Trevi Therapeutics enters the final stretch before its June 3 catalysts with a sharp 10.3% weekly decline creating a notable tension: every analyst still rates the stock a buy, yet the market has pulled it down 13% in a month.
The most striking feature of this week's setup is the options market. Call dominance is extreme — the put/call ratio has collapsed to 0.18, nearly two standard deviations below its 20-day average of 0.36. That is the most aggressively bullish options positioning seen in weeks, sitting close to the 52-week low of 0.08. Traders are adding calls, not buying protection, into a stock that has been falling steadily. It is a setup that either reflects conviction in the June 3 readout or a crowded one-directional bet.
Short interest tells a steadier story. At 11.8% of the free float, the short position is elevated but has been essentially flat for six weeks — down less than 0.2% on the week and 3.1% over the past month. There is no sign of fresh short-building on the price weakness. Borrow conditions remain very loose: availability runs at 372%, meaning for every share currently on loan there are nearly four more available to borrow. Cost to borrow sits at just 0.4% annually — barely above zero. The lending market carries none of the tension the chart might suggest.
The analyst consensus is firmly constructive, with all nine active ratings sitting at Buy. Needham reiterated its Buy and $23 target on May 20 — today — while HC Wainwright held its $21 target on May 6 after Trevi reported cash runway extended into 2030. That cash update, which drove a 5.9% gain on the session, was the clearest positive catalyst in the recent period. Needham had trimmed its target marginally from $24 to $23 earlier in May, and Morgan Stanley cut from $19 to $18 in March, but neither changed ratings. The bear case centres entirely on the binary clinical risk around Haduvio — the company has no approved products and the pipeline depends on Phase 3 success in chronic cough indications across IPF and non-IPF ILD populations.
Institutional ownership underlines the conviction held by larger holders. New Enterprise Associates added 1.85 million shares and now holds 9.3% of the company as of early May. FMR added 1.54 million shares and owns 5.7%. Wellington Management built a position of roughly 1.79 million new shares through Q1. Marshall Wace trimmed by 614,000 shares, representing the most notable institutional exit in recent filings. The top fifteen holders collectively account for over 60% of shares outstanding, leaving a relatively thin float — which amplifies the price sensitivity around binary events.
The ORTEX short score of 67.9 has drifted down from 70 a week ago, reflecting the slight easing of short positions and looser borrow. The factor score for EPS surprise ranks at the 81st percentile, while EPS momentum over 30 days sits at the 57th — modest improvement in how consensus estimates are trending without a dramatic shift. Peers ARVN and EYPT both fell harder than TRVI on the week, down 10.7% and 13.2% respectively, suggesting the sector is broadly under pressure rather than TRVI-specific selling dominating the tape.
The next data point is the June 3 event. Until then, the gap between the options market's bullish lean and the stock's continued slide is the tension worth watching.
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