Trevi Therapeutics (TRVI) was recently removed from several Russell indexes, including the Russell 3000E and Russell Microcap families. This index reshuffle can influence index fund trading and liquidity around the stock.

Despite the index removals, Trevi Therapeutics has shown strong momentum, with a 30 day share price return of 46.29% and a year to date share price return of 64.00%. The 1 year total shareholder return of 233.05% points to very strong longer term gains.

If Trevi’s recent moves have caught your attention and you are considering other healthcare opportunities, this is a good moment to scan 40 healthcare AI stocks.

Bulls highlight Trevi Therapeutics’ strong recent returns and focused pipeline, while bears emphasize index removals, zero reported revenue and ongoing losses. Which side does the current valuation appear to support based on the available numbers?

Most Popular Narrative: 18.4% Undervalued

Trevi Therapeutics last closed at $19.50, while the most followed narrative anchors on a fair value of $23.90, built around Haduvio’s chronic cough opportunity and funding runway, using a 7.11% discount rate.

Approximately US$188 million in cash, cash equivalents and marketable securities at year end 2025 with an indicated runway into 2028 funds top line data across key IPF, non IPF ILD and refractory chronic cough studies. This limits near term financing pressure and can support more controlled decision making around future capital structure, share count and potential earnings per share.

Want to see what sits behind that fair value for Trevi Therapeutics? The narrative leans on a single asset, ambitious revenue build up and a very high future earnings multiple. Curious which specific growth, margin and share count assumptions have to line up to reach $23.90?

Result: Fair Value of $23.90 (UNDERVALUED)

However, Trevi Therapeutics still faces key risks, including the fact that all value rests on Haduvio’s trial outcomes and the likelihood of further equity raises that could dilute shareholders.

Another View: Trevi Therapeutics Looks Expensive On P/B

The popular Trevi Therapeutics narrative leans on a fair value of $23.90, yet the current P/B ratio of 16.1x is far above the US Pharmaceuticals industry at 2.4x and peers at 5.3x. That gap points to meaningful valuation risk if sentiment or assumptions around Haduvio shift.

To see how this P/B gap is quantified and what the numbers say about today’s price, take a look at the See what the numbers say about this price — find out in our valuation breakdown.

Next Steps

With both strong recent returns and clear uncertainties in play for Trevi Therapeutics, it makes sense to review the underlying data yourself and form your own view on the stock. To weigh up both sides of the story, start by checking the 1 key reward and 4 important warning signs.

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This article by Simply Wall St is general in nature. We provide commentary based on historical data and analyst forecasts only using an unbiased methodology and our articles are not intended to be financial advice. It does not constitute a recommendation to buy or sell any stock, and does not take account of your objectives, or your financial situation. We aim to bring you long-term focused analysis driven by fundamental data. Note that our analysis may not factor in the latest price-sensitive company announcements or qualitative material. Simply Wall St has no position in any stocks mentioned.