with agreements established with contracted research organizations (“CRO”), contracted manufacturing organizations (“CMO”) and clinical trial sites which in turn impact the research & development expenses. ● Estimate of the grant date fair value share options granted to employees, consultants and directors, and the resulting share-based compensation expense, using the Black-Scholes option-pricing model. c) Significant Risks and Uncertainties The ongoing COVID-19 pandemic has had an impact on the Company’s business, operations and clinical development timelines. The pandemic has resulted in many state, local and foreign governments implementing, and making adjustments to, various orders and restrictions in order to control the spread of the disease, which have impacted patient recruitment, enrollment and follow-up visits at clinical sites The Company will continue to evaluate the COVID-19 pandemic impact on the development timelines of its clinical programs. Estimates and assumptions about future events and their effects cannot be determined with certainty and therefore require the exercise of judgment. As of the date of issuance of these consolidated financial statements, the Company is not aware of any specific event or circumstance that would require the Company to update its estimates, assumptions and judgments. These estimates may change as new events occur and additional information is obtained and are recognized in the consolidated financial statements as soon as they become known. Actual results could differ from those estimates and any such differences may be material to the Company’s unaudited interim condensed consolidated financial statements. ​ In addition, the Company is subject to other challenges and risks specific to its business and its ability to execute on its strategy, as well as risks and uncertainties common to companies in the pharmaceutical industry, including, without limitation, risks and uncertainties associated with: obtaining regulatory approval of its product candidate; delays or problems in the supply of its study drug or failure to comply with manufacturing regulations; identifying, acquiring or in-licensing product candidates; pharmaceutical product development and the inherent uncertainty of clinical success; and the challenges of protecting and enhancing its intellectual property rights; and complying with applicable regulatory requirements. ​ d) Recent Accounting Pronouncements ​ The Company has considered recent accounting pronouncements and concluded that they are either not applicable to the business or that the effect is not expected to be material to the unaudited condensed consolidated financial statements as a result of future adoption. ​ e) Sources of Liquidity and Funding Requirements The Company incurred operating losses and has experienced negative operating cash flows since its inception and anticipates to continue to incur losses for at least the next several years. As of June 30, 2022, the Company had cash, cash equivalents and short-term investments of $86.2 million and an accumulated deficit of $237.0 million. Management has evaluated the Company’s current operating plan against our existing cash and cash equivalents and access to potential financing sources and determined that we expect to be able to support our ongoing operations for at least the next twelve months from the date of issuance of this quarterly report on Form 10-Q. ​

Revenues

Revenues	6 Months Ended
	Jun. 30, 2022
Revenues
Revenues	3 Revenues For the quarter ended June 30, 2022, the Company has not recognized any revenue. During the quarter ended June 30, 2021, the Company recognized revenue of $15 million, in the form of a non-refundable upfront cash payment in connection with a license agreement ​

Short-term Investments

Short-term Investments	6 Months Ended
	Jun. 30, 2022
Short-term Investments
Short-term Investments	4 Short-term Investments Short term investments are classified as held-to-maturity, are initially recognized at fair value and are subsequently accounted for at amortized cost. They are comprised of guaranteed investment certificates with a maturity greater than 90 days but less than one year and, as such, are classified as current assets.

Accounts Payable and Accrued Li

Accounts Payable and Accrued Liabilities	6 Months Ended
	Jun. 30, 2022
Accounts Payable and Accrued Liabilities
Accounts Payable and Accrued Liabilities	5 Accounts Payable and Accrued Liabilities Accounts payable and accrued liabilities are comprised of the following: ​ ​ ​ ​ ​ ​ ​ ​ ​ June 30, 2022 ​ December 31, 2021 Trade accounts payable $ 1,507 ​ $ 4,384 Accrued compensation and benefits payable ​ 527 ​ ​ 1,458 Accrued research and development liabilities ​ 964 ​ ​ 272 Other accrued liabilities ​ 1,089 ​ ​ 437 Total $ 4,087 ​ $ 6,551 ​

Shareholders' equity

Shareholders' equity	6 Months Ended
	Jun. 30, 2022
Shareholders' equity
Shareholders' equity	6 Authorized Share Capital The Company has authorized and issued common shares, voting and participating, without par value, of which unlimited shares were authorized and 30,005,884 shares were issued and outstanding ​ As of June 30, 2022, there were 1,121,076 common shares available for issuance under the Employee Stock Purchase Plans and no common shares have been issued under such plan. ​ Additional Paid-in Capital ​ The additional paid-in capital balances were as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three months ended June 30, ​ Six months ended June 30, ​ ​ ​ 2022 2021 ​ 2022 2021 ​ Opening balance ​ $ 17,785 $ 9,883 ​ $ 15,711 $ 8,530 ​ Share-based compensation expense ​ ​ 2,411 ​ 1,912 ​ ​ 4,525 ​ 3,280 ​ Exercise of stock options ​ ​ (106) ​ — ​ ​ (146) ​ (15) ​ Closing balance ​ $ 20,090 $ 11,795 ​ $ 20,090 $ 11,795 ​ ​ ​

Share Based Compensation

Share Based Compensation	6 Months Ended
	Jun. 30, 2022
Share Based Compensation
Share Based Compensation	7 Share Based Compensation Under the Company’s 2019 Equity Incentive Plan (the 2019 Plan) and the Company’s Stock Option Plan (the 2011 Plan), unless otherwise decided by the Board of Directors, options vest and are exercisable as follows: 25% vest one thirty-sixth th anniversary On January 1, 2022, the number of the Company’s common shares reserved for issuance under the 2019 Plan increased by 1,195,902 common shares. In addition, 125,127 options have been forfeited under the 2011 Plan since the adoption of the 2019 Plan and have become available for issuance under the 2019 Plan. As of June 30, 2022, there were 5,811,310 shares available for issuance under the 2019 Plan, of which 660,669 shares were available for future grants. On November 10, 2021, the Company established a 2021 Inducement Plan through the granting of awards. This 2021 Inducement Plan is intended to help the Company provide an inducement material for certain individuals to enter into employment with the Company, incentives for such persons to exert maximum efforts for the success of the Company and provide a means by which employees may benefit from increases in value of the common shares. There were 523,000 options granted and outstanding Beginning July 15, 2022, the Company will begin to offer an ESPP (“Employee Stock Purchase Plan”), in which participation will be available to substantially all of our employees in the United States and Canada who meet certain service eligibility requirements. As of June 30, 2022, the Company has 1,121,076 shares available under the ESPP with no shares issued under this plan. The total outstanding and exercisable options from the 2011 Plan, 2019 Plan and Inducement Plan as of June 30 were as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 2022 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted ​ ​ Number ​ ​ ​ average ​ ​ of shares ​ ​ ​ exercise ​ 2019 Plan Inducement Plan ​ 2011 Plan Total price Outstanding at beginning of year - 2011 Plan $ — ​ — $ 1,995,971 1,995,971 $ 2.07 Outstanding at beginning of year - 2019 Plan ​ ​ 3,759,834 ​ — ​ ​ — ​ 3,759,834 ​ ​ 9.51 Granted - 2019 Plan ​ ​ 1,385,700 ​ — ​ ​ — ​ 1,385,700 ​ ​ 5.47 Granted - Inducement Plan ​ ​ — ​ 523,000 ​ ​ — ​ 523,000 ​ ​ 6.37 Expired - 2011 Plan ​ ​ — ​ — ​ ​ (1,121) ​ (1,121) ​ ​ 0.96 Exercised - 2011 Plan ​ ​ — ​ — ​ ​ (94,225) ​ (94,225) ​ ​ 1.43 Exercised - 2019 Plan ​ ​ (14,100) ​ — ​ ​ — ​ (14,100) ​ ​ 3.76 Cancelled - 2011 Plan ​ ​ — ​ — ​ ​ (19,387) ​ (19,387) ​ ​ 9.42 Cancelled - 2019 Plan ​ ​ (13,893) ​ — ​ ​ — ​ (13,893) ​ ​ 13.36 Outstanding at end of period $ 5,117,541 ​ 523,000 ​ ​ 1,881,238 ​ 7,521,779 ​ $ 6.68 Outstanding at end of period - Weighted average exercise price ​ $ 8.42 ​ 6.37 ​ $ 2.03 ​ ​ ​ ​ ​ Exercisable at end of period ​ ​ 2,017,527 ​ — ​ ​ 1,796,396 ​ 3,813,923 ​ $ 6.09 Exercisable at end of period - Weighted average exercise price $ 9.74 ​ — ​ $ 1.99 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 2021 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted ​ ​ Number ​ ​ ​ average ​ ​ of shares ​ ​ ​ exercise ​ ​ 2019 Plan Inducement Plan ​ 2011 Plan Total price Outstanding at beginning of year - 2011 Plan $ — ​ — ​ $ 2,080,097 ​ 2,080,097 ​ $ 2.15 Outstanding at beginning of year - 2019 Plan ​ 1,706,190 ​ — ​ ​ — ​ 1,706,190 ​ ​ 13.55 Granted - 2019 Plan ​ ​ 1,863,950 ​ — ​ ​ — ​ 1,863,950 ​ ​ 6.31 Exercised - 2011 Plan ​ ​ — ​ — ​ ​ (16,753) ​ (16,753) ​ ​ 0.88 Exercised - 2019 Plan ​ ​ (1,250) ​ — ​ ​ — ​ (1,250) ​ ​ 3.74 Outstanding at end of period ​ ​ 3,568,890 ​ — ​ ​ 2,063,344 ​ 5,632,234 ​ $ 6.99 Outstanding at end of period - Weighted average exercise price ​ $ 9.77 ​ — ​ $ 2.16 ​ ​ ​ ​ ​ Exercisable at end of period ​ ​ 591,885 ​ — ​ ​ 1,613,229 ​ 2,205,114 ​ $ 4.86 Exercisable at end of period - Weighted average exercise price ​ $ 12.55 ​ — ​ $ 2.05 ​ ​ ​ ​ ​ ​ The weighted average remaining contractual life was 8.1 and 8.3 years for outstanding options as of June 30, 2022 and 2021, respectively. The weighted average remaining contractual life was 6.9 and 7.0 years for vested options, as of June 30, 2022 and 2021, respectively. There was $19.0 million and $19.4 million total unrecognized compensation cost related to non-vested share options as of June 30, 2022 and 2021, respectively. The share options are expected to be recognized over a remaining weighted average vesting period of 2.7 years and 2.8 years as of June 30, 2022 and 2021, respectively. Options granted are valued using the Black-Scholes option pricing model. Amortization of the fair value of the options over vesting years has been expensed and credited to additional paid-in capital in shareholders’ equity. The non-vested options as of June 30 were as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 2022 ​ ​ Number ​ ​ ​ Weighted ​ ​ of options ​ ​ ​ average ​ ​ 2019 Plan Inducement Plan 2011 Plan Total fair value Non-vested share options at beginning of year - 2011 Plan — ​ ​ — ​ ​ 200,639 ​ 200,639 $ 1.86 Non-vested share options at beginning of year - 2019 Plan ​ ​ 2,665,518 ​ ​ — ​ ​ — ​ 2,665,518 ​ 6.39 Granted - 2019 Plan ​ 1,385,700 ​ ​ — ​ ​ — ​ 1,385,700 ​ ​ 4.13 Granted - Inducement Plan ​ ​ — ​ ​ 523,000 ​ ​ — ​ 523,000 ​ ​ 4.81 Vested, outstanding 2011 Plan ​ ​ — ​ ​ — ​ ​ (115,797) ​ (115,797) ​ 1.75 Vested, outstanding 2019 Plan ​ ​ (942,473) ​ ​ — ​ ​ — ​ (942,473) ​ ​ 5.63 Forfeited - 2019 Plan ​ ​ (8,731) ​ ​ — ​ ​ — ​ (8,731) ​ ​ 6.27 Non-vested share options at end of period ​ 3,100,014 ​ ​ 523,000 ​ ​ 84,842 ​ 3,707,856 $ 5.42 Non-vested share options at end of period - Weighted average fair value ​ $ 5.62 ​ $ — ​ $ 2.01 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 2021 ​ ​ Number ​ ​ ​ Weighted ​ ​ of options ​ ​ ​ average ​ 2019 Plan Inducement Plan 2011 Plan Total fair value Non-vested share options at beginning of year - 2011 Plan ​ — ​ ​ — ​ ​ 543,192 ​ 543,192 $ 1.81 Non-vested share options at beginning of year - 2019 Plan ​ ​ 1,438,026 ​ ​ — ​ ​ — ​ 1,438,026 ​ 10.28 Granted - 2019 Plan ​ 1,863,950 ​ ​ — ​ ​ — ​ 1,863,950 ​ ​ 4.79 Vested, outstanding 2011 Plan ​ ​ — ​ ​ — ​ ​ (93,087) ​ (93,087) ​ 1.61 Vested, outstanding 2019 Plan ​ ​ (324,971) ​ ​ — ​ ​ — ​ (324,971) ​ ​ 11.38 Non-vested share options at end of period ​ 2,977,005 ​ ​ — ​ ​ 450,105 ​ 3,427,110 $ 6.08 Non-vested share options at end of period - Weighted average fair value ​ $ 6.72 ​ $ — ​ $ 1.85 ​ ​ ​ ​ ​ ​ There were 523,000 options granted, outstanding ​ The fair value of share-based payment transaction is measured using Black-Scholes valuation model. This model also requires assumptions, including expected option life, volatility, risk-free interest rate and dividend yield, which greatly affect the calculated values. ​ The fair value of options granted for the 2011 Plan, 2019 Plan and 2021 Inducement Plan were estimated using the Black-Scholes option pricing model, resulting in the following weighted average assumptions for the options granted: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three months ended June 30, ​ ​ Six months ended June 30, ​ ​ 2022 2021 ​ 2022 2021 Exercise price $ 6.21 $ 5.56 ​ ​ $ 5.72 $ 6.24 ​ Share price $ 6.21 $ 5.56 ​ ​ $ 5.72 $ 6.24 ​ Volatility 91 % ​ 92 % ​ 91 % ​ 94 % Risk-free interest rate 2.72 % ​ 0.86 % ​ 2.31 % ​ 1.04 % Expected life 6.08 ​ 5.32 ​ ​ 6.08 ​ 6.01 ​ Dividend 0 % ​ 0 % ​ 0 % ​ 0 % ​ ​ Expected volatility is determined using comparable companies for which the information is publicly available. The risk-free interest rate is determined based on the U.S. sovereign rates benchmark in effect at the time of grant with a remaining term equal to the expected life of the option. Expected option life is determined based on the simplified method as the Company does not have sufficient historical exercise data to provide a reasonable basis upon which to estimate expected term. The simplified method is an average of the contractual term of the options and its ordinary vesting period. Dividend yield is based on the share option’s exercise price and expected annual dividend rate at the time of grant. ​ The Company recognized share-based compensation expense as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three months ended June 30, ​ Six months ended June 30, ​ ​ 2022 2021 ​ 2022 2021 Administration $ 880 ​ $ 750 ​ $ 1,792 $ 1,323 ​ Research and development ​ 1,105 ​ ​ 825 ​ ​ 1,953 ​ 1,405 ​ Commercial activities ​ 426 ​ ​ 337 ​ ​ 780 ​ 552 ​ Total $ 2,411 ​ $ 1,912 ​ $ 4,525 $ 3,280 ​ ​

Net Loss Per Share

Net Loss Per Share	6 Months Ended
	Jun. 30, 2022
Net Loss Per Share
Net Loss Per Share	8 Basic net loss per common share is determined by dividing net loss applicable to common shareholders by the weighted average number of common shares and pre-funded warrants outstanding during the period. For the six months ended June 30, 2022 and 2021, the Company was in a net loss position. Dilutive net loss per common share is determined by dividing net loss applicable to common shareholders by the weighted average number of common shares and shares issuable upon exercise of pre-funded warrants outstanding during the period. The following potentially dilutive securities have been excluded from the computation of diluted weighted average shares outstanding as of June 30, as they would be anti-dilutive: ​ ​ ​ ​ ​ ​ ​ 2022 2021 Share options 7,521,779 5,819,524 ​ Amounts above reflect the common share equivalents of the noted instruments. ​

Summary of significant accoun_2

Summary of significant accounting policies (Policies)	6 Months Ended
	Jun. 30, 2022
Summary of Significant Accounting Policies
Basis of consolidation	a) Basis of Consolidation The consolidated financial statements include the accounts of the Company and Milestone Pharmaceuticals USA, Inc. All intercompany transactions and balances have been eliminated.
Basis of presentation and use of accounting estimates and significant accounting policies	b) Basis of presentation and use of accounting estimates and significant accounting policies These unaudited interim condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (US GAAP) and on a basis consistent with those accounting principles followed by the Company and disclosed in Note 2 of its most recent annual consolidated financial statements. Certain information, in particular the accompanying notes normally included in the annual financial statements prepared in accordance with US GAAP have been omitted or condensed. Accordingly, the unaudited interim condensed consolidated financial statements do not include all the information required for full annual financial statements, and therefore, should be read in conjunction with the annual consolidated financial statements and the notes thereto for the year ended December 31, 2021. In the opinion of the Company's management, the accompanying unaudited interim condensed consolidated financial statements contain all adjustments, consisting of only normal recurring adjustments, necessary for a fair statement of its balance sheet as of June 30, 2022, and its statements of earnings (loss), shareholders’ equity for the three and six months ended June 30, 2022 and 2021 and its statement of cash flows for the six months ended June 30, 2022 and 2021. The condensed consolidated balance sheet as of December 31, 2021, was derived from audited annual consolidated financial statements, but does not contain all the footnote disclosures required by accounting principles generally accepted in the United States of America. These unaudited interim condensed consolidated financial statements are presented in US dollars, which is the Company’s functional currency. The preparation of unaudited interim condensed consolidated financial statements in conformity with US GAAP requires the Company to make estimates and judgments that affect certain reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the consolidated financial statements and the reported amounts of revenue and expenses during the period. The Company bases its estimates and assumptions on current facts, historical experience and various other factors that it believes are reasonable under the circumstances, to determine the carrying values of assets and liabilities that are not readily apparent from other sources. Significant estimates and judgments include, but are not limited to, ● Estimates of the percentage of work completed of the total work over the life of an individual clinical trial in accordance with agreements established with contracted research organizations (“CRO”), contracted manufacturing organizations (“CMO”) and clinical trial sites which in turn impact the research & development expenses. ● Estimate of the grant date fair value share options granted to employees, consultants and directors, and the resulting share-based compensation expense, using the Black-Scholes option-pricing model.
Significant Risks and Uncertainties	c) Significant Risks and Uncertainties The ongoing COVID-19 pandemic has had an impact on the Company’s business, operations and clinical development timelines. The pandemic has resulted in many state, local and foreign governments implementing, and making adjustments to, various orders and restrictions in order to control the spread of the disease, which have impacted patient recruitment, enrollment and follow-up visits at clinical sites The Company will continue to evaluate the COVID-19 pandemic impact on the development timelines of its clinical programs. Estimates and assumptions about future events and their effects cannot be determined with certainty and therefore require the exercise of judgment. As of the date of issuance of these consolidated financial statements, the Company is not aware of any specific event or circumstance that would require the Company to update its estimates, assumptions and judgments. These estimates may change as new events occur and additional information is obtained and are recognized in the consolidated financial statements as soon as they become known. Actual results could differ from those estimates and any such differences may be material to the Company’s unaudited interim condensed consolidated financial statements. ​ In addition, the Company is subject to other challenges and risks specific to its business and its ability to execute on its strategy, as well as risks and uncertainties common to companies in the pharmaceutical industry, including, without limitation, risks and uncertainties associated with: obtaining regulatory approval of its product candidate; delays or problems in the supply of its study drug or failure to comply with manufacturing regulations; identifying, acquiring or in-licensing product candidates; pharmaceutical product development and the inherent uncertainty of clinical success; and the challenges of protecting and enhancing its intellectual property rights; and complying with applicable regulatory requirements.
Recent Accounting Pronouncements	d) Recent Accounting Pronouncements ​ The Company has considered recent accounting pronouncements and concluded that they are either not applicable to the business or that the effect is not expected to be material to the unaudited condensed consolidated financial statements as a result of future adoption.
Sources of Liquidity and Funding Requirements	e) Sources of Liquidity and Funding Requirements The Company incurred operating losses and has experienced negative operating cash flows since its inception and anticipates to continue to incur losses for at least the next several years. As of June 30, 2022, the Company had cash, cash equivalents and short-term investments of $86.2 million and an accumulated deficit of $237.0 million. Management has evaluated the Company’s current operating plan against our existing cash and cash equivalents and access to potential financing sources and determined that we expect to be able to support our ongoing operations for at least the next twelve months from the date of issuance of this quarterly report on Form 10-Q.

Accounts payable and accrued _2

Accounts payable and accrued liabilities (Tables)	6 Months Ended
	Jun. 30, 2022
Accounts Payable and Accrued Liabilities
Schedule of accounts payable and accrued liabilities	​ ​ ​ ​ ​ ​ ​ ​ ​ June 30, 2022 ​ December 31, 2021 Trade accounts payable $ 1,507 ​ $ 4,384 Accrued compensation and benefits payable ​ 527 ​ ​ 1,458 Accrued research and development liabilities ​ 964 ​ ​ 272 Other accrued liabilities ​ 1,089 ​ ​ 437 Total $ 4,087 ​ $ 6,551

Shareholders' Equity (Tables)

Shareholders' Equity (Tables)	6 Months Ended
	Jun. 30, 2022
Shareholders' equity
Schedule of additional paid-in capital	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three months ended June 30, ​ Six months ended June 30, ​ ​ ​ 2022 2021 ​ 2022 2021 ​ Opening balance ​ $ 17,785 $ 9,883 ​ $ 15,711 $ 8,530 ​ Share-based compensation expense ​ ​ 2,411 ​ 1,912 ​ ​ 4,525 ​ 3,280 ​ Exercise of stock options ​ ​ (106) ​ — ​ ​ (146) ​ (15) ​ Closing balance ​ $ 20,090 $ 11,795 ​ $ 20,090 $ 11,795 ​

Share Based Compensation (Table

Share Based Compensation (Tables)	6 Months Ended
	Jun. 30, 2022
Share Based Compensation
Schedule of outstanding and exercisable options	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 2022 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted ​ ​ Number ​ ​ ​ average ​ ​ of shares ​ ​ ​ exercise ​ 2019 Plan Inducement Plan ​ 2011 Plan Total price Outstanding at beginning of year - 2011 Plan $ — ​ — $ 1,995,971 1,995,971 $ 2.07 Outstanding at beginning of year - 2019 Plan ​ ​ 3,759,834 ​ — ​ ​ — ​ 3,759,834 ​ ​ 9.51 Granted - 2019 Plan ​ ​ 1,385,700 ​ — ​ ​ — ​ 1,385,700 ​ ​ 5.47 Granted - Inducement Plan ​ ​ — ​ 523,000 ​ ​ — ​ 523,000 ​ ​ 6.37 Expired - 2011 Plan ​ ​ — ​ — ​ ​ (1,121) ​ (1,121) ​ ​ 0.96 Exercised - 2011 Plan ​ ​ — ​ — ​ ​ (94,225) ​ (94,225) ​ ​ 1.43 Exercised - 2019 Plan ​ ​ (14,100) ​ — ​ ​ — ​ (14,100) ​ ​ 3.76 Cancelled - 2011 Plan ​ ​ — ​ — ​ ​ (19,387) ​ (19,387) ​ ​ 9.42 Cancelled - 2019 Plan ​ ​ (13,893) ​ — ​ ​ — ​ (13,893) ​ ​ 13.36 Outstanding at end of period $ 5,117,541 ​ 523,000 ​ ​ 1,881,238 ​ 7,521,779 ​ $ 6.68 Outstanding at end of period - Weighted average exercise price ​ $ 8.42 ​ 6.37 ​ $ 2.03 ​ ​ ​ ​ ​ Exercisable at end of period ​ ​ 2,017,527 ​ — ​ ​ 1,796,396 ​ 3,813,923 ​ $ 6.09 Exercisable at end of period - Weighted average exercise price $ 9.74 ​ — ​ $ 1.99 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 2021 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted ​ ​ Number ​ ​ ​ average ​ ​ of shares ​ ​ ​ exercise ​ ​ 2019 Plan Inducement Plan ​ 2011 Plan Total price Outstanding at beginning of year - 2011 Plan $ — ​ — ​ $ 2,080,097 ​ 2,080,097 ​ $ 2.15 Outstanding at beginning of year - 2019 Plan ​ 1,706,190 ​ — ​ ​ — ​ 1,706,190 ​ ​ 13.55 Granted - 2019 Plan ​ ​ 1,863,950 ​ — ​ ​ — ​ 1,863,950 ​ ​ 6.31 Exercised - 2011 Plan ​ ​ — ​ — ​ ​ (16,753) ​ (16,753) ​ ​ 0.88 Exercised - 2019 Plan ​ ​ (1,250) ​ — ​ ​ — ​ (1,250) ​ ​ 3.74 Outstanding at end of period ​ ​ 3,568,890 ​ — ​ ​ 2,063,344 ​ 5,632,234 ​ $ 6.99 Outstanding at end of period - Weighted average exercise price ​ $ 9.77 ​ — ​ $ 2.16 ​ ​ ​ ​ ​ Exercisable at end of period ​ ​ 591,885 ​ — ​ ​ 1,613,229 ​ 2,205,114 ​ $ 4.86 Exercisable at end of period - Weighted average exercise price ​ $ 12.55 ​ — ​ $ 2.05 ​ ​ ​ ​ ​
Schedule of non-vested share options activity	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 2022 ​ ​ Number ​ ​ ​ Weighted ​ ​ of options ​ ​ ​ average ​ ​ 2019 Plan Inducement Plan 2011 Plan Total fair value Non-vested share options at beginning of year - 2011 Plan — ​ ​ — ​ ​ 200,639 ​ 200,639 $ 1.86 Non-vested share options at beginning of year - 2019 Plan ​ ​ 2,665,518 ​ ​ — ​ ​ — ​ 2,665,518 ​ 6.39 Granted - 2019 Plan ​ 1,385,700 ​ ​ — ​ ​ — ​ 1,385,700 ​ ​ 4.13 Granted - Inducement Plan ​ ​ — ​ ​ 523,000 ​ ​ — ​ 523,000 ​ ​ 4.81 Vested, outstanding 2011 Plan ​ ​ — ​ ​ — ​ ​ (115,797) ​ (115,797) ​ 1.75 Vested, outstanding 2019 Plan ​ ​ (942,473) ​ ​ — ​ ​ — ​ (942,473) ​ ​ 5.63 Forfeited - 2019 Plan ​ ​ (8,731) ​ ​ — ​ ​ — ​ (8,731) ​ ​ 6.27 Non-vested share options at end of period ​ 3,100,014 ​ ​ 523,000 ​ ​ 84,842 ​ 3,707,856 $ 5.42 Non-vested share options at end of period - Weighted average fair value ​ $ 5.62 ​ $ — ​ $ 2.01 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ 2021 ​ ​ Number ​ ​ ​ Weighted ​ ​ of options ​ ​ ​ average ​ 2019 Plan Inducement Plan 2011 Plan Total fair value Non-vested share options at beginning of year - 2011 Plan ​ — ​ ​ — ​ ​ 543,192 ​ 543,192 $ 1.81 Non-vested share options at beginning of year - 2019 Plan ​ ​ 1,438,026 ​ ​ — ​ ​ — ​ 1,438,026 ​ 10.28 Granted - 2019 Plan ​ 1,863,950 ​ ​ — ​ ​ — ​ 1,863,950 ​ ​ 4.79 Vested, outstanding 2011 Plan ​ ​ — ​ ​ — ​ ​ (93,087) ​ (93,087) ​ 1.61 Vested, outstanding 2019 Plan ​ ​ (324,971) ​ ​ — ​ ​ — ​ (324,971) ​ ​ 11.38 Non-vested share options at end of period ​ 2,977,005 ​ ​ — ​ ​ 450,105 ​ 3,427,110 $ 6.08 Non-vested share options at end of period - Weighted average fair value ​ $ 6.72 ​ $ — ​ $ 1.85 ​ ​ ​ ​ ​
Schedule of weighted average assumptions for the options granted	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three months ended June 30, ​ ​ Six months ended June 30, ​ ​ 2022 2021 ​ 2022 2021 Exercise price $ 6.21 $ 5.56 ​ ​ $ 5.72 $ 6.24 ​ Share price $ 6.21 $ 5.56 ​ ​ $ 5.72 $ 6.24 ​ Volatility 91 % ​ 92 % ​ 91 % ​ 94 % Risk-free interest rate 2.72 % ​ 0.86 % ​ 2.31 % ​ 1.04 % Expected life 6.08 ​ 5.32 ​ ​ 6.08 ​ 6.01 ​ Dividend 0 % ​ 0 % ​ 0 % ​ 0 %
Schedule of share-based compensation expense	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three months ended June 30, ​ Six months ended June 30, ​ ​ 2022 2021 ​ 2022 2021 Administration $ 880 ​ $ 750 ​ $ 1,792 $ 1,323 ​ Research and development ​ 1,105 ​ ​ 825 ​ ​ 1,953 ​ 1,405 ​ Commercial activities ​ 426 ​ ​ 337 ​ ​ 780 ​ 552 ​ Total $ 2,411 ​ $ 1,912 ​ $ 4,525 $ 3,280 ​

Net loss per share (Tables)

Net loss per share (Tables)	6 Months Ended
	Jun. 30, 2022
Net Loss Per Share
Schedule of potentially dilutive securities excluded from the computation of diluted weighted average shares	​ ​ ​ ​ ​ ​ ​ 2022 2021 Share options 7,521,779 5,819,524

Summary of Significant Accoun_3

Summary of Significant Accounting Policies - Sources of Liquidity and Funding Requirements (Details) - USD ($) $ in Thousands	Jun. 30, 2022	Dec. 31, 2021
Summary of Significant Accounting Policies
Cash, cash equivalents and short-term investments	$ 86,200
Accumulated deficit	$ (236,974)	$ (206,319)

Revenues (Details)

Revenues (Details) - USD ($) $ in Thousands	3 Months Ended	6 Months Ended
	Jun. 30, 2021	Jun. 30, 2021	Jun. 30, 2022	Dec. 31, 2021
Revenues
Recognized collaboration revenue	$ 15,000	$ 15,000
Warrants			$ 52,941	$ 52,941

Accounts payable and accrued _3

Accounts payable and accrued liabilities (Details) - USD ($) $ in Thousands	Jun. 30, 2022	Dec. 31, 2021
Accounts Payable and Accrued Liabilities
Trade accounts payable	$ 1,507	$ 4,384
Accrued compensation and benefits payable	527	1,458
Accrued research and development liabilities	964	272
Other accrued liabilities	1,089	437
Accounts payable and accrued liabilities	$ 4,087	$ 6,551

Shareholders' Equity - Authoriz

Shareholders' Equity - Authorized share capital (Details) - shares	6 Months Ended
	Jun. 30, 2022	Dec. 31, 2021
Authorized share capital
Common Stock, Shares, Issued	30,005,884	29,897,559
Common Stock, Shares, Outstanding	30,005,884	29,897,559
Employee Stock Purchase Plan
Authorized share capital
Number of common shares available for issuance	1,121,076
Number of shares issued under the ESPP	0

Shareholders' Equity - Addition

Shareholders' Equity - Additional paid-in capital (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Additional paid-in capital
Beginning balance	$ 100,756	$ 131,992	$ 112,600	$ 143,119
Share-based compensation expense	2,411	1,912	4,525	3,280
Exercise of stock options	140		189	19
Ending balance	86,659	139,594	86,659	139,594
Additional paid-in capital
Additional paid-in capital
Beginning balance	17,785	9,883	15,711	8,530
Share-based compensation expense	2,411	1,912	4,525	3,280
Exercise of stock options	(106)		(146)	(15)
Ending balance	$ 20,090	$ 11,795	$ 20,090	$ 11,795

Share Based Compensation (Detai

Share Based Compensation (Details) - $ / shares		6 Months Ended
	Jan. 01, 2022	Jun. 30, 2022	Jun. 30, 2021	Dec. 31, 2021	Dec. 31, 2020
2011 Plan
Share-based compensation
Number of options forfeited after termination of one plan	125,127
Number of options, Options outstanding		1,881,238	2,063,344	1,995,971	2,080,097
2019 Plan
Share-based compensation
Shares reserved for issuance	1,195,902	5,811,310
Shares available for future grants		660,669
Options granted		1,385,700	1,863,950
Number of options, Options outstanding		5,117,541	3,568,890	3,759,834	1,706,190
Weighted average exercise price		$ 5.47	$ 6.31
2021 Inducement Plan
Share-based compensation
Options granted		523,000
Number of options, Options outstanding		523,000
Weighted average exercise price		$ 6.37
ESPP
Share-based compensation
Shares reserved for issuance		1,121,076
Shares issued		0
Options | 2011 Plan
Share-based compensation
Vesting period		4 years
Options | 2011 Plan | Share-based Compensation Award, Tranche One
Share-based compensation
Percentage of shares to vest		25%
Options | 2019 Plan
Share-based compensation
Vesting period		4 years
Options | 2019 Plan | Share-based Compensation Award, Tranche One
Share-based compensation
Percentage of shares to vest		25%
Options | 2019 Plan | Share-based Compensation Award, Tranche Two
Share-based compensation
Percentage of shares to vest		2.78%

Share Based Compensation - Outs

Share Based Compensation - Outstanding and exercisable options (Details) - USD ($) $ / shares in Units, $ in Thousands		3 Months Ended		6 Months Ended
	Feb. 16, 2022	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Outstanding and exercisable options, weighted average exercise price
Weighted average remaining contractual life (in years)				8 years 1 month 6 days	8 years 3 months 18 days
Weighted average remaining contractual life for vested options (in years)				6 years 10 months 24 days	7 years
Share-based compensation expense		$ 2,411	$ 1,912	$ 4,525	$ 3,280
Unrecognized compensation cost		$ 19,000	$ 19,400	$ 19,000	$ 19,400
Expected period for recognition				2 years 8 months 12 days	2 years 9 months 18 days
Plans 2011 and 2019 and 2021 Inducement [Member]
Outstanding and exercisable options, number of shares
Outstanding at end of period		7,521,779	5,632,234	7,521,779	5,632,234
Exercisable at end of period		3,813,923	2,205,114	3,813,923	2,205,114
Outstanding and exercisable options, weighted average exercise price
Outstanding at end of period		$ 6.68	$ 6.99	$ 6.68	$ 6.99
Exercisable at end of period		$ 6.09	$ 4.86	$ 6.09	$ 4.86
2011 Plan
Outstanding and exercisable options, number of shares
Outstanding at beginning of period				1,995,971	2,080,097
Exercised				(94,225)	(16,753)
Cancelled				(19,387)
Expired				(1,121)
Outstanding at end of period		1,881,238	2,063,344	1,881,238	2,063,344
Exercisable at end of period		1,796,396	1,613,229	1,796,396	1,613,229
Outstanding and exercisable options, weighted average exercise price
Outstanding at beginning of period				$ 2.07	$ 2.15
Exercised				1.43	0.88
Cancelled				9.42
Expired				0.96
Outstanding at end of period		$ 2.03	$ 2.16	2.03	2.16
Exercisable at end of period		$ 1.99	$ 2.05	$ 1.99	$ 2.05
2019 Plan
Outstanding and exercisable options, number of shares
Outstanding at beginning of period				3,759,834	1,706,190
Granted				1,385,700	1,863,950
Exercised				(14,100)	(1,250)
Cancelled				(13,893)
Outstanding at end of period		5,117,541	3,568,890	5,117,541	3,568,890
Exercisable at end of period		2,017,527	591,885	2,017,527	591,885
Outstanding and exercisable options, weighted average exercise price
Outstanding at beginning of period				$ 9.51	$ 13.55
Granted				5.47	6.31
Exercised				3.76	3.74
Cancelled				13.36
Outstanding at end of period		$ 8.42	$ 9.77	8.42	9.77
Exercisable at end of period		$ 9.74	$ 12.55	9.74	12.55
Weighted average fair values of options granted				$ 4.13	$ 4.79
2021 Inducement Plan
Outstanding and exercisable options, number of shares
Granted				523,000
Outstanding at end of period		523,000		523,000
Outstanding and exercisable options, weighted average exercise price
Granted				$ 6.37
Exercised				6.37
Outstanding at end of period		$ 6.37		6.37
Weighted average fair values of options granted	$ 4.81			$ 4.81

Share Based Compensation - Non-

Share Based Compensation - Non-vested share options (Details) - $ / shares		6 Months Ended
	Feb. 16, 2022	Jun. 30, 2022	Jun. 30, 2021
Plans 2011 and 2019 and 2021 Inducement [Member]
Number of options
Non-vested share options at end of period		3,707,856	3,427,110
Weighted average fair value
Non-vested at end of period		$ 5.42	$ 6.08
2011 Plan
Number of options
Non-vested at beginning of period		200,639	543,192
Vested, outstanding		(115,797)	(93,087)
Non-vested share options at end of period		84,842	450,105
Weighted average fair value
Non-vested at beginning of period		$ 1.86	$ 1.81
Vested, outstanding		1.75	1.61
Non-vested at end of period		$ 2.01	$ 1.85
2019 Plan
Number of options
Non-vested at beginning of period		2,665,518	1,438,026
Granted		1,385,700	1,863,950
Vested, outstanding			(324,971)
Non-vested share options at end of period		3,100,014	2,977,005
Weighted average fair value
Non-vested at beginning of period		$ 6.39	$ 10.28
Granted		4.13	4.79
Vested, outstanding			11.38
Non-vested at end of period		$ 5.62	$ 6.72
2021 Inducement Plan
Number of options
Granted		523,000
Vested, outstanding		(942,473)
Forfeited		(8,731)
Non-vested share options at end of period		523,000
Weighted average fair value
Granted	$ 4.81	$ 4.81
Vested, outstanding		5.63
Forfeited/expired		$ 6.27

Share Based Compensation - Weig

Share Based Compensation - Weighted average assumptions for the options granted (Details) - USD ($)	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Share Based Compensation
Exercise price	$ 6.21	$ 5.56	$ 5.72	$ 6.24
Share price (in dollars per share)	$ 6.21	$ 5.56	$ 5.72	$ 6.24
Volatility (as a percent)	91%	92%	91%	94%
Risk-free interest rate (as a percent)	2.72%	0.86%	2.31%	1.04%
Expected life (in years)	6 years 29 days	5 years 3 months 25 days	6 years 29 days	6 years 3 days
Dividend (as a percent)	0%	0%	0%	0%

Share Based Compensation - Reco

Share Based Compensation - Recognized share-based compensation expense (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Share-based compensation
Share-based compensation expense	$ 2,411	$ 1,912	$ 4,525	$ 3,280
Administration
Share-based compensation
Share-based compensation expense	880	750	1,792	1,323
Research and development
Share-based compensation
Share-based compensation expense	1,105	825	1,953	1,405
Commercial activities
Share-based compensation
Share-based compensation expense	$ 426	$ 337	$ 780	$ 552

Net loss per share (Details)

Net loss per share (Details) - shares	6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021
Share options
Net income (loss) per share
Share-based compensation options exercisable and in the money	7,521,779	5,819,524