A Phase 3, Randomized, Double-Blind, Placebo-Controlled Study of the Combination of PI3Kδ Inhibitor Parsaclisib and Ruxolitinib in Participants With Myelofibrosis
Phase: PHASE3
Conditions: Myelofibrosis, Primary Myelofibrosis, Post Essential Thrombocythemia Myelofibrosis, Post Polycythemia Vera Myelofibrosis
Sponsor: Incyte Corporation

Official Title:    A Phase 3, Randomized, Double-Blind, Placebo-Controlled Study of 
the Combination of PI3Kδ Inhibitor Parsaclisib and Ruxolitinib in 
Participants With Myelofibrosis
NCT Number: 
 NCT04551066 
Document Date: 
Clinical Study Protocol (Amendment 2): 14-Oct-2022

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Protocol INCB 50465-313 Am 2 
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CONFIDENTIAL 
Clinical Study Protocol 
TITLE PAGE 
INCB 50465-313 
A Phase 3, Randomized, Double-Blind, Placebo-Controlled Study of 
the Combination of PI3Kδ Inhibitor Parsaclisib and Ruxolitinib in 
Participants With Myelofibrosis 
Product: 
Parsaclisib (INCB050465) 
IND Number: 
147,207 
EudraCT Number: 
2020-003130-21 
Phase of Study: 
3 
Sponsor: 
Incyte Corporation 
1801 Augustine Cut-Off 
Wilmington, DE 19803 
Original Protocol: 
20 JUL 2020 
Amendment 1: 
11 OCT 2021 
Amendment 2: 
14 OCT 2022 
This study will be performed in accordance with ethical principles that have their origin in the Declaration of 
Helsinki and conducted in adherence to the study Protocol, applicable Good Clinical Practices, and applicable laws 
and country-specific regulations in which the study is being conducted. 
The information in this document is confidential.  No part of this information may be duplicated, referenced, or 
transmitted in any form or by any means (electronic, mechanical, photocopy, recording, or otherwise) without prior 
written consent. 

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INVESTIGATOR'S AGREEMENT 
I have read the INCB 50465-313 Protocol Amendment 2 (Version 3 dated 14 OCT 2022) and 
agree to conduct the study as outlined.  I agree to maintain the confidentiality of all information 
received or developed in connection with this Protocol. 
 
 
 
 
 
(Printed Name of Investigator) 
 
 
 
 
 
 
 
 
(Signature of Investigator) 
 
(Date) 

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TABLE OF CONTENTS 
TITLE PAGE ...................................................................................................................................1 
INVESTIGATOR'S AGREEMENT ................................................................................................2 
TABLE OF CONTENTS .................................................................................................................3 
LIST OF ABBREVIATIONS ........................................................................................................10 
1. 
PROTOCOL SUMMARY ..........................................................................................13 
2. 
INTRODUCTION ......................................................................................................23 
2.1. 
Overview of Myelofibrosis .........................................................................................23 
2.2. 
Role of Janus Kinase Pathway in Myelofibrosis ........................................................24 
2.3. 
Role of PI3K/Protein Kinase B Signaling Pathway in Myelofibrosis ........................25 
2.4. 
Treatment of Myelofibrosis ........................................................................................25 
2.5. 
Study Rationale ...........................................................................................................26 
2.5.1. 
Scientific Rationale for Study Design ........................................................................26 
2.5.2. 
Justification for Dose ..................................................................................................27 
2.6. 
Benefit/Risk Assessment ............................................................................................27 
2.6.1. 
Risks and Benefits of Parsaclisib ................................................................................27 
2.6.1.1. 
Potential Risks of Parsaclisib Based on Preclinical Findings .....................................27 
2.6.1.2. 
Potential Risks of Parsaclisib Based on Prior and Ongoing Clinical Studies .............27 
2.6.1.3. 
Potential Risks of PI3K Inhibition Based on Other Agents in Class ..........................28 
2.6.1.4. 
Potential Benefits of Parsaclisib .................................................................................28 
2.6.2. 
Risks of Ruxolitinib ....................................................................................................29 
2.6.2.1. 
Potential Risks of Ruxolitinib .....................................................................................29 
2.6.2.2. 
Potential Risks of Parsaclisib Plus Ruxolitinib ..........................................................29 
3. 
OBJECTIVES AND ENDPOINTS ............................................................................30 
4. 
STUDY DESIGN .......................................................................................................32 
4.1. 
Overall Design ............................................................................................................32 
4.1.1. 
Study Schedule/Procedures ........................................................................................32 
4.1.2. 
Unblinding and Crossover ..........................................................................................33 
4.1.3. 
Early Unblinding and Crossover ................................................................................33 
4.1.3.1. 
Before Week 24 ..........................................................................................................33 
4.1.3.2. 
After Week 24 .............................................................................................................34 
4.1.4. 
Early Unblinding/Crossover Process ..........................................................................35 

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4.1.5. 
Study Unblinding/Crossover Process .........................................................................36 
4.2. 
Overall Study Duration ...............................................................................................36 
4.3. 
Study Termination ......................................................................................................36 
5. 
STUDY POPULATION .............................................................................................37 
5.1. 
Inclusion Criteria ........................................................................................................37 
5.2. 
Exclusion Criteria .......................................................................................................38 
5.3. 
Lifestyle Considerations .............................................................................................40 
5.4. 
Screen Failures ............................................................................................................40 
5.5. 
Replacement of Participants .......................................................................................40 
5.6. 
Data Monitoring Committee .......................................................................................41 
6. 
STUDY TREATMENT ..............................................................................................41 
6.1. 
Study Treatments Administered .................................................................................41 
6.2. 
Preparation, Handling, and Accountability ................................................................43 
6.3. 
Measures to Minimize Bias:  Randomization and Blinding .......................................44 
6.4. 
Dose and Requirement to Start Dosing After Crossover ............................................44 
6.5. 
Study Treatment Compliance .....................................................................................45 
6.6. 
Dose-Limiting Toxicity and Determination of Maximum Tolerated Dose 
and/or Pharmacologically Active Dose ......................................................................45 
6.7. 
Dose Modifications .....................................................................................................45 
6.7.1. 
Dose Increases for Inadequate Efficacy .....................................................................45 
6.7.1.1. 
Dose Increases for Parsaclisib ....................................................................................45 
6.7.1.2. 
Dose Increases for Ruxolitinib for Participants Entering the Study With a 
Platelet Count ≥ 100 × 109/L ......................................................................................45 
6.7.1.3. 
Dose Increases for Ruxolitinib for Participants Entering the Study With a 
Platelet Count of 50 to < 100 × 109/L Inclusive .........................................................46 
6.7.2. 
Dose Decreases of Parsaclisib/Placebo for Toxicity ..................................................46 
6.7.3. 
Supportive Care for Diarrhea/Colitis ..........................................................................50 
6.7.4. 
Follow-Up for Immune-Related Adverse Events .......................................................50 
6.7.5. 
COVID-19 ..................................................................................................................51 
6.7.6. 
Criteria for Permanent Discontinuation of Parsaclisib/Matching Placebo .................51 
6.7.7. 
Dose Decreases of Ruxolitinib for Safety ..................................................................51 
6.8. 
Concomitant Medications and Procedures .................................................................52 
6.8.1. 
Permitted Medications ................................................................................................52 

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6.8.2. 
Pneumocystis jirovecii Pneumonia Prophylaxis .........................................................53 
6.8.3. 
Use of Growth Factors such as Erythropoietin ...........................................................53 
6.8.4. 
Restricted Medications and Procedures ......................................................................53 
6.8.5. 
Prohibited Medications and Procedures .....................................................................54 
6.9. 
Treatment After Week 24 ...........................................................................................54 
7. 
DISCONTINUATION OF STUDY TREATMENTS AND PARTICIPANT 
WITHDRAWAL ........................................................................................................55 
7.1. 
Discontinuation of Study Treatment ...........................................................................55 
7.1.1. 
Reasons for Discontinuation .......................................................................................55 
7.1.2. 
Discontinuation Procedures ........................................................................................55 
7.2. 
Participant Withdrawal From the Study .....................................................................56 
7.3. 
Lost to Follow-Up.......................................................................................................56 
8. 
STUDY ASSESSMENTS AND PROCEDURES ......................................................57 
8.1. 
Administrative and General Procedures .....................................................................57 
8.1.1. 
Informed Consent Process ..........................................................................................57 
8.1.2. 
Screening Procedures ..................................................................................................58 
8.1.3. 
Baseline .......................................................................................................................58 
8.1.4. 
Interactive Response Technology Procedure ..............................................................59 
8.1.5. 
Distribution of Reminder Cards ..................................................................................59 
8.1.6. 
Prior and Concomitant Medications ...........................................................................59 
8.1.7. 
Demography and Medical History ..............................................................................60 
8.1.7.1. 
Demographics and General Medical History .............................................................60 
8.1.7.2. 
Disease Characteristics and Treatment History ..........................................................60 
8.1.7.3. 
Transfusion History Status .........................................................................................60 
8.1.7.4. 
Dosing Diary ...............................................................................................................60 
8.1.7.5. 
Screening Symptom Form ..........................................................................................60 
8.1.8. 
Study Site Visit Coordination .....................................................................................60 
8.2. 
Efficacy Assessments .................................................................................................61 
8.2.1. 
Bone Marrow Biopsy and Aspirate ............................................................................61 
8.2.2. 
Spleen Palpation .........................................................................................................61 
8.2.3. 
Imaging .......................................................................................................................61 
8.2.4. 
Symptom Diary ...........................................................................................................62 
 
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8.2.6. 
Eastern Cooperative Oncology Group Status .............................................................62 
 
62 
 
62 
 
63 
 
63 
 
63 
 
63 
8.2.13. 
Health Economics .......................................................................................................63 
8.3. 
Safety Assessments .....................................................................................................63 
8.3.1. 
Adverse Events ...........................................................................................................63 
8.3.2. 
Physical Examinations ................................................................................................64 
8.3.3. 
Vital Signs ..................................................................................................................64 
8.3.4. 
Electrocardiograms .....................................................................................................64 
8.3.5. 
Laboratory Assessments .............................................................................................65 
8.3.5.1. 
Chemistry ....................................................................................................................65 
8.3.5.2. 
Hematology .................................................................................................................65 
8.3.5.3. 
Urinalysis ....................................................................................................................65 
8.3.5.4. 
Serology and Virology ................................................................................................66 
8.3.5.5. 
Lipid Panel ..................................................................................................................66 
8.3.5.6. 
Pregnancy Testing ......................................................................................................66 
8.3.5.7. 
Coagulation Panel .......................................................................................................66 
 
68 
 
68 
 
69 
8.5. 
Pharmacodynamic and Translational Assessments ....................................................69 
8.5.1. 
Timing of Biomarker Assessments .............................................................................69 
8.5.2. 
Biomarker Assessments ..............................................................................................69 
8.6. 
Unscheduled Visits .....................................................................................................70 
8.7. 
End of Treatment and/or Early Termination ..............................................................70 
8.8. 
Follow-Up ...................................................................................................................70 
8.8.1. 
Safety Follow-Up ........................................................................................................70 
8.8.2. 
Survival Follow-Up ....................................................................................................70 

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9. 
ADVERSE EVENTS:  DEFINITIONS AND PROCEDURES FOR 
RECORDING, EVALUATING, FOLLOW-UP, AND REPORTING ......................71 
9.1. 
Definition of Adverse Event .......................................................................................71 
9.2. 
Definition of Serious Adverse Event ..........................................................................71 
9.3. 
Recording and Follow-Up of Adverse Events and/or Serious Adverse Events .........73 
9.4. 
Reporting of Serious Adverse Events .........................................................................75 
9.5. 
Adverse Events of Special Interest .............................................................................76 
9.6. 
Emergency Unblinding of Treatment Assignment .....................................................77 
9.7. 
Pregnancy ...................................................................................................................77 
9.8. 
Warnings and Precautions ..........................................................................................78 
9.9. 
Product Complaints ....................................................................................................78 
9.10. 
Treatment of Overdose ...............................................................................................78 
10. 
STATISTICS ..............................................................................................................79 
10.1. 
Sample Size Determination ........................................................................................79 
10.2. 
Populations for Analysis .............................................................................................79 
10.3. 
Level of Significance ..................................................................................................80 
10.4. 
Statistical Analyses .....................................................................................................80 
10.4.1. 
Primary and Secondary Analyses ...............................................................................80 
10.4.2. 
Safety Analyses ..........................................................................................................82 
 
83 
10.5. 
Interim Analysis ..........................................................................................................84 
11. 
SUPPORTING DOCUMENTATION AND OPERATIONAL 
CONSIDERATIONS ..................................................................................................86 
11.1. 
Investigator Responsibilities .......................................................................................86 
11.1.1. 
Identification of the Coordinating Principal Investigator ...........................................87 
11.2. 
Data Management .......................................................................................................87 
11.3. 
Data Quality Assurance ..............................................................................................89 
11.4. 
Data Privacy and Confidentiality of Study Records ...................................................90 
11.5. 
Financial Disclosure ...................................................................................................90 
11.6. 
Publication Policy .......................................................................................................91 
11.7. 
Study and Site Closure................................................................................................91 
12. 
REFERENCES ...........................................................................................................93 

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APPENDIX A. INFORMATION REGARDING EFFECTIVENESS OF 
CONTRACEPTIVE METHODS ...............................................................................96 
APPENDIX B. WORSENING SYMPTOMATIC SPLENOMEGALY FORM ........................97 
APPENDIX C. SCREENING SYMPTOM FORM ....................................................................98 
APPENDIX D. EASTERN COOPERATIVE ONCOLOGY GROUP 
PERFORMANCE STATUS .......................................................................................99 
 
100 
 
 
 
101 
APPENDIX G. INHIBITORS AND INDUCERS OF CYTOCHROME P450........................103 
APPENDIX H. INSTRUCTION TO PARTICIPANTS FOR HANDLING STUDY 
DRUG (PARSACLISIB OR PLACEBO) AND REFERENCE 
TREATMENT (RUXOLITINIB) .............................................................................110 
APPENDIX I. BONE MARROW BIOPSY AND ASPIRATE EVALUATION ....................111 
APPENDIX J. PROTOCOL AMENDMENT SUMMARY OF CHANGES ...........................112 
 
LIST OF TABLES 
Table 1: 
Primary and Secondary Objectives and Endpoints .....................................................13 
Table 2: 
Key Study Design Elements .......................................................................................14 
Table 3: 
Schedule of Activities for Randomized Participants in Group A, in Group B, 
and After Crossover ....................................................................................................16 
Table 4: 
Schedule of Additional Study Visits for Participants Who Cross Over .....................19 
Table 5: 
Schedule of Laboratory Assessments for All Participants .........................................20 
Table 6: 
Risk Categories for Myelofibrosis ..............................................................................24 
Table 7: 
Objectives and Endpoints ...........................................................................................30 
Table 8: 
Risk Categories According to DIPSS .........................................................................37 
Table 9: 
Risk Factors and Point Assignments for DIPSS .........................................................37 
Table 10: Study Treatment Information .....................................................................................42 
Table 11: Guidelines for Interruption and Restarting of Parsaclisib/Matching Placebo ............47 
Table 12: Dose Strengths for Parsaclisib/Matching Placebo ......................................................50 
Table 13: Dose Reductions/Interruptions and Restarts for Hematologic Toxicities That 
Persist for > 14 Days After Interruption of Parsaclisib ..............................................52 
Table 14: Required Laboratory Analytes ....................................................................................67 
 
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Table 16: Populations for Analysis .............................................................................................79 
Table 17: Primary and Secondary Analyses Methods and Populations .....................................80 
Table 18: Criteria for Clinically Notable Electrocardiogram Abnormalities .............................83 
Table 19: Interim Analysis for Spleen Volume With HSD(0) ...................................................85 
Table 20: Interim Analysis for MFSAF TSS With HSD(0) .......................................................85 
 
LIST OF FIGURES 
Figure 1: 
Study Design Schema .................................................................................................15 

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LIST OF ABBREVIATIONS 
Abbreviations and 
Special Terms 
Definition 
AE 
adverse event 
AKT 
protein kinase B 
ALT 
alanine aminotransferase 
ANC 
absolute neutrophil count 
aPTT 
activated partial thromboplastin time 
AST 
aspartate aminotransferase 
AUC 
area under the plasma or serum concentration-time curve 
BID 
twice daily 
 
 
CI 
clinical improvement 
Cmax 
maximum observed concentration 
CMH 
Cochran-Mantel-Haenzel 
CMV 
cytomegalovirus 
COVID-19 
coronavirus disease 2019 
CR 
complete response  
CRF 
case report form 
CRO 
contract research organization 
CSR 
clinical study report 
CT 
computed tomography 
CTCAE 
Common Terminology Criteria for Adverse Events 
CYP 
cytochrome P450 
DIPSS 
Dynamic International Prognostic Scoring System 
DLT 
dose-limiting toxicity 
DMC 
Data Monitoring Committee  
DNA 
deoxyribonucleic acid 
ECG 
electrocardiogram 
ECOG 
Eastern Cooperative Oncology Group 
eCRF 
electronic case report form 
EDC 
electronic data capture 
 
 
 
EOT 
end of treatment   
ET 
essential thrombocythemia 

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Abbreviations and 
Special Terms 
Definition 
FDA 
Food and Drug Administration 
FGF2 
basic fibroblast growth factor  
FSH 
follicle-stimulating hormone 
GCP 
Good Clinical Practice 
GDPR 
General Data Protection Regulation 
HBV 
hepatitis B virus 
HCV 
hepatitis C virus 
HDL 
high-density lipoprotein 
HGB 
hemoglobin  
HIPAA 
Health Insurance Portability and Accountability Act of 1986 
HIV 
human immunodeficiency virus 
HSD 
Hwang-Shih-DeCani 
IB 
Investigator's Brochure 
ICF 
informed consent form  
ICH 
International Conference on Harmonisation 
IEC 
independent ethics committee 
IL 
interleukin 
INR 
international normalized ratio 
irAE 
immune-related adverse event 
IRB 
institutional review board 
ITT 
intent-to-treat 
IV 
intravenous 
 
 
IXRS 
interactive web/voice response system 
JAK 
Janus kinase 
LCM 
left costal margin 
LDL 
low-density lipoprotein 
MedDRA 
Medical Dictionary for Regulatory Activities 
MF 
myelofibrosis 
MFSAF v4.0 
Myelofibrosis Symptom Assessment Form v4.0 
MPN 
myeloproliferative neoplasm 
 
 
MRI 
magnetic resonance imaging 

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Abbreviations and 
Special Terms 
Definition 
MRT 
Myeloproliferative Neoplasms Research and Treatment 
OS 
overall survival 
 
 
PD 
pharmacodynamic  
PET-MF 
post–essential thrombocythemia myelofibrosis 
 
 
PI3K 
phosphatidylinositol 3-kinase 
PK 
pharmacokinetic 
PJP 
Pneumocystis jirovecii pneumonia 
PMDA 
Pharmaceutical and Medical Devices Agency 
PMF 
primary myelofibrosis 
PP 
per protocol 
PPV-MF 
post–polycythemia vera myelofibrosis 
PR 
partial response 
PT 
prothrombin time 
PTT 
partial thromboplastin time 
PV 
polycythemia vera 
Q12W 
every 12 weeks 
QD 
once daily 
RBC 
red blood cell 
RNA 
ribonucleic acid 
SAE 
serious adverse event 
SARS-CoV-2 
severe acute respiratory syndrome coronavirus 2 
SmPC 
Summary of Product Characteristics 
SoA 
schedule of activities 
SOP 
standard operating procedure 
STAT 
signal transduction and activator of transduction 
TEAE 
treatment-emergent adverse event 
TNF 
tumor necrosis factor 
TSS 
total symptom score 
ULN 
upper limit of normal 
WBC 
white blood cell 
 
 
 

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1. 
PROTOCOL SUMMARY 
Protocol Title:  A Phase 3, Randomized, Double-Blind, Placebo-Controlled Study of the 
Combination of PI3Kδ Inhibitor Parsaclisib and Ruxolitinib in Participants With Myelofibrosis 
Protocol Number:  INCB 50465-313 
Objectives and Endpoints: 
Table 1 presents the primary and major/key secondary objectives and endpoints. 
Table 1: 
Primary and Secondary Objectives and Endpoints 
Objectives 
Endpoints 
Primary 
To evaluate and compare the efficacy of 
parsaclisib plus ruxolitinib versus placebo plus 
ruxolitinib on spleen volume at Week 24.  
Proportion of participants achieving ≥ 35% 
reduction in spleen volume from baseline to 
Week 24 as measured by MRI (or CT scan in 
applicable participants). 
Major/Key Secondary 
To evaluate and compare the effect of parsaclisib 
plus ruxolitinib versus placebo plus ruxolitinib 
on participant reports of MF symptoms. 
Proportion of participants who have a ≥ 50% 
reduction in TSS from baseline to Week 24 as 
measured by the MFSAF v4.0 diary. 
Change in TSS from baseline to Week 24 as 
measured by the MFSAF v4.0 diary. 
Time to the first ≥ 50% reduction in TSS as 
measured by the MFSAF v4.0 diary. 
To evaluate and compare the effect of parsaclisib 
plus ruxolitinib versus placebo plus ruxolitinib 
with respect to OS. 
OS determined from the date of randomization 
until death due to any cause. 
To evaluate and compare the safety and 
tolerability of parsaclisib plus ruxolitinib versus 
placebo plus ruxolitinib.  
Safety and tolerability will be assessed by 
monitoring the frequency and severity of AEs, 
performing physical examinations, and evaluating 
changes in vital signs, ECGs, and laboratory 
results. 
Overall Design: 
Table 2 presents the key study design elements.  Further study details are presented after the 
table. 

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Table 2: 
Key Study Design Elements 
Study Phase 
Phase 3 
Clinical Indication 
Treatment of patients with primary and secondary MF 
Population 
Participants with primary or secondary MF with DIPSS risk category of 
intermediate or high who are in need of treatment for MF and are naive to both 
prior JAK inhibitor and prior PI3K inhibitor therapy 
Number of 
Participants 
Approximately 440 participants will be randomized 1:1 to 1 of 2 groups. 
Note:  Certain countries must meet a minimum enrollment regulatory 
requirement; therefore, enrollment in these countries may continue after 
enrollment in other countries ends. 
Group A:  parsaclisib plus ruxolitinib 
Group B:  placebo plus ruxolitinib 
Study Design 
Randomized, double-blind.  Participants will be randomized on Day 1 to 
Group A or Group B, with stratification for DIPSS risk category 
(intermediate-1 vs intermediate-2 vs high) and baseline platelet count 
(≥ 100 × 109/L vs 50 to < 100 × 109/L inclusive).  If a participant's platelet 
count has decreased to < 50 × 109/L at baseline, the platelet count at screening 
will be used for stratification/randomization.  
Estimated Duration 
of Study 
Participation 
Screening:  Up to 28 days. 
Baseline:  7 days before the first dose of parsaclisib/matching placebo plus 
ruxolitinib. 
Treatment period:  Begins with the first dose of parsaclisib or matching 
placebo and ruxolitinib (Day 1).  Participants will receive daily doses of 
parsaclisib or matching placebo of 5 mg together with  ruxolitinib.  The 
primary endpoint portion of study treatment is from Day 1 to the end of 
Week 24.   
Extension period:  After 24 weeks, participants may enter the extension period 
of the study.  Treatment will continue as long as the regimen is tolerated and 
the participant does not meet discontinuation criteria.   
Participants who discontinue study treatment will be followed for subsequent 
MF treatments and survival. 
When the last enrolled participant has completed the Week 24 with 
assessments (including imaging), the study will be unblinded.  Participants 
randomized to the placebo/ruxolitinib group may then cross over to treatment 
with parsaclisib plus ruxolitinib.  Early crossover is possible in exceptional 
circumstances for participants who demonstrate worsening symptomatic 
splenomegaly.   
Safety follow-up period:  30 to 35 days after the last dose of medication is 
taken. 
Survival follow-up period:  Until death, withdrawal of consent, or the end of 
the study, whichever occurs first. 
It is estimated that an individual participant will be in the study for 
approximately 36 months. 
DSMB/DMC 
Yes (external) 

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Table 2: 
Key Study Design Elements (Continued) 
Interim Analyses 
Two interim futility analyses will be performed.  Interim analysis 1 will be 
performed when 100 participants have been randomized to the 2 groups 
(approximately 50 per group) and have completed Week 12 assessments 
(including imaging).  Interim analysis 2 will be performed when 
220 participants have been randomized to the 2 groups (approximately 110 per 
group) and have completed Week 12 assessments (including imaging).    
Coordinating 
Principal 
Investigator 
, MD 
 
 
Treatment Groups and Duration: 
This is a Phase 3, randomized, double-blind study of the combination of the PI3Kδ inhibitor 
parsaclisib or matching placebo and the JAK1/2 inhibitor ruxolitinib in participants with primary 
MF or secondary MF (PPV-MF or PET-MF) with DIPSS risk category of intermediate or high.  
After participants have been determined to meet all criteria, they will be randomized to 1 of 
2 treatment groups and will receive parsaclisib or matching placebo at a dose of 5 mg once daily 
beginning on Day 1.  Participants will also receive ruxolitinib, at doses determined by baseline 
platelet count, beginning on Day 1.  Both parsaclisib/matching placebo and ruxolitinib dosing 
will continue for the duration of participation in the study. 
Figure 1 presents the study design schema, and Table 3, Table 4, and Table 5 show the SoA for 
study site visit assessments, post-crossover assessments, and laboratory assessments, 
respectively.  Adherence to the study design requirements, including those specified in the SoA, 
is essential and required for study conduct. 
Figure 1: 
Study Design Schema 
 
 

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Table 3: 
Schedule of Activities for Randomized Participants in Group A, in Group B, and After Crossover 
Visit Day (Range) 
Screening 
(Day −35 
to 
Day −8) 
Baseline 
(Day −7 
to 
Day −1) 
Day 
1 
End of 
Week 2 ± 
3 Days 
End of 
Weeks 
4, 8, 16, 
and 20 
± 5 Days 
End of 
Weeks 12 
and 24 ± 5 
Days 
Extension 
Visits (Every 
12 Weeks 
After 
Week 24)  
± 7 Days 
EOT or 
Early 
Termination 
Visit 
± 5 Days 
Safety 
Follow-Up 
(End of 
Treatment 
+ 30-35 
Days) 
Survival 
Follow-Up 
(Every 
12 Weeks 
± 2 Weeks) 
Notes 
Administrative procedures 
 
Informed consent 
X 
 
 
 
 
 
 
 
 
 
 
Contact IXRS 
X 
 
X 
 
X 
X 
X 
X 
 
 
 
Inclusion/exclusion 
criteria 
X 
X 
X 
 
 
 
 
 
 
 
 
General and disease 
medical history 
X 
 
 
 
 
 
 
 
 
 
 
Prior/concomitant 
medications 
X 
X 
X 
X 
X 
X 
X 
X 
X 
 
 
Dispense 
parsaclisib/matching 
placebo and ruxolitinib 
 
 
X 
 
X 
X 
X 
 
 
 
 
Administer 
parsaclisib/matching 
placebo and ruxolitinib 
at clinic visit 
 
 
X 
X 
X 
X 
 
 
 
 
 
Distribute reminder 
cards and dosing diary 
where applicable 
X 
X 
X 
X 
X 
X 
X 
X 
 
 
 
Collect study drug and 
review dosing diary  
 
 
 
 
X 
X 
X 
X 
 
 
 
Assess drug 
compliance 
 
 
 
 
X 
X 
X 
X 
 
 
 
Transfusion history 
status 
X 
Record of transfusions 
must include at least 
12 weeks prior to screening 
visit. 

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Table 3: 
Schedule of Activities for Randomized Participants in Group A, in Group B, and After Crossover (Continued) 
Visit Day (Range) 
Screening 
(Day −35 
to 
Day −8) 
Baseline 
(Day −7 
to 
Day −1) 
Day 
1 
End of 
Week 2 ± 3 
Days 
End of 
Weeks 
4, 8, 16, 
and 20 
± 5 Days 
End of 
Weeks 12 
and 24 ± 5 
Days 
Extension 
Visits (Every 
12 Weeks 
After 
Week 24)  
± 7 Days 
EOT or 
Early 
Termination 
Visit 
± 5 Days 
Safety 
Follow-Up 
(End of 
Treatment 
+ 30-35 
Days) 
Survival 
Follow-Up 
(Every 
12 Weeks 
± 2 Weeks) 
Notes 
Safety assessments 
 
Record AEs 
X 
X 
X 
X 
X 
X 
X 
X 
X 
 
Body systems with 
symptoms should be 
physically examined. 
Physical examination 
X 
X 
 
 
X 
X 
X 
X 
X 
 
Comprehensive physical 
examination at screening 
and EOT visits, targeted 
physical examination at the 
other visits.   
Vital signs, weight, 
height 
X 
X 
 
 
X 
X 
X 
X 
X 
 
Height at screening only. 
12-lead ECG 
X 
 
 
 
 
X* 
 
X 
 
 
*Week 24 only. 
PJP 
 
X 
X 
X 
X 
X 
X 
X 
 
PJP prophylaxis can be 
started anytime beginning 
at the baseline visit up to 
Day 1 and will continue 
through at least 2-6 months 
beyond the last dose of 
study treatment. 
Efficacy assessments 
 
Screening Symptom 
Form 
X 
 
 
 
 
 
 
 
 
 
 
Spleen palpation 
X 
X 
 
 
X 
X 
X 
X 
X 
 
 
Bone marrow biopsy 
and aspirate 
X* 
 
 
 
X* 
X* 
 
 
 
*Screening or baseline, 
Week 24, and every 
24 weeks thereafter.  
Screening or baseline not 
required if biopsy from 
prior 2 months available 
(report and samples).  

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Table 3: 
Schedule of Activities for Randomized Participants in Group A, in Group B, and After Crossover (Continued) 
Visit Day (Range) 
Screening 
(Day −35 
to 
Day −8) 
Baseline 
(Day −7 
to 
Day −1) 
Day 
1 
End of 
Week 2 ± 3 
Days 
End of 
Weeks 
4, 8, 16, 
20 
± 5 Days 
End of 
Weeks 12 
and 24 ± 5 
Days 
Extension 
Visits (Every 
12 Weeks 
After 
Week 24)  
± 7 Days 
EOT or 
Early 
Termination 
Visit 
± 5 Days 
Safety 
Follow-Up 
(End of 
Treatment 
+ 30-35 
Days) 
Survival 
Follow-Up 
(Every 
12 Weeks 
± 2 Weeks) 
Notes 
MRI/CT scan of the 
upper and lower 
abdomen and pelvis 
 
X 
 
 
 
X 
X 
 
 
 
No MRI/CT scan after 
Week 144. 
Dispense and/or bring 
MFSAF v4.0 diary to 
visit 
 
X 
X 
 
X 
X 
 
 
 
 
 
MFSAF v4.0 diary  
 
Completed every evening from baseline through 
Week 24 
 
 
 
 
 
ECOG performance 
status 
X 
Laboratory 
assessments* 
X 
X 
X 
X 
X 
X 
X 
X 
X 
 
*Participants will also have 
laboratory-only visits to 
collect hematology 
samples at Week 6, 
Week 10, Week 30, and 
every 12 weeks thereafter  
(except where coincident 
with study visit); see 
Table 5.  
Survival follow-up 
data collection 
 
 
 
 
 
 
 
 
 
X 
 

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Table 4: 
Schedule of Additional Study Visits for Participants Who Cross Over 
Visit Day (Range) 
Crossover Visit 
4 Weeks 
Post-Crossover 
± 5 Days 
Notes 
Administrative 
Contact IXRS 
X 
X 
 
Review criteria for crossover 
X 
 
 
Concomitant medications 
X 
X 
 
Dispense parsaclisib and ruxolitinib  
X 
X 
 
Distribute reminder cards  
X 
X 
 
Collect study drug and reference 
treatment and review diary cards 
X* 
X† 
*Parsaclisib/matching placebo and ruxolitinib bottles/blister packs to be collected.   
†Parsaclisib and ruxolitinib bottles/blister packs  to be collected.  
Transfusion history status 
X 
X 
 
Safety assessments 
Record AEs 
X 
X 
Body systems with symptoms should be physically examined. 
PJP 
X 
X 
Prophylaxis continues from crossover visit through at least 2-6 months beyond the last 
dose of study treatment.. 
Efficacy assessments 
Spleen palpation 
X 
X 
 
Dispense and/or bring MFSAF v4.0 
diary to visit 
X 
X 
Diary continues only for early crossover before Week 24 and ends at Week 24. 
MFSAF v4.0 diary  
X 
X 
Diary continues only for early crossover before Week 24 and ends at Week 24. 
ECOG performance status 
Laboratory assessments 
Serum chemistry 
X 
X 
Then follow Table 5. 
Hematology 
X 
X 
Then follow Table 5. 

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Table 5: 
Schedule of Laboratory Assessments for All Participants 
 
Screening 
Baseline Day 1 
End of Weeks 
2, 6, 10, and 
30 and Then 
Q12W 
End of 
Weeks 
4, 8, 12, 16, 20, 
and 24 and 
Then Q12W 
EOT or Early 
Termination 
Visit  
Safety 
Follow-Up 
30-35 Days 
After Last Dose 
of Parsaclisib 
Notes 
Window 
 
 
 
The window for laboratory-only visits is ± 3 days through Week 10 
inclusive, and ± 7 days for laboratory-only visits beginning at 
Week 30 and Q12W 
 
Local laboratory assessments 
Serum chemistry 
X 
X* 
 
X 
X 
X 
*Should be collected as close as possible 
to Day 1 but may be drawn up to 3 days 
before first dose.  Only 1 sample for 
baseline/Day 1 is required. 
Hematology 
X 
X* 
X 
X 
X 
X 
*Sample should be collected as close as 
possible to Day 1 but may be drawn up 
to 3 days before first dose.  Only 
1 sample for baseline/Day 1 is required.  
Note that if platelet count is < 50 × 109/L 
at baseline, the platelet count at 
screening will be used for 
stratification/randomization.  
See Section 8.1.3. 
Coagulation panel 
X 
 
 
 
X* 
X 
X 
*Required at Weeks 12 and 24 and 
Q12W thereafter. 
Urine pregnancy test 
 
X 
 
 
X* 
X* 
 
All female participants of childbearing 
potential. 
*Pregnancy tests should be repeated if 
required by local regulations. 

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Table 5: 
Schedule of Laboratory Assessments for All Participants (Continued) 
 
Screening 
Baseline Day 1 
End of Weeks 
2, 6, 10, and 
30 and Then 
Q12W 
End of 
Weeks 
4, 8, 12, 16, 20, 
and 24 and 
Then Q12W 
EOT or Early 
Termination 
Visit  
Safety 
Follow-Up 
30-35 Days 
After Last Dose 
of Parsaclisib 
Notes 
Window 
 
 
 
The window for laboratory-only visits is ± 3 days through Week 10 
inclusive, and ± 7 days for laboratory-only visits beginning at 
Week 30 and Q12W 
 
Bone marrow biopsy and 
aspirate analysis 
X* 
 
 
X† 
 
 
Local pathologist to document findings.   
*Predose biopsy/aspirate  is not required 
if biopsy has occurred within previous 
2 months of screening as long as 
biopsy/aspirate and data are available for 
review by investigator and/or sponsor. 
†Week 24 and then every 24 weeks 
thereafter.   
Note:  Samples of biopsy and aspirate 
will also be sent to a central vendor.  The 
Laboratory Manual will describe 
procedures for biopsy and aspirate 
sample preparation and shipping.  These 
samples for central analysis will only be 
collected in designated countries. 
Central laboratory samples* 
*The central laboratory is the sponsor or 
sponsor's designee. 
Lipid panel (requires 
overnight fast) 
X 
 
 
 
X* 
X 
 
*Required at Weeks 12 and 24 and 
Q12W thereafter. 
Virology and serology 
(hepatitis and HIV) 
X 
 
 
 
 
 
 
HBV, HCV, HIV 
Virology - CMV 
X 
 
 
 
X* 
 
 
*CMV measured at Weeks 4, 8, and 12 
and Q12W thereafter. 
Urinalysis 
X 
 
 
 
X* 
 
X 
*Required at Weeks 12 and 24 and 
Q12W thereafter. 
Serum pregnancy test 
X 
 
 
 
 
 
X 
All female participants of childbearing 
potential. 
FSH level 
X 
 
 
 
 
 
 
To document hormonal menopause in 
relevant participants. 

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Table 5: 
Schedule of Laboratory Assessments for All Participants (Continued) 
 
Screening 
Baseline Day 1 
End of Weeks 
2, 6, 10, and 
30 and Then 
Q12W 
End of 
Weeks 
4, 8, 12, 16, 20, 
and 24 and 
Then Q12W 
EOT or Early 
Termination 
Visit  
Safety 
Follow-Up 
30-35 Days After 
Last Dose of 
Parsaclisib 
Notes 
Window 
 
 
 
The window for laboratory-only visits is ± 3 days through Week 10 
inclusive, and ± 7 days for laboratory-only visits beginning at Week 
30 and Q12W 
 
 

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2. 
INTRODUCTION 
Parsaclisib (INCB050465) represents a novel, potent, and selective inhibitor of the Class IA 
PI3K enzymes, with selectivity for the δ isoform, which is proposed for development for 
treatment of hematologic malignancies.  For a thorough discussion of the pharmacology of 
INCB054065, refer to the parsaclisib IB.  Ruxolitinib, a potent and selective inhibitor of the JAK 
family of protein tyrosine kinases, JAK1 and JAK2, is approved in multiple jurisdictions for the 
treatment of MF, with variations on the specific indication language, and is currently in 
development for the treatment of MPNs, hematologic malignancies, and solid tumors.  For a 
thorough discussion of the pharmacology of ruxolitinib (INCB018424), refer to the ruxolitinib 
IB and the Jakafi® package insert (Jakafi 2021).  
2.1. 
Overview of Myelofibrosis 
The classic MPNs include chronic myelogenous leukemia, PV, ET, and PMF.  Myelofibrosis can 
present as a de novo disorder (PMF) or evolve secondarily from previous PV or ET (PPV-MF or 
PET-MF).  Regardless of whether MF is a primary or secondary disorder, it is characterized by a 
clonal stem cell proliferation associated with production of elevated serum levels of multiple 
inflammatory and proangiogenic cytokines, a characteristic bone marrow stromal pattern that 
includes varying degrees of collagen fibrosis, osteosclerosis and angiogenesis, and a peripheral 
blood smear showing a leukoerythroblastic pattern with varying degrees of circulating progenitor 
cells.  Clinically, MF is characterized by progressive anemia, leukopenia or leukocytosis, 
thrombocytopenia or thrombocythemia, and multiorgan extramedullary hematopoiesis most 
prominently involving the liver and spleen.  Patients may experience debilitating symptoms 
(Mesa et al 2013a, Mesa et al 2013b), sequelae of massive splenomegaly (pain, limitations of 
movement, early satiety and shortness of breath, hepatic obstruction, and splenic infarction), a 
hypermetabolic state with cachexia, progressive hematopoietic failure, progression to leukemia, 
and premature death. 
The median age at diagnosis of MF is approximately 60 to 67 years, and the incidence of PMF 
has been estimated at 4 to 6 cases per 100,000 people in the United States (Stein et al 2015).  
Survival in MF varies with the presence or absence of specific risk factors.  Analysis of risk 
factors over the past 20 years has resulted in a number of prognostic scoring systems (for a 
review, refer to Bose and Verstovsek 2016).  A prognostic scoring system based on a 
time-dependent risk evaluation has been developed:  the DIPSS for PMF (Passamonti 
et al 2010).  Age older than 65 years, presence of constitutional symptoms, anemia (hemoglobin 
< 100 g/L), leukocytosis (WBC count > 25 × 109/L), and a circulating blast percentage of ≥ 1% 
were assessed for their impact on survival when analyzed as time-dependent covariates in a 
multivariate Cox proportional hazards model.  The approach showed that acquisition of anemia 
over time affects survival with a hazard ratio roughly double that of other parameters, and 
therefore anemia was assigned a score of 2, while the other 4 factors were assigned scores of 1.  
Four risk categories with nonoverlapping survival curves are described in Table 6. 

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Table 6: 
Risk Categories for Myelofibrosis 
Total Risk Score 
Risk Category 
Median Survival (years) 
0 
Low 
Not reached 
1 or 2 
Intermediate-1 
14.2 
3 or 4 
Intermediate-2 
4 
5 or 6 
High 
1.5 
Recent literature has indicated that although the prognostic factors for OS for patients with 
PET-MF and PPV-MF overlap with those for patients with PMF, the relative importance of these 
factors and their associated outcomes show differences.  Additional improvements in scoring 
systems that include disease subtypes is warranted (Masarova et al 2017).  Although not included 
in the DIPSS, somatic mutations in PMF, JAK2 V617F point mutation, mutations in exon 9 of 
the gene encoding CALR, and mutations in the gene encoding the thrombopoietin receptor 
(MPL) have been examined for impact on DIPSS score, thrombotic risk, and OS and together are 
grouped as "driver" mutations.  These mutations often coexist with several somatic mutations:  
genes for the epigenetic regulators EZH2 (enhancer of zeste 2 polycomb repressive complex 
2 subunit), ASXL1 (additional sex combs-like 1 transcriptional regulator), the splicing gene 
SRSF2 (serine/arginine-rich splicing factor), and the genes encoding the Krebs cycle enzymes 
isocitrate dehydrogenase 1 and 2 (IDH1 and IDH2).  These factors have been combined into 
genetic-based scoring systems, although they are currently restricted to PMF (Tefferi et al 2018). 
2.2. 
Role of Janus Kinase Pathway in Myelofibrosis 
In recent years, it was discovered that approximately 95% of patients with PV and approximately 
50% of patients with PMF and ET have a somatic gain-of-function mutation in the JAK2 gene, 
resulting in substitution of phenylalanine for valine at position 617 (JAK2 V617F) within the 
pseudokinase domain of the encoded protein.  Janus kinase 2 is 1 of 4 members of the JAK 
family, along with JAK1, JAK3, and TYK2.  The JAKs are responsible for transduction of cell 
signaling from Type I and II cytokine receptor families, because these receptors do not possess 
intrinsic kinase activity to activate downstream signal transduction.  Under physiologic 
conditions, the JAKs associate with the intracellular domain of the cytokine receptors in response 
to cytokine binding.  They then undergo autophosphorylation, resulting in conformational 
changes that enable them to transduce intracellular signaling by phosphorylating and activating 
transcription factors called STAT proteins.  The activated STATs translocate to the nucleus, 
where they regulate transcription of a number of genes involved in cellular activation, 
proliferation, and survival.  JAKs associate with the intracellular domain of the Type I and II 
cytokine receptors in pairs, which may be homodimers (eg, 2 JAK2s) or heterodimers (eg, a 
JAK1 and a JAK2).  A large number of inflammatory mediators, such as IL-6, interferon gamma, 
and IL-17, are known to signal primarily through receptors that utilize JAK heterodimers. 
It is also apparent that MF, as well as ET and even PV, occur in the absence of the JAK2 V617F 
mutation.  In a minority of patients, other mutations in the JAK-STAT pathway have been 
identified, but in many patients, the mutations have not been identified yet or may not exist.  
Regardless, it appears that the majority of patients with MF have overactivation of the 
JAK-STAT pathway.  In MF, excessive cytokine signaling through both JAK1 and JAK2 has 

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been observed both in patients harboring the JAK2V617F mutation and in patients without 
known mutations.  Therefore, JAK inhibitors have the potential to treat some or all of the 
manifestations of MF, despite the potential for mechanism-based myelosuppression. 
2.3. 
Role of PI3K/Protein Kinase B Signaling Pathway in Myelofibrosis 
Recent evidence suggests that other regulatory pathways in addition to the JAK-STAT pathway 
are dysregulated in MPNs.  Targeting multiple signaling pathways might provide synergistic 
effects on the overall pathogenic process of MF.  The PI3K/AKT pathway is a signal 
transduction pathway that promotes survival and growth of cells in response to extracellular 
signals.  There are several isoforms of PI3K.  When activated, PI3Ks generate the lipid second 
messenger PIP3, leading to activation of several kinases, including AKT.  Activated AKT 
initiates numerous downstream effects, including on cell survival, proliferation, growth, 
migration, and metabolism (Thorpe et al 2015, Tzenaki et al 2013).  Meadows et al (2013) 
reported that the primary isoform of PI3K expressed in CD34+ cells obtained from 
ruxolitinib-treated or -naive patients with MF was PI3Kδ.  Bartalucci et al (2013) and Khan 
et al (2013) demonstrated that inhibition of the PI3K/mTOR pathway in combination with JAK2 
inhibition was synergistic in mouse models of MPN as well as in clonogenic assays of 
hematopoietic progenitors of patients with PMF.  Hermouet et al (2015) recently reviewed the 
multiple pathways activated by inflammatory cytokines and grown factors and affected by 
MPN-associated mutations.  Activators such as granulocyte colony-stimulating factor, 
erythropoietin, and thrombopoietin stimulate both JAK and PI3K-AKT pathways with 
considerable overlap and potential for synergistic effects. 
2.4. 
Treatment of Myelofibrosis 
The early drug therapies used in MF, including hydroxyurea, busulfan, 6-mercaptopurine, 
anagrelide, thalidomide, lenalidomide, interferon, corticosteroids, and erythropoiesis-stimulating 
agents or growth factors, have not been shown to improve survival.  Some can increase the risk 
of leukemic transformation and can be poorly tolerated, and all have limited effectiveness in 
improving splenomegaly and constitutional symptoms. 
Ruxolitinib, a potent and selective inhibitor of JAKs 1 and 2, is approved for use in patients with 
intermediate- or high-risk MF, including PMF, PPV-MF, and PET-MF.  Registration studies 
showed improvement in spleen size, symptom burden, and OS with ruxolitinib use in this patient 
population (Cervantes et al 2013, Harrison et al 2012, Mesa et al 2013a, Mesa et al 2013b, 
Vannucchi et al 2015, Verstovsek et al 2012, Verstovsek et al 2015).  Another JAK inhibitor, 
fedratinib, was approved more recently (August 2019) for intermediate-2 or high-risk MF.  Both 
a significant decrease in spleen volume and reduction in MF-related symptoms were observed in 
double-blind, placebo-controlled studies (Pardanani et al 2015). 
For the subset of patients who are younger (generally younger than 65 years), are otherwise 
healthy, and have a histocompatible donor, allogeneic stem cell transplantation may provide a 
curative option, although with a substantial risk of mortality (10%-20%; Deeg et al 2003, Robin 
et al 2019).  Splenectomy, performed in approximately 10% of the patient cohort reported by 
Cervantes et al (2009), is associated with significant morbidity and mortality.  Splenic irradiation 
is also used to reduce symptoms secondary to splenomegaly, but symptomatic improvement is 

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variable and short-lived; moreover, transient and life-threatening pancytopenia and an 
approximate 20% treatment-related mortality have been noted. 
Currently, there are no approved agents designed specifically for use with ruxolitinib to improve 
overall response or increase the number of patients who might respond.  A number of agents are 
under investigation in this setting.  Preliminary data using buparlisib, a pan-PI3K inhibitor, 
together with ruxolitinib demonstrated effects on both spleen size and symptoms in patients with 
MF with or without prior JAK therapy, but these results did not demonstrate synergy and the 
anticipated risk/benefit profile was modest (Durrant et al 2019).   
2.5. 
Study Rationale 
Ruxolitinib is approved for use in patients with intermediate- and high-risk primary or secondary 
MF.  Overall, the response rate based on 35% spleen volume reduction was 32% to 42% at 
Week 24 based on Phase 3 studies; therefore, not all patients with MF treated with ruxolitinib 
monotherapy experience optimal response.  Targeting additional signaling pathways might have 
an additive or synergistic effect on the overall disease burden of MF.  The present study 
compares the impact of the combination of the JAK inhibitor ruxolitinib and the PI3Kδ inhibitor 
parsaclisib with ruxolitinib plus placebo on signs and symptoms of MF in participants with 
intermediate- or high-risk MF who are naïve to both prior JAK and prior PI3K therapy.   
2.5.1. 
Scientific Rationale for Study Design 
Despite statistically significant improvements in signs and symptoms of MF and OS rates 
compared with either placebo or best available therapy demonstrated in the registration studies, 
ruxolitinib therapy fails to provide optimal response for some patients.  For some of these 
patients, individual genetic or systemic factors may impact the effects of JAK inhibition on 
overall disease.  For other patients, declining hemoglobin levels or platelet counts may preclude 
optimal ruxolitinib dosages.  Regardless of etiology, there is a patient population for whom 
ruxolitinib monotherapy is insufficient for optimal response.    
The persistent activation of the PI3K/AKT pathway in patients with MF suggests that this 
pathway may also be a driver of MPN diseases.  For example, Bartalucci et al (2013) and Khan 
et al (2013) demonstrated that inhibition of the PI3K/mTOR pathway in combination with JAK2 
inhibition was synergistic in mouse models of MPN as well as in clonogenic assays of 
hematopoietic progenitors of patients with PMF.    
An ongoing Phase 2 study in participants with MF, INCB 50465-201, showed that additional 
alleviation of both symptoms and splenomegaly occurred when the PI3Kδ inhibitor parsaclisib 
(INCB050465) was added to the regimen of participants with suboptimal response to ruxolitinib 
monotherapy.  Preliminary data showed > 20% reduction in spleen volume after 24 weeks of 
daily parsaclisib therapy together with continued ruxolitinib, along with reductions in symptoms 
(Yacoub et al 2021).  Importantly, these patients had been receiving continuous ruxolitinib for 
≥ 6 months before the start of the study yet still had significant splenomegaly, indicating that this 
population was likely more difficult to treat than JAK inhibitor–naïve patients.  The present 
study will explore the combination of parsaclisib and ruxolitinib in participants with MF who are 
naïve to both JAK and PI3K inhibitor therapies.  The study design is placebo-controlled and 
double-blind and will compare dual therapy of parsaclisib and ruxolitinib versus placebo and 
ruxolitinib.  The objective measurement of spleen volume at 24 weeks comprises the primary 

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endpoint.  The study is blinded; symptom data will be collected objectively using daily electronic 
diary entries.  Participants randomized to placebo will have the opportunity to cross over to 
receive parsaclisib after all participants in the study have reached Week 24; early crossover will 
be available to participants who meet Protocol-defined criteria.  
2.5.2. 
Justification for Dose 
In the ongoing Phase 2 study in MF (INCB 50465-201), DLTs were not observed with daily 
doses of parsaclisib of up to 20 mg for 8 weeks followed by weekly dosing at 10 or 20 mg or 
with continuous daily dosing of 5 mg or 20 mg for 8 weeks followed by daily dosing of 5 mg.  
In the INCB 50465-201 study, AEs frequently reported with first-generation PI3K inhibitors 
(Coutré et al 2015, Flinn et al 2018), including hepatotoxicity (fatal or serious elevations of liver 
enzymes), severe and/or fatal diarrhea and colitis, intestinal perforation, and infections such as 
CMV retinitis, have not been observed (colitis, CMV retinitis, intestinal perforation) or rarely 
observed (diarrhea, elevated liver enzymes) with either daily or weekly parsaclisib dosing in the 
MF population.  One SAE of diarrhea has been reported (Grade 3), unrelated to study drug, and 
resolved with drug interruption.  This same participant also had Grade 4 elevation of bilirubin; 
multiple AEs involving the renal, gastrointestinal, and pulmonary system (assessed as unrelated 
to study medication); increased peripheral blasts and subsequently died, with a cause of death of 
disease progression.  The present Phase 3 study will use an all daily dose regimen with 5 mg of 
parsaclisib or matching placebo administered QD from Day 1 until a given participant 
discontinues treatment.  Starting doses of ruxolitinib will be based on baseline platelet counts 
(except that in participants whose baseline count has decreased to < 50 × 109/L, the platelet count 
at screening will be used), with dose escalation allowed in the first 16 weeks of study.  Starting 
doses and dose escalations reflect prior Phase 2 and 3 studies of ruxolitinib (Talpaz et al 2013, 
Verstovsek et al 2012).   
2.6. 
Benefit/Risk Assessment 
The following sections describe risks and benefits of the study drug (parsaclisib) and risks for 
reference (background) treatment (ruxolitinib). 
2.6.1. 
Risks and Benefits of Parsaclisib 
2.6.1.1. 
Potential Risks of Parsaclisib Based on Preclinical Findings 
Based on the nonclinical toxicology studies, the primary potential risk associated with clinical 
administration of parsaclisib is immunosuppression and associated inflammatory complications 
and/or infections.  Participants receiving parsaclisib should be frequently monitored and 
appropriate treatment, including but not limited to drug withdrawal, should be considered.  
Immunosuppressive findings showed evidence of recovery following 4 to 6 weeks of drug 
withdrawal, confirming the reversibility of immunosuppressive complications. 
2.6.1.2. 
Potential Risks of Parsaclisib Based on Prior and Ongoing Clinical Studies 
As of the data cutoff of 30 MAR 2022, 1159 unique individuals have been exposed to parsaclisib 
monotherapy, including healthy participants and participants with renal or hepatic impairment 
(N = 69), as monotherapy in oncology indications (N = 592), as monotherapy in inflammation 

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and autoimmunity indications (N = 35), or in combination with other agents in oncology 
indications (N = 463).  
The most common AEs with parsaclisib monotherapy in advanced malignancies (N = 592) have 
been diarrhea, nausea, cough, fever, and fatigue.  
Parsaclisib has effects on the immune system and serious infection events have occurred in 
patients treated with parsaclisib, including PJP, CMV, and COVID-19.  Therefore, participants 
must be monitored closely for evidence of infections or new cancers, and administration should 
be discontinued if there is evidence of clinically significant infection or new cancer.  All irAEs 
must be completely resolved to baseline for 2 weeks before starting parsaclisib. 
Four cases of PJP have been reported with the use of parsaclisib as monotherapy and another in 
combination with pembrolizumab.  None of these events occurred in the MF population.  None 
of the participants were on PJP prophylaxis at the time of the event.  Participants in the present 
study will receive PJP prophylaxis beginning with the baseline visit. 
More detailed information about the known and expected benefits and risks and reasonably 
expected AEs of parsaclisib may be found in the parsaclisib IB. 
2.6.1.3. 
Potential Risks of PI3K Inhibition Based on Other Agents in Class 
Idelalisib was approved by the FDA in July 2014 for treatment of relapsed/refractory follicular 
lymphoma and relapsed small lymphocytic lymphoma and for treatment of chronic lymphocytic 
leukemia in combination with rituximab.  Severe toxicities seen with the use of this agent include 
hepatotoxicity (fatal and/or serious occurring in 16%-18%), fatal and/or serious diarrhea or 
colitis (14%-20%), intestinal perforation, pneumonitis, and infections (fatal and/or serious 
occurring in 21%-48%).  PJP infection and CMV infection have also been reported 
(Zydelig® 2018). 
Copanlisib was approved in 2017 for the treatment of relapsed follicular lymphoma.  Clinically 
important toxicities observed with this agent include SAEs, including fatal infections (19%), 
usually pneumonia, Grade 3 or 4 hyperglycemia (41%), and Grade 3 hypertension (26%).  
Serious PJP occurred in 0.6% of patients treated with copanlisib (Aliqopa® 2019). 
Duvelisib was approved in 2019 for the treatment of relapsed or refractory chronic lymphocytic 
leukemia, small lymphocytic lymphoma, or follicular lymphoma.  Clinically important toxicities 
observed with this agent include fatal and/or serious infections (31%), fatal and/or serious 
diarrhea or colitis (18%), fatal and/or serious cutaneous reactions (5%), or fatal and/or serious 
pneumonitis (5%).  Serious, including fatal PJP occurred in 1% of patients taking duvelisib, and 
CMV reactivation also occurred in 1% of patients taking duvelisib (Copiktra® 2019). 
Participants in the present study will be monitored closely for the development of bacterial, 
fungal, or viral infections and will have treatment interrupted and dose reduced as appropriate.  
Participants will receive prophylaxis for PJP and will be monitored for CMV viremia during the 
study. 
2.6.1.4. 
Potential Benefits of Parsaclisib 
The ongoing Phase 2 study showed that additional alleviation of both symptoms and 
splenomegaly occurred when the PI3Kδ inhibitor parsaclisib (INCB050465) was added to 

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participants on a stable ruxolitinib regimen.  Specifically, at the time of efficacy data cutoff of 
27 AUG 2020, 35 participants had been enrolled to receive all daily dosing regimens (18 dosed 
with 5 mg QD from Day 1 forward and 17 dosed with 20 mg QD for the first 8 weeks followed 
by 5 mg QD going forward).  The median reduction in spleen volume at 12 and 24 weeks was 
13.0% and 21.8%, respectively.  Seven of 23 participants (30%) had at least 25% reduction in 
spleen volume at Week 24.  Thirty percent of participants had 50% reduction in TSS at Week 12 
and 19% at Week 24 (Yacoub et al 2021).  These preliminary findings in the difficult-to-treat 
ruxolitinib-refractory population suggest that the combination of parsaclisib and ruxolitinib may 
also be efficacious in JAK- and PI3K-naïve patients with MF.   
2.6.2. 
Risks of Ruxolitinib 
2.6.2.1. 
Potential Risks of Ruxolitinib 
The primary clinical risks with ruxolitinib treatment are the potential sequelae of decreased 
hematopoietic proliferation attributable to the inhibition of growth factor pathways associated 
with JAK inhibition.  Dose-dependent, reversible thrombocytopenia has been observed in studies 
of participants with MF.  Anemia and, less frequently, neutropenia have also been observed in 
studies in participants with MF.  In healthy volunteers, participants with rheumatoid arthritis, and 
participants with hormone-refractory prostate cancer with greater bone marrow reserve, the 
effects on hematopoietic proliferation appear to be less pronounced.  Increased rates of infection 
and anemia are potential risks of myelosuppression, and there are multiple sequelae of anemia, 
including the burden and risks of transfusion.  Serious bacterial, mycobacterial, fungal, viral, and 
other opportunistic infections, including tuberculosis, have occurred in patients treated with 
ruxolitinib.  Before starting treatment, patients should be evaluated for active and latent 
infections and treatment with ruxolitinib delayed until active, serious infections have been 
resolved.  During the study, investigators should carefully assess participants for signs and 
symptoms of infections and initiate appropriate treatment promptly. Progressive multifocal 
leukoencephalopathy has been reported with ruxolitinib treatment.  Investigators should be alert 
to signs or symptoms and provide appropriate referrals or diagnostic measures.  For additional 
information on ruxolitinib risks, see the Investigator's Brochure and commercial labeling 
information (ruxolitinib IB, Jakafi 2021, Jakavi 2022).  
2.6.2.2. 
Potential Risks of Parsaclisib Plus Ruxolitinib 
As of the data cutoff date of 30 MAR 2022, 74 participants with MF had received parsaclisib 
together with continued ruxolitinib in study INCB 50465-201.  The most common AEs observed 
were thrombocytopenia, diarrhea, nausea, abdominal pain, anemia, fall, and platelet count 
decreased. 

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3. 
OBJECTIVES AND ENDPOINTS 
Table 7 presents the objectives and endpoints. 
Table 7: 
Objectives and Endpoints 
Objectives 
Endpoints 
Primary 
To evaluate and compare the efficacy of 
parsaclisib plus ruxolitinib versus placebo plus 
ruxolitinib on spleen volume at Week 24. 
Proportion of participants achieving ≥ 35% 
reduction in spleen volume from baseline to 
Week 24 as measured by MRI (or CT scan in 
applicable participants). 
Secondary 
To evaluate and compare the effect of parsaclisib 
plus ruxolitinib versus placebo plus ruxolitinib on 
participant reports of MF symptoms. 
Proportion of participants who have a ≥ 50% 
reduction in TSS from baseline to Week 24 as 
measured by the MFSAF v4.0 diary. 
Change in TSS from baseline to Week 24 as 
measured by the MFSAF v4.0 diary. 
Time to the first ≥ 50% reduction in TSS as 
measured by the MFSAF v4.0 diary. 
To evaluate and compare the effect of parsaclisib 
plus ruxolitinib versus placebo plus ruxolitinib 
with respect to OS. 
OS determined from the date of randomization 
until death due to any cause.   
To evaluate and compare the safety and 
tolerability of parsaclisib plus ruxolitinib versus 
placebo plus ruxolitinib.  
Safety and tolerability will be assessed by 
monitoring the frequency and severity of AEs, 
performing physical examinations, and evaluating 
changes in vital signs, ECGs, and laboratory 
results. 
To evaluate and compare the time to onset or 
response and duration of response in spleen 
volume of participants receiving parsaclisib plus 
ruxolitinib versus placebo plus ruxolitinib. 
Time of onset of a ≥ 35% reduction in spleen 
volume and duration of maintenance of a ≥ 35% 
reduction in spleen volume. 

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Table 7: 
Objectives and Endpoints (Continued) 
Objectives 
Endpoints 

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4. 
STUDY DESIGN 
4.1. 
Overall Design 
This is a Phase 3, randomized, double-blind study of the combination of the PI3Kδ inhibitor 
parsaclisib or matching placebo and the JAK1/2 inhibitor ruxolitinib in participants with PMF or 
secondary MF (PPV-MF or PET-MF) with DIPSS risk category of intermediate or high.  
Prospective participants must have not received prior MF therapy with a JAK inhibitor  or a 
PI3K inhibitor.  After participants have been determined to be eligible for the study and 
completed the baseline symptom diary assessment for 7 days, they will be randomized to 1 of 
2 treatment groups, with stratification for baseline platelet count (≥ 100 × 109/L vs 50 to 
< 100 × 109/L inclusive) and DIPSS risk category (high vs intermediate-2 vs intermediate-1).  
Note that if a participant's platelet count is < 50 × 109/L at baseline, the platelet count at 
screening will be used for stratification/randomization. Participants will receive study drug or 
matching placebo at a dose of 5 mg QD beginning on Day 1 and continuing for the duration of 
their participation in the study.  Ruxolitinib dosing will also begin on Day 1, and dose level will 
be determined by baseline platelet count.   
Figure 1 presents the study design schema, and Table 3, Table 4, and Table 5 present the SoA for 
study site visit assessments, post-crossover assessments, and laboratory assessments, 
respectively.  
4.1.1. 
Study Schedule/Procedures 
There will be study site visits and laboratory-only visits in the study. 
Participants will have a regularly scheduled study site visit at screening, baseline, Day 1, and at 
the end of 2, 4, 8, 12, 16, 20, and 24 weeks of treatment (ie, visits designated Week 2, Week 4, 
and so on) and then every 12 weeks thereafter if continuing on treatment in the extension period. 
During these visits, assessments including blood samples and spleen measurements will be 
performed.  All serology, lipid profile, and urinalysis laboratory assessments will be analyzed by 
a central laboratory.  Serum chemistry, hematology, and coagulation parameters will be assessed 
using local laboratories.  
 
. 
Participants will have laboratory-only visits to collect hematology laboratory samples at Week 6, 
Week 10, and, if continuing beyond Week 24, every 12 weeks beginning with Week 30.  
Participants may visit a local laboratory or a location convenient to the participant for these 
interim hematology assessments provided that the laboratory data and corresponding normal 
ranges can be scanned and e-mailed to the investigative site; interim laboratory visits at the study 
site laboratory are preferred.  Additional and unscheduled laboratory assessments may be 
performed at investigator discretion, including following changes in dose, or if laboratory 
parameters are at Grade 3 or Grade 4 levels based on CTCAE v5.0. 
Participants who cross over (defined in the following text) will have 2 additional study site visits:  
the day of crossover and 4 weeks after crossover.  Participants who have crossed over will 
otherwise remain on the same study schedule they were on prior to crossover.  Note these 
crossover participants may not need to have the laboratory visit at Week 30 as this may coincide 
with the Week 4 post-crossover visit.   

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Participants will have an MRI of the upper and lower abdomen and pelvis to determine the 
spleen volume at baseline, Week 12, Week 24, and every 12 weeks thereafter through Week 144.  
A CT scan will be substituted for participants who are not candidates for MRI or when MRI is 
not readily available.  
 
 
 
Participants will complete an electronic symptom diary (MFSAF v4.0) daily from baseline 
through the Week 24 visit (total of 25 weeks). 
All participants must receive prophylaxis against PJP beginning as early as the baseline visit and 
no later than Day 1 through at least 2 to 6 months after the last dose of parsaclisib/matching 
placebo. 
After 24 weeks, participants may enter the extension period of the study.  Treatment will 
continue as long as the regimen is tolerated and the participant does not meet discontinuation 
criteria. 
4.1.2. 
Unblinding and Crossover 
When the last enrolled participant has completed the Week 24 assessments and the data entered 
by all sites for all participants has been verified and cleaned through the Week 24 visit (including 
imaging), the database will be frozen.  The study will then be unblinded, and participants 
randomized to placebo will have the opportunity to cross over to begin receiving parsaclisib, 
together with continued ruxolitinib, as long as hematology parameters are adequate (see 
Section 6.4 for hematology requirements).  Similarly, participants found to have been 
randomized to parsaclisib will continue treatment with parsaclisib, together with continued 
ruxolitinib, as long as the regimen is tolerated and the participant does not meet discontinuation 
criteria. 
4.1.3. 
Early Unblinding and Crossover  
Participants with protocol-defined spleen growth may be eligible for unblinding and, if found to 
have been randomized to the placebo group, may be eligible for crossover to parsaclisib, together 
with continued ruxolitinib, before the study is unblinded.   
4.1.3.1. 
Before Week 24 
Participants who show symptomatic spleen growth may be eligible for unblinding and crossover 
if they meet both of the following criteria:  
• Score of 5 or higher on at least 2 of 3 symptoms related to spleen size (abdominal 
discomfort, pain under the left ribs, early satiety), as assessed by the Worsening 
Symptomatic Splenomegaly Form (see Appendix B).   

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• Participants must demonstrate worsening spleen growth measured as an increase of 
≥ 25% in spleen volume by MRI (or CT scan in applicable participants) compared to 
baseline.  In addition to the regularly scheduled MRIs (or CT scans in applicable 
participants) at Week 12 and Week 24, 1 additional MRI (or CT scan in applicable 
participants) may be conducted between Week 2 and Week 10 and/or between 
Week 14 and Week 22 provided the participant meets the definition of worsening 
symptoms above.  Only MRI or CT scans performed by the protocol-qualified 
facilities and submitted to the central imaging laboratory may be used.  No other MRI 
or CT scans for the purpose of documenting spleen growth are permitted.   
Participants showing an increase in spleen volume of at least 25% compared to baseline will be 
identified by the central imaging laboratory; if the requirement for worsening symptoms is also 
met, the investigator will be notified that unblinding may occur. 
Participants who meet both criteria and are early-unblinded and found to have been 
randomized to placebo must either cross over or be discontinued from the study treatments 
(placebo and ruxolitinib) and have an EOT visit scheduled.  Participants who cross over 
will continue on ruxolitinib in addition to parsaclisib. 
Participants who meet both criteria and are early-unblinded and found to have been 
randomized to parsaclisib must be discontinued from the study treatments (parsaclisib and 
ruxolitinib) and have an EOT visit scheduled.  
4.1.3.2. 
After Week 24 
Participants who show an increase in spleen growth may be eligible for unblinding and 
crossover. 
4.1.3.2.1. Participants With Worsening Symptomatic Spleen Growth 
• Participants with worsening symptomatic spleen growth may have 1 additional MRI 
(or CT scan in applicable participants) between Week 26 and Week 34 and/or 
between Week 38 and Week 46 and/or between Week 50 and Week 58 and/or 
between Week 62 and Week 70 provided the participant meets the definition of 
worsening symptoms as defined above for potential early crossover prior to Week 24.  
No other MRI or CT scans for the purpose of documenting spleen growth are 
permitted. 
• Participants showing an increase in spleen volume of ≥ 25% compared to baseline 
will be identified by the central imaging laboratory; if the requirement for worsening 
symptoms is also met, the investigator will be notified that unblinding may occur (see 
Section 4.1.4). 
Participants who meet both criteria and are early-unblinded and found to have been 
randomized to placebo must either cross over or be discontinued from the study treatments 
(placebo and ruxolitinib) and have an EOT visit scheduled.  Participants who cross over 
will continue on ruxolitinib in addition to parsaclisib.  
Participants who meet both criteria and are early-unblinded and found to have been 
randomized to parsaclisib must be discontinued from the study treatments (parsaclisib and 
ruxolitinib) and have an EOT visit scheduled.  

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4.1.3.2.2. Participants With Worsening Asymptomatic Spleen Growth 
• Participants who demonstrate worsening spleen growth measured as an increase of 
≥ 25% in spleen volume by MRI (or CT scan in applicable participants) compared to 
baseline, based on the regularly scheduled MRI or CT scan that is conducted at 
Week 24, Week 36, and every 12 weeks.  
• Participants who meet this criteria have the option to unblind, and if found to be 
randomized to the control arm, cross over to receive parsaclisib together with 
continued ruxolitinib or discontinue from the study. 
Participants who meet both criteria and are early-unblinded and found to have been 
randomized to placebo must either cross over or be discontinued from the study treatments 
(placebo and ruxolitinib) and have an EOT visit scheduled.  Participants who cross over 
will continue on ruxolitinib in addition to parsaclisib. 
Participants who meet both criteria and are early-unblinded and found to have been 
randomized to parsaclisib must be discontinued from the study treatments (parsaclisib and 
ruxolitinib) and have an EOT visit scheduled.  
4.1.4. 
Early Unblinding/Crossover Process 
The site, CRO, central imaging laboratory, and IXRS system will work together to ensure 
efficient data capture and verification of criteria for unblinding and crossover.  The process steps 
will include the following: 
• The investigator will begin to complete the Worsening Symptomatic Splenomegaly 
Form in the eCRF, with appropriate entries for symptom scores.   
• The investigator will send the MRI (or CT scans for applicable participants) to the 
central imaging laboratory. 
• The site will start entering all available data in the eCRF up to the current visit. 
• The eCRF system will verify that the data fulfill the symptom criteria, and a 
notification will be sent to the site and to the central imaging laboratory that the 
participant has fulfilled the symptom-based criteria for early crossover. 
• The central imaging laboratory will process the scan and compare it to the baseline 
scan.  If the on-study scan shows a ≥ 25% increase from baseline, the CRO and IXRS 
will be notified.  The CRO will confirm in the IXRS that the spleen growth–based 
criteria for early crossover have been met. 
• The eCRF system will verify that all data up to the current visit are indeed in the 
eCRF and are verified and cleaned.  The database for that participant will then be 
frozen through the current visit. 
• IXRS will be notified that final conditions have been met.  
• An e-mail will be sent to the site, CRO, and sponsor that the participant may be 
unblinded. 

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4.1.5. 
Study Unblinding/Crossover Process 
The site, CRO, central imaging laboratory, and IXRS system will work together to ensure 
efficient data capture and verification of study unblinding/crossover timing.  The process steps 
will include the following: 
• Sites will be advised to continuously enter data into the eCRF and address queries. 
• The imaging vendor will communicate to the sponsor and CRO that the final 
Week 24 spleen volume image has been read and verified. 
• The eCRF system will verify that all data up to the current visit are in the eCRF for 
all participants and are verified and cleaned.  The database will then be frozen for all 
visits completed to date. 
• IXRS will be notified that final conditions have been met.  
• The CRO and sponsor will communicate unblinded status of participants to sites.   
4.2. 
Overall Study Duration 
The study begins when the first participant signs the ICF.  Treatment will continue for an 
individual participant as long as the regimen is tolerated and the participant does not meet 
discontinuation criteria.  The end of the study is defined as the date of the last visit/last contact of 
the last participant in the study. 
4.3. 
Study Termination 
The investigator retains the right to terminate study participation at any time, according to the 
terms specified in the study contract.  The investigator/head of study site (Japan) is to notify the 
IRB/IEC of the study's completion or early termination in writing, send a copy of the notification 
to the sponsor or sponsor's designee, and retain 1 copy for the site study regulatory file. 
The sponsor may terminate the study electively if, for example, required by regulatory decision 
or upon advice of the DMC.  If the study is terminated prematurely, the sponsor will notify the 
investigators/head of study site (Japan), the IRBs and IECs, and the regulatory bodies of the 
decision and reason for termination of the study.  The DMC may recommend termination of the 
study if warranted, as described in Sections 5.6 and 10.5.  For Japan, the head of the study site 
will notify the investigators and IRBs of the decision and reason for termination of the study. 

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5. 
STUDY POPULATION 
Male or female participants aged 18 years or older (19 years or older in South Korea) who have 
been diagnosed with PMF or secondary MF (PPV-MF or PET-MF), who have intermediate- or 
high-risk disease according to DIPSS, who are naive to both prior JAK and prior PI3K therapy, 
and for whom treatment of MF is indicated may enroll.  
Deviations from eligibility criteria are not allowed because they can potentially jeopardize the 
scientific integrity of the study, regulatory acceptability, and/or participant safety.  Therefore, 
adherence to the criteria as specified in the Protocol is essential.  Prospective approval of 
Protocol deviations to recruitment and enrollment criteria, also known as Protocol waivers or 
exemptions, are not permitted. 
5.1. 
Inclusion Criteria 
Participants are eligible to be included in the study only if all of the following criteria apply: 
1. Men and women aged 18 years or older. 
Note:  For South Korea, men and women aged 19 years or older. 
2. Diagnosis of PMF, PPV-MF, or PET-MF. 
3. DIPSS risk category of intermediate-1, intermediate-2, or high (see Table 8 and Table 9).  
Table 8: 
Risk Categories According to DIPSS 
Number of Risk Factor Points Present 
Risk Category 
0 
Low 
1-2 
Intermediate-1 
3-4 
Intermediate-2 
5-6 
High 
Table 9: 
Risk Factors and Point Assignments for DIPSS 
Risk Factor 
Points Assigned 
Age older than 65 years 
1 
Presence of constitutional symptoms 
1 
Hemoglobin < 10 g/dL 
2 
WBC count > 25 × 109/L 
1 
Presence of peripheral blood blasts (lab value ≥ 1%) 
1 

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4. Evidence of need for treatment for MF (both a and b must be satisfied): 
a. Palpable spleen of ≥ 5 cm below the left costal margin on physical examination at the 
screening visit  
b. Active symptoms of MF at the screening visit, as demonstrated by the presence of a 
TSS of ≥ 10 using the Screening Symptom Form (see Appendix C). 
5. Participants with an ECOG performance status score of 0, 1, or 2 (see Appendix D). 
6. Screening bone marrow biopsy specimen and pathology report(s) available that was 
obtained within the prior 2 months or willingness to undergo a bone marrow biopsy at 
screening/baseline; willingness to undergo bone marrow biopsy at Week 24 and every 
24 weeks thereafter.  Screening/baseline biopsy specimen must show diagnosis of MF. 
7. Life expectancy of at least 24 weeks. 
8. Willingness to avoid pregnancy or fathering children based on the criteria below.  
a. Female participants without childbearing potential (ie, surgically sterile with a 
hysterectomy and/or bilateral oophorectomy OR ≥ 12 months of amenorrhea and at 
least 50 years of age) are eligible. 
b. Female participants with childbearing potential must have a negative serum 
pregnancy test at screening and negative urine pregnancy test before the first dose on 
Day 1 and must agree to take appropriate precautions to avoid pregnancy (with at 
least 99% certainty) from screening through safety follow-up.  Permitted methods that 
are at least 99% effective in preventing pregnancy (see Appendix A) should be 
communicated to the participant and their understanding confirmed. 
c. Male participants with childbearing potential must agree to take appropriate 
precautions to avoid fathering children (with at least 99% certainty) from screening 
through 93 days after the last dose of study drug and must refrain from donating 
sperm during this period.  Permitted methods that are at least 99% effective in 
preventing pregnancy (see Appendix A) should be communicated to the participant 
and their understanding confirmed. 
5.2. 
Exclusion Criteria 
Participants are excluded from the study if any of the following criteria apply: 
1. Prior use of any JAK inhibitor. 
2. Prior therapy with any drug that inhibits PI3K (examples of drugs targeting this pathway 
include but are not limited to INCB040093, idelalisib, duvelisib, buparlisib, copanlisib, 
and umbralisib). 
3. Use of experimental drug therapy for MF or any other standard drug (except 
hydroxyurea) used for MF or another indication within 3 months of starting study drug 
and/or lack of recovery from all toxicities from previous therapy to ≤ Grade 1.  
Hydroxyurea used for MF or another indication must be discontinued 3 weeks prior to 
starting study drugs (Day 1).  
4. Inability to swallow food or any condition of the upper gastrointestinal tract that 
precludes administration of oral medications. 

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5. Recent history of inadequate bone marrow reserve; examples include but are not limited 
to the following: 
a. Platelet count < 50 × 109/L in the 4 weeks before screening or at the screening 
laboratory assessment; or platelet transfusion(s) within 8 weeks before screening. 
b. Absolute neutrophil count < 0.5 × 109/L in the 4 weeks before screening or at the 
screening laboratory assessment. 
c. Peripheral blood blast count of ≥ 10% at the screening hematology assessment. 
6. Inadequate liver function at screening visit, as demonstrated by the following:  
a. Total bilirubin > 2.0 × ULN.  Note:  if total bilirubin is > 2.0 × ULN, the participant 
may enroll if the direct bilirubin is <2.0 × ULN.  
b. ALT or AST > 2.5 × ULN. 
7. Inadequate renal function at screening, as demonstrated by creatinine clearance 
≤ 50 mL/min estimated based on Cockcroft-Gault formula.  The cutoffs for mild, 
moderate, and severe renal insufficiency based on the Cockcroft-Gault formula are 60 to 
90 mL/min, 30 to 59 mL/min, and 0 to 29 mL/min, respectively.  If the investigator 
prefers, he/she may use measured creatinine clearance instead of estimated. 
8. Active bacterial, fungal, parasitic, or viral infection that requires therapy.  Participants 
with acute infections requiring treatment should delay screening/enrollment until the 
course of therapy has been completed and the event is considered resolved.  Prophylactic 
antibiotics or antivirals will be permitted. 
9. Active HBV or HCV infection that requires treatment or at risk for HBV reactivation.  
Hepatitis B virus DNA and HCV RNA must be undetectable upon testing.  At risk for 
HBV reactivation is defined as hepatitis B surface antigen positive or anti–hepatitis B 
core antibody positive.  Cytomegalovirus must be undetectable by polymerase chain 
reaction. 
10. Known HIV infection. 
11. Uncontrolled, severe, or unstable cardiac disease that in the investigator's opinion may 
jeopardize the safety of the participant or compliance with the Protocol. 
12. Active invasive malignancy over the previous 2 years except treated basal or squamous 
carcinomas of the skin, completely resected intraepithelial carcinoma of the cervix, and 
completely resected papillary thyroid and follicular thyroid cancers.  Participants with 
malignancies with indolent behavior such as prostate cancer treated with radiation or 
surgery may be enrolled as long as they have a reasonable expectation to have been cured 
with the treatment modality received. 
13. Splenic irradiation within 6 months before receiving the first dose of study drug.  
14. Concurrent use of any prohibited medications (see Section 6.8.5 for specific prohibited 
medications and the associated timeframe over which they are prohibited). 
15. Active alcohol or drug addiction that would interfere with the ability to comply with the 
study requirements. 

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16. Use of any potent CYP3A4 inhibitors or inducers within 14 days or 5 half-lives 
(whichever is longer) before the first dose of study drug or anticipated during the study. 
17. Inadequate recovery from toxicity and/or complications from a major surgery before 
starting therapy. 
18. Currently breastfeeding or pregnant. 
19. Any condition that would, in the investigator's judgment, interfere with full participation 
in the study, including administration of study drug and attending required study visits; 
pose a significant risk to the participant; or interfere with interpretation of study data. 
20. Inability to comprehend or unwilling to sign the ICF. 
21. History of Grade 3 or 4 irAEs from prior immunotherapy.   
a. Any irAEs of Grade 1 or 2 must be resolved before receiving the first dose of study 
drug. 
22. Receipt of any live vaccine within 30 days of the first dose of study drug. 
23. Unwillingness to receive RBC transfusions to treat low hemoglobin levels. 
24. Immediately eligible for allogeneic stem cell transplantation. 
25. Known hypersensitivity or severe reaction to parsaclisib or ruxolitinib or excipients of 
parsaclisib/matching placebo or ruxolitinib formulations. 
5.3. 
Lifestyle Considerations 
No restrictions are required. 
5.4. 
Screen Failures 
Screen failures are defined as participants who consent to participate in the clinical study but are 
not subsequently randomly assigned to study treatment/entered in the study. 
Results from the screening visit evaluations will be reviewed to confirm participant eligibility 
before enrollment/randomization or the administration of study drug.  Tests with results that fail 
eligibility requirements may be repeated once during screening if the investigator believes the 
results to be in error.  For screening assessments that are repeated, the most recent available 
result before randomization/treatment assignment will be used to determine participant 
eligibility. 
Additionally, a participant who fails screening may repeat the screening process 1 time if the 
investigator believes that there has been a change in eligibility status (eg, after recovery from an 
infection).  Participants who rescreen must reconsent and be assigned a new participant number. 
5.5. 
Replacement of Participants 
No participants will be replaced at any time during this study. 

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5.6. 
Data Monitoring Committee 
Preplanned analyses of safety and efficacy will be provided to an independent DMC as specified 
in the DMC charter.  The process by which the DMC will review data and make 
recommendations and decisions will be documented in the DMC charter.  The external DMC 
will also conduct the interim analyses (see Section 10.5).  
6. 
STUDY TREATMENT 
6.1. 
Study Treatments Administered 
Table 10 presents the study treatment information.

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Table 10: 
Study Treatment Information 
 
Study Treatment 1 
Study Treatment 2 
Reference (Background) Treatment 
Study treatment name: 
Parsaclisib 
 
Placebo 
 
Ruxolitinib 
 
Dosage formulation: 
Tablets 
Tablets 
Tablets 
Starting dose: 
5 mg QD without regard to food 
5 mg QD without regard to food 
5 mg BID if baseline platelet count is 
50 to < 100 × 109/L inclusivea; 15 mg 
BID if baseline platelet count is 
≥ 100 × 109/L; dosing is without regard 
to food 
Start day for dosing 
Day 1 
Day 1 
Day 1 
Time of dosing 
Morning 
Morning 
Morning/evening, approximately 
12 hours apart 
Unit dose strength(s)/ 
dosage level(s): 
5 mg tablets, 2.5 mg tablets, 1.0 mg 
tablets 
5 mg tablets, 2.5 mg tablets, 1.0 mg 
tablets 
5 mg tablets 
15 mg tablets (in some countries) 
Route, frequency of 
administration:  
Oral, QD 
Oral, QD 
Oral, BID 
Packaging and labeling: 
Parsaclisib will be provided in 
bottles. 
Each bottle will be labeled as 
required per country requirement. 
Placebo will be provided in bottles. 
Each bottle will be labeled as 
required per country requirement. 
Ruxolitinib will be provided in bottles, 
blister packs, or other packaging and 
will be labeled as required per country 
requirement. 
Storage Conditions 
Refer to the Pharmacy Manual. 
Refer to the Pharmacy Manual. 
Per labeling instructions. 
Status of treatment in 
participating countries: 
Experimental 
Not applicable 
Approved 
a If a baseline platelet count has decreased to < 50 × 109/L at baseline, the platelet count at screening should be used to determine the starting dose of ruxolitinib. 

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Note there is no order for the morning doses of parsaclisib/matching placebo and ruxolitinib.  
They may be taken together or in any order in the morning. 
6.2. 
Preparation, Handling, and Accountability 
The investigator, investigational drug storage manager (for Japan), or designee must confirm 
appropriate temperature conditions have been maintained during transit for all study treatments 
received and any discrepancies are reported and resolved before use of the study treatment. 
Only participants enrolled in the study may receive study treatment, and only authorized site 
staff may supply or administer study treatment.  All study treatment must be stored in a secure, 
environmentally controlled, and monitored (manual or automated) area in accordance with the 
labeled storage conditions with access limited to the investigator, investigational drug storage 
manager (for Japan), and authorized site staff. 
The investigator, investigational drug storage manager (for Japan), or designee is responsible for 
study treatment accountability, reconciliation, and record maintenance (ie, receipt, reconciliation, 
and final disposition records).  Inventory and accountability records must be maintained and 
readily available for inspection by the study monitor and are open to inspection at any time by 
any applicable regulatory authorities.  The investigator, investigational drug storage manager (for 
Japan), or designee must maintain records that document: 
• Delivery of study drug and reference treatment to the study site. 
• Inventory of study drug and reference treatment at the site. 
• Participant use of the study drug and reference treatment, including pill counts from 
each supply dispensed. 
• Return of study drug and reference treatment to the investigator, investigational drug 
storage manager (for Japan), or designee by participants. 
The investigational product must be used only in accordance with the Protocol.  The investigator 
(or investigational drug storage manager for Japan) will also maintain records adequately 
documenting that the participants were provided the specified study drug.  These records should 
include dates, quantities, and any available batch or serial numbers or unique code numbers 
assigned to the investigational product and study participants. 
Completed accountability records will be archived by the site.  The investigator, investigational 
drug storage manager (for Japan), or designee will be expected to collect and retain all used, 
unused, and partially used containers of study drug and reference treatment until verified by the 
study monitor (unless otherwise agreed to by the sponsor).  At the conclusion of the study, the 
investigator, investigational drug storage manager (for Japan), or designee will oversee shipment 
of any remaining study drug and reference treatment back to the sponsor or its designee for 
destruction according to institutional SOPs.  If local procedures mandate on-site destruction of 
the investigational supply, the site should (where local procedures allow) maintain the 
investigational supply until the study monitor inspects the accountability records in order to 
evaluate compliance and accuracy of accountability by the investigative site.  At sites where the 
study drug is destroyed before monitor inspection, the monitors rely on documentation of 
destruction per the site SOP. 

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Further guidance and information for the final disposition of unused study drug and reference 
treatment are provided in the Pharmacy Manual. 
Administration instructions for the participant are provided in Appendix H. 
6.3. 
Measures to Minimize Bias:  Randomization and Blinding 
This is a double-blind, placebo-controlled study.  Participants will receive ruxolitinib plus 
blinded study drug (parsaclisib or placebo).  Participants, investigators, and the sponsor will 
remain blinded to each participant's treatment assignment (Group A or Group B) throughout the 
study.  Emergency unblinding will occur if an AE requires the investigator to be made aware of 
the participant's treatment assignment (see emergency unblinding procedures in Section 9.6 and 
the Study Reference Manual).   
A sponsor-designated statistician (in-house or contract) who is not part of the study team will be 
unblinded and will provide summary aggregated data by treatment group to the DMC for 
scheduled interim analyses or other DMC meetings, but individual participant data will remain 
blinded. 
Block randomization with stratification for baseline platelet count (50 to < 100 × 109/L vs 
≥ 100 × 109/L) and DIPSS category (high vs intermediate-2 vs intermediate-1) will be used.  If a 
participant's platelet count is < 50 × 109/L at baseline, the platelet count at screening will be used 
for stratification/randomization.  Participants will be randomly assigned to either Group A or 
Group B.  All participants will be centrally assigned to study treatment using an IXRS.  
Randomization schedule will be generated by a sponsor-independent statistician and sent directly 
to the IXRS without provision to the sponsor.  Before the study is initiated, the telephone number 
and call-in directions for the IVRS and/or the log-in information and directions for the IWRS 
will be provided to each site.  Full details will be provided in the IXRS Manual. 
The primary endpoint, spleen volume as measured by MRI (or CT scan in applicable 
participants), will be assessed by a blinded central reader and reviewer. 
Study treatment will be dispensed at the study visits summarized in the SoA (see Table 3). 
Returned study treatment should not be redispensed to the participants. 
6.4. 
Dose and Requirement to Start Dosing After Crossover 
After criteria for crossover have been met (early or for entire study) and sites have received 
notification that unblinding and crossover may occur, the crossover visit will be scheduled and 
dosing with parsaclisib will begin as long as the following hematology criteria are met based on 
a laboratory visit within 2 weeks of the planned parsaclisib start date: 
• The platelet count is at least 50 × 109/L. 
• The ANC is at least 0.5 × 109/L. 
No more than 3 repeat assessments for platelet count and ANC are allowed.  Participants who 
have received 1 or more platelet transfusions must have a platelet count ≥ 50 × 109/L at least 
7 days after the most recent platelet transfusion to qualify for crossover.  Participants in whom 
the platelet count and/or ANC remain below these thresholds at the time of the later of 
(a) 4 weeks or (b) the next regularly scheduled study visit following the date at which it was 

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determined that crossover could occur will be discontinued from the study and that visit will 
constitute the EOT.   
The dose of parsaclisib will be 5 mg QD, taken in the morning, without regard to food.   
6.5. 
Study Treatment Compliance 
Compliance with all study-related treatments should be emphasized to the participant by the site 
personnel, and appropriate steps should be taken to optimize compliance during the study.   
Participants will complete daily dosing diaries (electronic or paper) and will bring them to each 
study visit.  Compliance with parsaclisib/matching placebo and with ruxolitinib administration 
will be calculated by the sponsor based on the drug accountability documented by the site staff 
and monitored by the sponsor/designee (tablet counts).  Participants will be instructed to bring all 
unused study drug with them to the study visits in order for site personnel to conduct tablet 
counts to assess study drug accountability.  The drug accountability documentation will be used 
by the sponsor to calculate treatment compliance. 
6.6. 
Dose-Limiting Toxicity and Determination of Maximum Tolerated 
Dose and/or Pharmacologically Active Dose 
Previously, the Phase 2 study INCB 50465-201 examined daily doses up to 20 mg for 8 weeks 
followed by doses up to 20 mg weekly or 5 mg daily.  Pharmacological activity was observed at 
all dose combinations with 8 weeks of daily dosing followed by continued daily dosing or 
weekly dosing, although activity appeared to diminish with time with weekly dosing.  
Dose-limiting toxicities were not observed in any dosing part of the study, and the maximum 
tolerated dose was not reached. 
6.7. 
Dose Modifications 
6.7.1. 
Dose Increases for Inadequate Efficacy 
6.7.1.1. 
Dose Increases for Parsaclisib  
The dose of parsaclisib (or matching placebo) will be 5 mg QD.  Dose increases are not allowed 
at any time during the study.  If a dose has been reduced due to AEs, the dose may be increased 
back to the original starting dose of 5 mg QD once safety has adequately resolved (see 
Section 6.7.2). 
6.7.1.2. 
Dose Increases for Ruxolitinib for Participants Entering the Study With a 
Platelet Count ≥ 100 × 109/L   
The initial dose of ruxolitinib will be 15 mg BID.  Dose increases are optional.  After the first 
4 weeks of therapy, doses may be increased by 5 mg BID for participants who demonstrate 
inadequate efficacy and who meet the following 3 conditions: 
1. Inadequate efficacy is demonstrated by palpable spleen length below the costal margin 
that has been reduced by < 50% at the Week 4 visit relative to baseline.  

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2. Platelet count at the Week 4 blood draw is > 125 × 109/L and platelet count has never 
been < 100 × 109/L at a prior laboratory evaluation since baseline. 
3. Absolute neutrophil count has remained > 0.75 × 109/L since baseline. 
A second dose increase may be instituted at Week 8 if these 3 criteria are still met (reference 
point is 8 weeks). 
No dose increases after Week 8 are allowed except dose increases related to a recovery from a 
prior dose reduction or hold.   
A dose increase at Week 4 does not mean an automatic dose increase at Week 8.  A dose not 
being increased at Week 4 because criteria were not met does not preclude a dose increase at 
Week 8 if criteria are met.   
The dose of ruxolitinib may never exceed 25 mg BID.   
6.7.1.3. 
Dose Increases for Ruxolitinib for Participants Entering the Study With a 
Platelet Count of 50 to < 100 × 109/L Inclusive   
The initial dose of ruxolitinib will be 5 mg BID.  Dose increases are optional.   
Starting at the Week 4 visit, doses of ruxolitinib may be increased in 5 mg QD increments up to a 
dose of 10 mg BID.  Dose increases may occur no more frequently than every 4 weeks and only 
if the following conditions are met: 
• Platelet count was always ≥ 40 × 109/L since the last scheduled study visit. 
• Platelet count, if decreased since the last scheduled study visit, was decreased by no 
more than 20% of the platelet count at the last scheduled visit. 
• No dose decreases or holds for safety occurred during the preceding 4-week interval. 
• Absolute neutrophil count has been  > 1.0 × 109/L since the last scheduled study visit. 
Doses may not exceed 10 mg BID except in participants who continue to meet the above 
dose-escalation criteria 
 
 while receiving 10 mg BID.  Such participants may continue dose escalation to a 
maximum dose of 15 mg BID.  Note that when a 5 mg QD increment is added, creating a 
regimen such as 5 mg/10 mg, the higher dose should be taken in the evening and the lower dose 
in the morning.  
Doses may never exceed 15 mg BID. 
No dose increases after Week 16 are allowed except for dose increases related to a recovery from 
a prior dose reduction or hold. 
6.7.2. 
Dose Decreases of Parsaclisib/Placebo for Toxicity 
Parsaclisib or matching placebo should be interrupted/decreased first, with no change to the 
ruxolitinib dosage.  Adjustments to ruxolitinib may be utilized if interruption/dose adjustment of 
parsaclisib or matching placebo does not lead to resolution or at least improvement of the AE 
within a 14-day period (see Section 6.7.7).  Treatment with parsaclisib or matching placebo may 
be delayed up to 2 weeks (14 days) to allow for resolution of toxicity.  Participants may resume 

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treatment if no medical condition or other circumstance exists that, in the opinion of the 
investigator, would make the participant unsuitable for further participation in the study.  The 
treating investigator should contact the sponsor to discuss the case of any participant whose 
treatment has been delayed for more than 14 days before restarting treatment with parsaclisib or 
matching placebo and/or ruxolitinib.  Adverse events that have a clear alternative explanation or 
transient (≤ 72 hours) abnormal laboratory values without associated clinically significant signs 
or symptoms may be exempt from dose-reduction rules.   
Table 11 shows dose-reduction and interruption guidelines for parsaclisib and matching placebo.  
Because participants may enter the study with extensive pretreatment and/or severe bone marrow 
infiltration by the primary disease, these dose-reduction rules are provided as guidelines (see 
Table 11).  Individual decisions regarding dose reduction/interruption should be made 
using investigator clinical judgment and in consultation with the sponsor's medical monitor 
in those cases where the guidelines will not be followed, taking into account relatedness of 
the AE to parsaclisib and the participant's underlying condition.  Available dose strengths 
for parsaclisib/matching placebo are shown in Table 12. 
Table 11: 
Guidelines for Interruption and Restarting of Parsaclisib/Matching Placebo 
Adverse Event 
Action Taken 
Chemistry 
• AST and/or ALT > 5.0 × ULN 
(Grade 3). 
 
Step 1:  Interrupt parsaclisib or matching placebo for up to 2 weeks 
(14 days) until the toxicity has resolved to ≤ Grade 1 except by 
approval of the medical monitor. 
Step 2:  Restart parsaclisib or matching placebo at the same dose.  
If assessed as related to parsaclisib or matching placebo, restart 
parsaclisib or matching placebo at the next lower dose; monitor as 
clinically indicated. 
Hematology 
• ANC < 1.0 × 109/L (Grade 3) unless 
because of underlying disease.  Applies 
only if this represents a worsening grade 
from baseline. 
• Platelet count ≥ 25 × 109/L and 
< 40 × 109/L.  Applies only if this 
represents a worsening grade from 
baseline. 
Step 1:  Interrupt parsaclisib or matching placebo for up to 2 weeks 
(14 days) until the toxicity has resolved to ≤ Grade 1 or pretherapy 
baseline. 
Step 2:  Restart parsaclisib or matching placebo at the same dose 
and monitor as clinically indicated. 
• Grade 4 ANC (< 0.5 × 109/L) regardless 
of baseline grade. 
• ≥ Grade 3 ANC with temperature of at 
least 38.5°C OR with ≥ Grade 3 
infection regardless of baseline grade. 
• Platelet count is < 25 × 109/L (Grade 4), 
regardless of baseline grade. 
Step 1:  Interrupt parsaclisib or matching placebo for up to 2 weeks 
(14 days) until the toxicity has resolved to ≤ Grade 1 or pretherapy 
baseline. 
Step 2:  Restart parsaclisib or matching placebo at the next lower 
dose; monitor as clinically indicated.  Escalate to original dose with 
recovery to preinterruption levels of analyte.   
Nonhematologic toxicities 
• Diarrhea/colitis (Grade 1) 
Step 1:  Treat with antimotility agents (eg,  loperamide) and initiate 
supportive care.  If not improved after 48 hours, treat per guidance 
for Grade ≥ 2. 

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Table 11: 
Guidelines for Interruption and Restarting of Parsaclisib/Matching Placebo 
(Continued) 
Adverse Event 
Action Taken 
• Diarrhea/colitis (Grade 2) 
Step 1:  Interrupt parsaclisib or matching placebo.  Perform 
workup for infection (including CMV, Clostridium difficile, etc) 
immediately.  Initiate or continue supportive care.  Monitor 
approximately every 48 hours until resolution. 
Step 2:  If improved within 48 hours and/or infection* is 
confirmed, restart parsaclisib/matching placebo at the same 
schedule and dose after resolved to ≤ Grade 1 and continue to 
monitor. 
*For infectious diarrhea/colitis, follow institutional standard of care 
guidelines and restart parsaclisib/matching placebo according to 
clinical judgment after resolved to ≤ Grade 1.  Consult with 
medical monitor if needed. 
Step 3:  If not improved within 48 hours and infection is ruled out, 
start oral steroids or consider IV steroids if participant is being 
given IV fluids.  If no improvement with oral steroids, switch to IV 
steroids. 
Step 4:  When diarrhea resolves to ≤ Grade 1, continue supportive 
care and taper steroids according to institutional standard of care.  
When taper is complete (eg, no steroid or ≤ 10 mg/day prednisone 
or equivalent) and diarrhea is ≤ Grade 1, restart 
parsaclisib/matching placebo at the next lower dose with approval 
of the medical monitor. 
Step 5:  If Grade 2 diarrhea reoccurs, treat per guidance for 
diarrhea (≥ Grade 3)/noninfectious colitis. 
Step 6:  If  ≥ Grade 2 diarrhea reoccurs a third time, permanently 
discontinue parsaclisib/matching placebo. 
• Diarrhea (≥ Grade 3) 
Noninfectious colitis (any grade;  
confirmed or suspected) 
Step 1:  Interrupt parsaclisib.  Perform workup for infection 
(including CMV, C difficile, etc) immediately.  Initiate or continue 
supportive care (see Section 6.7.3).  Consider colonoscopy with 
biopsy for diarrhea ≥ Grade 3 and/or if symptoms suggestive of 
colitis (diarrhea accompanied by abdominal pain and/or mucus or 
blood in stool).  Monitor every 48 hours until resolution. 
Step 2:  If infection* is ruled out, start oral steroids or consider IV 
steroids if participant is being given IV fluids.  If no improvement 
with oral steroids within 48 hours, switch to IV steroids. 
*For infectious diarrhea/colitis, follow institutional standard of care 
guidelines and restart parsaclisib according to clinical judgment 
after resolved to ≤ Grade 1.  Consult with medical monitor if 
needed. 
Step 3:  When diarrhea/colitis resolves to ≤ Grade 1, continue 
supportive care and taper steroids according to institutional 
standard of care.  When taper is complete (eg, no steroid or 
≤ 10 mg/day prednisone or equivalent) and diarrhea/colitis is 
≤ Grade 1, restart parsaclisib with approval of the medical monitor.  
Continue to monitor. 
Step 4:  If ≥ Grade 3 diarrhea or noninfectious colitis (any grade) 
reoccurs, permanently discontinue parsaclisib/placebo. 

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Table 11: 
Guidelines for Interruption and Restarting of Parsaclisib/Matching Placebo 
(Continued) 
Adverse Event 
Action Taken 
• Pneumonitis (Grade 1) 
Step 1:  Interrupt parsaclisib or matching placebo until the toxicity 
has resolved.   
Step 2:  Restart parsaclisib or matching placebo at the next lower 
dose.  Monitor as clinically indicated. 
• Pneumonitis (≥ Grade 2) 
Permanently discontinue parsaclisib or matching placebo. 
• Skin toxicity (eg, rash, pruritus, etc, 
unless otherwise specified) (Grade 2-3) 
Step 1:  Interrupt parsaclisib or matching placebo until the toxicity 
has resolved to ≤ Grade 1. 
Step 2: Restart parsaclisib or matching placebo at the same dose.  
If assessed as related to parsaclisib or matching placebo, restart at 
the next lower dose. 
• Exfoliative dermatitis (Grade 1) 
Step 1:  Interrupt parsaclisib or matching placebo until the toxicity 
has resolved. 
Step 2:  Restart parsaclisib or matching placebo at the next lower 
dose.  Monitor as clinically indicated. 
• Exfoliative dermatitis (≥ Grade 2) 
Permanently discontinue parsaclisib or matching placebo. 
• Intestinal perforation (any grade) 
Permanently discontinue parsaclisib or matching placebo. 
• PJP 
Interrupt parsaclisib or matching placebo.  Permanently discontinue 
parsaclisib or matching placebo if PJP is confirmed. 
• CMV infection 
Participants with CMV viremia without associated clinical signs of 
CMV infection should be carefully monitored.  Consider 
interrupting parsaclisib or matching placebo for participants with 
CMV viremia and clinical signs of infection until the infection has 
resolved.  Restart parsaclisib or matching placebo reduced by 
1 dose level if approved by the medical monitor. 
• Varicella zoster infection 
Interrupt parsaclisib or matching placebo.  Restart parsaclisib or 
matching placebo only by approval of the medical monitor. 
• Any Grade 1 or Grade 2 toxicity unless 
otherwise specified. 
Continue parsaclisib or matching placebo treatment and treat the 
toxicity; monitor as clinically indicated. 
• Any Grade 3 toxicity, if clinically 
significant and not manageable by 
supportive care unless otherwise 
specified. 
Step 1:  Interrupt parsaclisib or matching placebo for up to 2 weeks 
(14 days) until toxicity resolves to ≤ Grade 1. 
Step 2:  Restart parsaclisib or matching placebo at the same dose.  
If assessed as related to parsaclisib or matching placebo, restart at 
the next lower dose.  If interrupted for > 14 days, contact the 
medical monitor for approval to restart parsaclisib or matching 
placebo.  Monitor as clinically indicated. 
• Any recurrent Grade 3 toxicity after 
2 dose reductions. 
Discontinue parsaclisib or matching placebo administration and 
follow-up per Protocol.  Exceptions require approval of sponsor. 
• Any other Grade 4 toxicity. 
Discontinue parsaclisib or matching placebo administration and 
follow-up per Protocol.  Exceptions require approval of sponsor. 

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Table 12: 
Dose Strengths for Parsaclisib/Matching Placebo 
Current Dose Level 
Dose After 1 Reduction 
Dose After 2 Reductions 
5 mg QD 
2.5 mg QD 
1 mg QD 
2.5 mg QD 
1 mg QD 
Contact medical monitor 
1 mg QD 
Contact medical monitor 
Contact medical monitor 
6.7.3. 
Supportive Care for Diarrhea/Colitis 
Participants should be informed to immediately report to the investigator any event of diarrhea.  
Participants should receive appropriate supportive care measures as deemed necessary by the 
investigator.  For any ≥ Grade 1 diarrhea, participants should be advised to drink liberal 
quantities of clear fluids.  If sufficient oral fluid intake is not feasible, fluid and electrolytes 
should be substituted via IV infusion.  Participants should try to eat 5 to 6 small meals per day; 
low-fat, high-protein foods; and cooked instead of raw vegetables.  Participants may supplement 
their diet with bananas, rice, applesauce, and toast to reduce the number of bowel movements 
and may also try crackers, gelatin, noodles, or oatmeal.  Participants should avoid fried, fatty, 
greasy, or spicy foods; milk, milk products, and acidic drinks; high-fiber foods and foods that 
cause gas; and alcohol, caffeine, and herbal supplements (Coutré et al 2015). 
For each occurrence, attempts should be made to rule out other causes, such as metastatic disease 
or bacterial or viral infection (including CMV), which might require additional supportive care. 
It may be necessary to perform conditional procedures such as colonoscopy with biopsy as part 
of evaluation of the event.  Note that several courses of steroid tapering may be necessary 
because symptoms may worsen when the steroid dose is decreased. 
Participants should be carefully monitored for signs and symptoms of enterocolitis (such as 
diarrhea, abdominal pain or cramping, and blood or mucus in stool, with or without fever) and of 
bowel perforation (such as peritoneal signs and ileus). 
6.7.4. 
Follow-Up for Immune-Related Adverse Events 
An AE with a potential immunologic etiology, or an irAE, may be defined as an AE consistent 
with an immune phenomenon associated with study drug exposure after all other etiologies have 
been eliminated.  Immune-related AEs may be expected based on previous experience with 
parsaclisib and other drugs (eg, idelalisib) that inhibit PI3Kδ.  Special attention should be paid to 
AEs that may be suggestive of potential irAEs.  Based on emerging data from the ongoing 
parsaclisib clinical program (parsaclisib IB), most irAEs occur after the first 9 weeks of study 
drug administration.  However, an irAE could occur at any time.  Suspected irAEs should be 
discussed with the medical monitor when possible. 
Participants should receive appropriate supportive care measures as deemed necessary by the 
treating investigator.  Suggested supportive care measures for the management of drug-related 
AEs with potential immunologic etiology are outlined in Table 11.  For each AE, attempts 
should be made to rule out other causes, including but not limited to metastatic disease or 
bacterial or viral infection, which might require specific supportive care. 

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6.7.5. 
COVID-19 
Infection with SARS-CoV-2, the coronavirus that causes COVID-19, is more frequent and 
severe in patients with hematologic dysfunction (Jee et al 2022).  The presence of hematologic 
malignancy, baseline neutropenia and lymphopenia, B-cell depletion, and other factors have been 
identified as risk factors for loss of humoral immunity to COVID-19, poor vaccine response, 
viral persistence, and severe disease (Lee et al 2022, Lyudovyk et al 2022, Shree et al 2022).  
Targeting B-cell function, proliferation, and survival with various therapies are current strategies 
for improving the outcome of several hematologic malignancies.  PI3Kδ inhibition with 
parsaclisib alone or in combination with other therapies, which may also suppress humoral 
immunity, has the potential to negatively impact SARS-CoV-2 infection risk, vaccine 
effectiveness, recovery from COVID-19, and disease severity (Cheson 2022).  Investigators and 
participants in trials of parsaclisib, alone or in combination, need to be aware of these potential 
risks and consider the local standards of care and available therapies for disease prevention, 
vaccination, and infection management of COVID-19. 
6.7.6. 
Criteria for Permanent Discontinuation of Parsaclisib/Matching Placebo 
The occurrence of unacceptable toxicity not caused by the underlying disease will be presumed 
to be related to study drug treatment and will require that the study drug be permanently 
discontinued.  Unacceptable toxicity is defined as follows: 
• Occurrence of an AE that is related to treatment with the study drug that, in the 
judgment of the investigator or the sponsor's medical monitor, compromises the 
participant's ability to continue study-specific procedures or is considered to not be in 
the participant's best interest. 
• An AE requiring more than 2 dose reductions. 
• Persistent AE requiring a delay of therapy for more than 2 weeks (14 days) unless a 
greater delay has been approved by the sponsor. 
See Section 7.1.2 for discontinuation procedures. 
6.7.7. 
Dose Decreases of Ruxolitinib for Safety 
Dose modifications/interruptions of ruxolitinib because of toxicity are not required unless 
parsaclisib modifications/interruptions have been first implemented for 14 days with no 
improvement in toxicity grade.  Doses of ruxolitinib may be modified/interrupted earlier if the 
study investigator deems this necessary.  Dose interruptions and modifications for ruxolitinib 
because of hematologic toxicity that continues after interruption of INCB050465 are shown in 
Table 13.  

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Table 13: 
Dose Reductions/Interruptions and Restarts for Hematologic Toxicities That 
Persist for > 14 Days After Interruption of Parsaclisib 
ANC 
(× 109/L) 
 
Platelet Count 
(× 109/L) 
Dose of Ruxolitinib 
Value 
CTCAE 
Grade 
Value 
CTCAE 
Grade 
0.5 to < 1.0 
3 
or 
25 to < 40 
Below 
UL of 
Grade 3 
If Grade 3 cytopenia persists for > 14 days after interrupting 
parsaclisib/matching placebo or if the primary investigator deems 
that earlier interruption of ruxolitinib is necessary, then 
ruxolitinib will be interrupted until the toxicity is resolved to 
≤ Grade 1 or pretherapy baseline and then restarted at the current 
dose.  If a Grade 3 event recurs and persists for > 14 days after 
interrupting parsaclisib/matching placebo or if the primary 
investigator deems that earlier interruption of ruxolitinib is necessary, 
then ruxolitinib will be interrupted and the restart dose (after 
recovery to ≤ Grade 1 or pretherapy baseline) of ruxolitinib will be 
1 dose level (5 mg BID less) lower than the dose that resulted in the 
cytopenia.  A participant who was taking 5 mg BID will restart at 
5 mg QD. 
< 0.5 
4 
or 
< 25 
4 
If Grade 4 thrombocytopenia or neutropenia occurs and persists for 
> 14 days after interrupting parsaclisib/matching placebo or if the 
primary investigator deems that earlier interruption of 
ruxolitinib is necessary, then ruxolitinib will be interrupted until 
toxicity is resolved to ≤ Grade 1 or pretherapy baseline and the restart 
dose will be 1 dose level (5 mg BID less) lower than the dose that 
resulted in the cytopenia.  A participant who was taking 5 mg BID 
ruxolitinib will restart at 5 mg QD.   
Neutropenic fever 
If neutropenia (ANC < 1.0) persists for > 14 days after interrupting 
parsaclisib/matching placebo or if the primary investigator deems 
that earlier interruption of ruxolitinib is necessary, then ruxolitinib 
will be interrupted until recovery of ANC to ≥ 1.0 × 109/L and the 
restart dose will be 1 dose level (5 mg BID less) lower than the dose 
that resulted in the cytopenia. 
6.8. 
Concomitant Medications and Procedures 
All concomitant medications and treatments (including over-the-counter or prescription 
medicines, vitamins, vaccines, and/or herbal supplements) must be recorded in the eCRF.  Any 
prior medication received up to 30 days before the first dose of study treatment and 30 to 35 days 
after the last dose of study treatment, or until the participant begins a new MF therapy, 
whichever occurs first, will be recorded in the eCRF.  Any addition, deletion, or change in the 
dose of these medications will also be recorded.  Concomitant medications administered after the 
last dose of study treatment should be recorded for SAEs as defined in Section 9.2.  Prior 
medication history for MF should be entered in its entirety, as well as complete ruxolitinib 
dosing history.   
6.8.1. 
Permitted Medications 
Concomitant treatments/procedures that are required to manage a participant's medical condition 
during the study will also be recorded in the eCRF.  The medical monitor should be contacted if 
there are any questions regarding concomitant or prior therapy for conditions other than MF. 

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6.8.2. 
Pneumocystis jirovecii Pneumonia Prophylaxis 
All participants receiving combination study treatment with parsaclisib/matching placebo and 
ruxolitinib are required to receive a standard PJP prophylaxis regimen determined by the 
investigator.  Examples of standard PJP prophylaxis therapies for this population include 
trimethoprim-sulfamethoxazole, atovaquone, diaminodiphenylsulfone (Dapsone) with or without 
pyrimethamine, and pentamidine (National Comprehensive Cancer Network 2017).  Note:  In 
Japan, diaminodiphenylsulfone and pentamidine are not approved for PJP prophylaxis, thus these 
will not be used.  Participants with sulfonamide allergy should be treated with either inhaled 
pentamidine or atovaquone for PJP prophylaxis; diaminodiphenylsulfone should not be used in 
such participants.  Prophylaxis should be given while participants are receiving parsaclisib and 
continue for 2 to 6 months after the last dose of study treatment.  Prophylaxis may be started as 
soon as the baseline visit but no later than Day 1 of the study. 
6.8.3. 
Use of Growth Factors such as Erythropoietin 
Hematopoietic growth factor receptor agonists (eg, erythropoietin, granulocyte-colony 
stimulating factor, romiplostim, eltrombopag) are strongly discouraged.  Ruxolitinib may 
interfere with efficacy of growth factors, and they may cause an increase in spleen size. 
6.8.4. 
Restricted Medications and Procedures 
• Aspirin in doses exceeding 125 mg/day is not permitted.  Low-dose aspirin 
(≤ 125 mg/day) is permitted. 
• Caution should be used when administering ibuprofen or other nonsteroidal 
anti-inflammatory drugs.   Systemic corticosteroid doses less than or equal to the 
equivalent of 10 mg prednisolone per day are permitted, and higher dosages are not 
allowed.  Participants should be monitored closely for toxicity, especially for 
myelosuppression and renal and gastrointestinal toxicity. 
• Inducers of CYP3A4 may be used with caution, and investigators should seek other 
options if available (see Appendix G). 
• Moderate CYP3A4 inhibitors may be used with caution.  Differences in individual 
sensitivity and variation in potency of inhibition of various CYP enzymes may result 
in the need for a reduced dose of ruxolitinib during a period of concomitant 
medication use.  If required for safety, the dose of ruxolitinib may be reduced from 
BID to QD in these circumstances; this should be clearly documented in the treating 
physician's notes.  The sponsor's medical monitor may be consulted for advice when 
using these agents. 
If concomitant administration of an anticoagulant/antiplatelet medication is indicated, then 
caution and enhanced monitoring is required.  History of thrombocytopenia and any concurrent 
ruxolitinib-related thrombocytopenia should be a factor in the choice of anticoagulant and dose. 

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6.8.5. 
Prohibited Medications and Procedures 
The following medications are prohibited during the treatment and maintenance portions of the 
study (see also Jakafi 2021 and Jakavi 2022): 
• Any concurrent MF therapy other than that specified in the Protocol. 
• Use of experimental drug therapy for MF or any other standard drug (except 
hydroxyurea) used for MF or another indication within 3 months of starting study 
drugs (ie, Day 1).  Hydroxyurea used for MF or another indication must be 
discontinued 3 weeks prior to starting study drugs (ie, Day 1).  
• Any investigational medication (for a non-MF indication) within 28 days or 
5 half-lives, whichever is longer, before the first dose of study drug and at any time 
before complete withdrawal from the study. 
• Use of potent inhibitors of CYP3A4 (eg, ketoconazole, clarithromycin, itraconazole, 
nefazodone or telithromycin, voriconazole or posaconazole); ketoconazole may be 
used with caution if other options are not available.  Based on the low overall 
bioavailability of topical ketoconazole, there are no restrictions on topical 
ketoconazole in the study. 
• Any live vaccine beginning 30 days before the first dose of study drug through the 
safety follow-up visit. 
6.9. 
Treatment After Week 24 
After 24 weeks, participants will enter the extension period of the study.  Treatment will 
continue as long as the regimen is tolerated and the participant does not meet discontinuation 
criteria.  Participants randomized to placebo will have the opportunity to cross over to receive 
parsaclisib (together with continued ruxolitinib) after the last randomized participant has reached 
Week 24 and all relevant data are entered and cleaned.  These crossover participants may also 
continue as long as the regimen is tolerated and they do not meet discontinuation criteria.  It is 
anticipated that individual participants will continue in the study for approximately 3 years.  
Extension studies may be implemented for continued access to study treatment. 

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7. 
DISCONTINUATION OF STUDY TREATMENTS AND 
PARTICIPANT WITHDRAWAL 
7.1. 
Discontinuation of Study Treatment 
7.1.1. 
Reasons for Discontinuation 
Participants must be discontinued from study treatments (parsaclisib/matching placebo and 
ruxolitinib) for the following reasons: 
• The participant becomes pregnant. 
• Consent is withdrawn.   
Note:  Consent withdrawn means that the participant has explicitly indicated that 
he/she does not want to be followed any longer; in this case, no further data, except 
data in the public domain, may be solicited from or collected on the participant.  
Participants may choose to discontinue study treatment and remain in the study to be 
followed for progression and survival. 
• Further participation would be injurious to the participant's health or well-being, in 
the investigator's medical judgment. 
• Unacceptable toxicity, such as noted in Section 6.7.2. 
• The study is terminated by the sponsor. 
• The study is terminated by the local health authority, IRB, or IEC. 
A participant may be discontinued from study drug and reference treatment as follows: 
• If a participant is noncompliant with study procedures or study drug/treatment 
administration in the investigator's opinion, the sponsor should be consulted for 
instruction on handling the participant. 
7.1.2. 
Discontinuation Procedures 
The decision to discontinue study treatment and reference treatment will not constitute study 
withdrawal or study completion.  In the event that the decision is made to discontinue study 
treatment and reference treatment, the treatment portion will be considered complete and the 
follow-up part of the study will begin. 
If a participant is discontinued from study treatment: 
• The study monitor or sponsor must be notified. 
• The reason(s) for discontinuation must be documented in the participant's medical 
record and the primary reason for discontinuation must be included in the eCRF. 
• The EOT visit should be performed and date recorded. 
• The last date of the last dose of study drug/reference treatment will be recorded in the 
eCRF. 
• The status of the participant should be updated to EOT in the IXRS. 

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• Participants must be followed for safety until the time of the follow-up visit or until 
study drug/reference treatment–related toxicities resolve, return to baseline, or are 
deemed irreversible, whichever is longest. 
• Participants will be followed for subsequent MF treatment regimens and survival via 
periodic telephone contact.  Results of these contacts will be recorded in the eCRF. 
If the participant discontinues study treatment/reference treatment and actively withdraws 
consent for collection of follow-up data (safety follow-up or disease assessment), then no 
additional data collection should occur; however, participants will have the option of 
withdrawing consent for study treatment/reference treatment and further assessments but 
allowing survival follow-up. 
7.2. 
Participant Withdrawal From the Study 
A participant may withdraw from the study at any time at his/her own request, or may be 
withdrawn at any time at the discretion of the investigator for safety, behavioral, compliance, or 
administrative reasons. 
If the participant withdraws consent for disclosure of future information, the sponsor may retain 
and continue to use any data collected before such a withdrawal of consent. 
If a participant withdraws from the study, he/she may request destruction of any samples taken 
and not tested, and the investigator must document this in the site study records. 
See Table 3 and Table 5 for data to be collected at the time of study withdrawal and follow-up 
and for any further evaluations that need to be completed. 
7.3. 
Lost to Follow-Up 
A participant will be considered lost to follow-up if he/she repeatedly fails to return for 
scheduled visits and is unable to be contacted by the study site. 
The following actions must be taken if a participant fails to return to the clinic for a required 
study visit: 
• The site must attempt to contact the participant and reschedule the missed visit as 
soon as possible and counsel the participant on the importance of maintaining the 
assigned visit schedule and ascertain whether or not the participant wishes to and/or 
should continue in the study. 
• Before a participant is deemed lost to follow-up, the investigator or designee must 
make every effort to regain contact with the participant (where possible, 3 telephone 
calls and, if necessary, a certified letter to the participant's last known mailing address 
or local equivalent methods).  These contact attempts should be documented in the 
participant's medical record. 
• Should the participant continue to be unreachable, he/she will be considered to have 
withdrawn from the study. 

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8. 
STUDY ASSESSMENTS AND PROCEDURES 
All assessments mandated throughout the study must be performed on a calendar schedule; 
delays in treatment administration will not delay performance of study visits, laboratory-only 
visits, or assessments (except 
 
 because participant accidentally took the study drugs in the morning of the 
study visit at Week 2 or 4; see Section 8.4.1).  
8.1. 
Administrative and General Procedures 
8.1.1. 
Informed Consent Process 
• The investigator or his/her representative will explain the nature of the study to the 
participant or his/her legally authorized representative and answer all questions 
regarding the study. 
− Informed consent must be obtained before any study-related procedures are 
conducted, unless otherwise specified by the Protocol. 
− Informed consent must be obtained using the IRB/IEC-approved version in a 
language that is native and understandable to the participant.  A template will be 
provided by the sponsor or its designee.  The sponsor or its designee must review 
and acknowledge the site-specific changes to the ICF template.  The ICF must 
include a statement that the sponsor or its designee and regulatory authorities have 
direct access to participant records. 
− The ICF must contain all required elements and describe the nature, scope, and 
possible consequences of the study in a form understandable to the study 
participant. 
• Participants must be informed that their participation is voluntary.  Participants or 
their legally authorized representative will be required to sign a statement of informed 
consent that meets the applicable requirements and regulations for the country(ies) in 
which the study is being conducted as well as the IRB/IEC or study center. 
• The participant must be informed that his/her personal study-related data will be used 
by the sponsor in accordance with local data protection laws.  The level of disclosure 
must also be explained to the participant. 
• The participant must be informed that his/her medical records may be examined by 
Clinical Quality Assurance auditors or other authorized personnel appointed by the 
sponsor, by appropriate IRB/IEC members, and by inspectors from regulatory 
authorities. 
• The medical record must include a statement that written informed consent was 
obtained before the participant was enrolled in the study and the date the written 
consent was obtained.  The authorized person obtaining the informed consent must 
also sign the ICF. 
• Participants must provide consent to the most current version of the ICF during their 
participation in the study. 

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• A copy of the ICF(s) must be provided to the participant or the participant's legally 
authorized representative. 
• Participants who are rescreened are required to sign a new ICF. 
8.1.2. 
Screening Procedures 
Screening is the interval between signing the ICF and the beginning of the 7-day baseline period 
(ie, Day –35 to Day –7).  Screening may not exceed 28 days.  Assessments that are required to 
demonstrate eligibility may be performed over the course of 1 or more days during the screening 
process.  Assessments to be performed are indicated in Table 3. 
Participants should arrive for the screening visit after an overnight fast (no food or liquid except 
water) of at least 8 hours or since midnight.  A participant who has not fasted should be 
scheduled for the screening blood draws on a morning when he/she can arrive after an overnight 
fast of at least 8 hours.  For participants who are randomized into the study,  information 
associated with eligibility requirements must be entered into the appropriate eCRF pages. 
Procedures conducted as part of the participant's routine clinical management and obtained 
before signing of the ICF may be used for screening provided that the procedure meets the 
Protocol-defined criteria and has been performed in the timeframe of the study (ie, up to 35 days 
before Day 1). 
Bone marrow biopsy and aspirate collection for confirmation of MF diagnosis and degree of 
fibrosis must be performed at the screening or baseline visit intervals.  Note:  Participants may 
use a historical biopsy obtained within 2 months before screening as long as a written report 
showing the diagnosis is available along with biopsy/aspirate samples.  Participants without a 
prior biopsy report and biopsy/aspirate as indicated in the preceding text must have a biopsy at 
screening/baseline in order to participate in the study.  The prior data or the newly obtained data 
must be entered into the eCRF. 
Results from the screening visit evaluations will be reviewed to confirm eligibility before 
enrollment/randomization or the administration of study drug and reference treatment.  Tests 
with results that fail eligibility requirements may be repeated once during screening if the 
investigator believes the results to be in error.  For screening assessments that are repeated, the 
most recent available result before randomization/treatment assignment will be used to determine 
eligibility.  Treatment should start as soon as possible but within 3 days after the date of 
enrollment/randomization. 
See Sections 5.4 and 5.5 for information regarding screen failures and replacement of 
participants, respectively. 
8.1.3. 
Baseline 
Participants who have signed the ICF and meet all of the inclusion criteria (see Section 5.1) and 
none of the exclusion criteria (see Section 5.2) may be enrolled in the study and will be contacted 
by clinical site staff to schedule the baseline visit.  The baseline interval corresponds to the 
7 days before initiating treatment with parsaclisib/matching placebo plus ruxolitinib and during 
which the baseline MRI (or CT scan in applicable participants) and symptom diary will be 
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• The MFSAF v4.0 diary should be distributed.  Participants will be issued a handheld 
device and will complete the diary questions each night beginning on Day –7 up to 
the Week 24 visit. 
• The MRI (or CT scan in applicable participants) should be conducted on the first or 
second day of the baseline interval to allow ample time for the laboratory to verify 
scan quality. 
• To ensure per-protocol imaging completions, all MRI (or CT) scans for the study 
should be scheduled if possible to avoid missing scans at later timepoints in the study.  
• Baseline laboratory samples should be collected within 3 days of projected Day 1 to 
avoid repeating on Day 1.  Baseline platelet count values will be used for 
stratification/randomization.  Note that platelet count at baseline for a participant with 
a screening value of ≥ 50 × 109/L may have decreased below 50 × 109/L.  For such 
participants, the screening value for platelet count will be used for 
stratification/randomization.   
8.1.4. 
Interactive Response Technology Procedure 
The IXRS will be accessed to obtain a participant ID number when a participant enters the 
screening portion of the study.  After determining that the participant is eligible for study entry 
and the participant has entered the baseline interval and is completing the daily diary for 
symptoms, using the platelet value determined at baseline, the IXRS will be contacted to obtain 
treatment group assignment and study drug assignment.  The IXRS will be contacted at each 
regular study visit, except for the end of Week 2 visit, to update the study drug supply and at 
EOT (see Table 3 and Table 4).  Full details will be provided in the IXRS Manual. 
8.1.5. 
Distribution of Reminder Cards 
Participants will be provided with a reminder card at each visit.  The reminder card will indicate 
the date/time of the next visit and will also remind the participant that they should not take their 
morning dose of study drug or reference treatment (ruxolitinib) on the day of the study visit.  The 
reminder card will also indicate to arrive after an overnight fast (no food or liquid except water) 
of at least 8 hours for the visits at screening, Week 12, Week 24, the extension visits every 
12 weeks thereafter, and the EOT visit, since blood samples for lipid profile will be drawn at 
these visits.   Laboratory-only visits do not require overnight fasting or holding of morning doses 
of parsaclisib/matching placebo or ruxolitinib.  Space will be provided on the reminder card for 
the Week 2 and Week 4 visits to record the time of the prior evening dose of ruxolitinib. 
8.1.6. 
Prior and Concomitant Medications 
Prior and concomitant medications and procedures will be reviewed to determine participant 
eligibility.  All concomitant medications and measures must be recorded in the CRF, and any 
medication received or procedure performed within 30 days before the first dose of 
parsaclisib/matching placebo plus ruxolitinib and up to the end of study will be recorded in the 
eCRF.  The medication record will be maintained after signing the ICF to document concomitant 
medications, including any changes to the dose or regimen.  Concomitant medications include 
any prescription, over-the-counter, or natural/herbal preparations taken or administered during 

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the study period.  Concomitant treatments and/or procedures that are required to manage a 
participant's medical condition during the study will also be recorded in the eCRF. 
8.1.7. 
Demography and Medical History 
8.1.7.1. 
Demographics and General Medical History 
Demographic data and general medical history will be collected at screening by the investigator 
or qualified designee and will include year of birth/age, race, ethnicity, medical and surgical 
history, and current illnesses.  Medical history will include relevant medical or surgical treatment 
within the past 10 years that are considered to be clinically significant by the investigator. 
8.1.7.2. 
Disease Characteristics and Treatment History 
A disease-targeted medical and treatment history will be collected at screening.  Details 
regarding the participant's history of MF and other MPNs, including date of diagnosis, as well as 
relevant disease characteristics and prior treatments, including systemic treatments, radiation, 
and surgical procedures, will be recorded. 
8.1.7.3. 
Transfusion History Status 
All transfusions of RBC products or platelets from at least 12 weeks before the screening visit up 
to the first dose of study drugs will be recorded on the transfusion history page.  
 
 
 
 
8.1.7.4. 
Dosing Diary 
Diaries will be provided to the participant to record doses of parsaclisib and ruxolitinib taken 
each day.  Participant will bring the diaries with them to each study visit. 
8.1.7.5. 
Screening Symptom Form 
In order to satisfy inclusion criterion 4, active symptoms of MF at the screening visit as 
demonstrated by presence of a TSS ≥10 using the Screening Symptom Form (see Appendix C) 
will be recorded in the eCRF. 
8.1.8. 
Study Site Visit Coordination 
Participants will follow the study visit schedule shown in Table 3.  Unblinding and potential 
crossover for the entire study will occur after the last randomized participant has completed 
Week 24 and the data entered by all sites for all participants have been verified and cleaned 
through the Week 24 visit (including imaging).  If the planned crossover visit does not coincide 
with a regularly scheduled study visit, an additional study visit may be scheduled in order to 
perform visit assessments; the 4-week post-crossover visit will also need to be scheduled (see 
Table 4 for crossover visit and 4-week post-crossover visit assessments).   
For early unblinding/crossover, a regularly scheduled visit may be used once the process defined 
in Section 4.1.4 has been completed.  If the planned crossover visit does not coincide with a 
regularly scheduled study visit, an additional study visit may be scheduled in order to perform 

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visit assessments; the 4-week post–crossover visit will also need to be scheduled (see Table 4 for 
crossover visit and 4-week post–crossover visit assessments).   
8.2. 
Efficacy Assessments 
8.2.1. 
Bone Marrow Biopsy and Aspirate 
Bone marrow biopsy (and additional aspirate collection) will be collected at screening or 
baseline, at Week 24, and every 24 weeks thereafter.  Participants may use a historical biopsy 
obtained within 2 months before screening, and all data and reports and samples of 
biopsy/aspirate are available for investigator review.  The previous data will need to be entered 
into the eCRF for this study, with explanation as to the origin of the data (date of 
biopsy/aspirate).  Collection, processing, and staining of bone marrow samples will be performed 
in accordance with standard procedures at the investigative sites.  The bone marrow biopsy and 
aspirate should be assessed by an experienced hematopathologist using his/her standard 
examination; see Appendix I for a guide.  
 
.  Bone marrow and 
aspirate samples for central analysis will only be collected in designated countries.  The 
Laboratory Manual will provide instructions for preparing/shipping these samples. 
8.2.2. 
Spleen Palpation 
Spleen length will be assessed by manual palpation at every study visit (Day 1, Week 2, and 
laboratory-only visits not included) and will be used for routine participant management.  
Investigators will be provided with a soft centimeter ruler so that palpable spleen length is 
measured in centimeters and not in finger breadths.  The edge of the spleen shall be determined 
by palpation and measured in centimeters, using a soft ruler, from the costal margin to the point 
of greatest splenic protrusion.  Spleen length must be recorded in the eCRF. 
8.2.3. 
Imaging 
The primary measure of spleen volume will be by MRI (or CT scan in applicable participants).  
An MRI of the upper and lower abdomen and pelvis will be performed at baseline, Week 12, 
Week 24, and every 12 weeks thereafter through Week 144.  An MRI will be performed with a 
body coil because the objective is to measure organ volume rather than to find very small 
lesions.  MRIs will be read initially by local radiologists, who will be instructed to not provide a 
quantitative measure of spleen volume but may provide a qualitative assessment such as 
enlarged, smaller, larger, and so on.  However, should a quantitative result be provided to the 
investigator, this will not be considered a protocol violation, and the participant will still be 
evaluable.  The local radiologist should assess the scan for quality and send all scans (MRI or 
CT) to the central imaging laboratory the same day if at all possible.  The scans from an 
individual participant will be read by a central reader.  The central imaging laboratory 
radiologist(s) will be blinded to initial treatment assignment.  Spleen and liver volume will be 
obtained by outlining the circumference of the organ and determining the volume using the 
validated technique of least squares.  The MRI will not determine spleen length below the costal 
margin because there are no validated approaches for determining this measurement.  
Procedure-specific training for scanning and image capture will be provided by the vendor and in 
the Imaging Manual. 

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An MRI is the preferred method for obtaining spleen volume data.  However, CT scans may be 
performed at the visits where MRI is designated if the participant is not a candidate for MRI 
(eg, because of the presence of metal clips in the body, because of claustrophobia) or if MRI is 
not readily available.  CT scans will be similarly processed by the same central laboratory as 
used for MRIs.  Procedure-specific training for scanning and image capture will be provided by 
the vendor.  Note:  The same method (MRI vs CT) must be used for all visits for a given 
participant unless a new contraindication to the use of MRI occurs (eg, pacemaker insertion). 
8.2.4. 
Symptom Diary 
Symptoms of MF will be assessed using a symptom diary (MFSAF v4.0 diary).  Participants will 
be issued a handheld device on which to record answers to queries regarding MF symptoms.  
Symptoms assessed will include filling up quickly/early satiety, abdominal discomfort, 
abdominal pain, fatigue, night sweats, itching, and bone/muscle pain.  The MFSAF v4.0 diary 
will be completed by participants each night beginning at Day –7 (first day of baseline) and 
continuing to the Week 24 visit (25 weeks total).  Participants will bring the device to the study 
site at study visits on Day 1 and Weeks 4, 8, 12, 16, and 20, so that the device charging can be 
verified and the accumulated data can be downloaded.  Note:  Participants who will have 
overnight stays associated with their study visit must also bring their docking station so that their 
device can be fully charged at all times and so that they can complete the evening diary entries.  
The device will then be returned to the participant at these same visits for continued use each 
night.  The participant will return the device and the docking station for the final time at the 
Week 24 visit so that the data can be archived.  Detailed directions for the administration of the  
MFSAF v4.0 diary will be provided in a reference manual.  Translations of the MFSAF v4.0 
diary will be available. 
8.2.6. 
Eastern Cooperative Oncology Group Status 
The ECOG performance status score (see Appendix D) will be required at screening to evaluate 
eligibility 
 
 
 
 
 
 
  
 
 
 

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8.2.13. 
Health Economics 
Not applicable. 
8.3. 
Safety Assessments 
8.3.1. 
Adverse Events 
Adverse events will be monitored from the time the participant signs the ICF until at least 30 to 
35 days after the last dose of study drug (parsaclisib/placebo).  Adverse events that begin or 
worsen after informed consent should be recorded on the Adverse Events Form in the eCRF 
regardless of the assumption of a causal relationship with the study treatment.  Conditions that 
were already present at the time of informed consent should be recorded on the Medical History 
Form in the eCRF.  Adverse events (including laboratory abnormalities that constitute AEs) 
should be described using a diagnosis whenever possible rather than by individual underlying 
signs and symptoms.  See Section 9 for full reporting requirements for adverse events.   
Adverse events will be reported by the participant (or, when appropriate, by a caregiver, 
surrogate, or the participant's legally authorized representative).  The investigator and any 
qualified designees are responsible for detecting, documenting, and recording events that meet 
the definition of an AE or SAE and remain responsible for following-up on AEs that are serious, 
considered related to the study treatment/procedures, or that caused the participant to discontinue 
the study treatment.  Care will be taken not to introduce bias when detecting AEs and/or SAEs.  
Open-ended and nonleading verbal questioning of the participant, such as "How are you 
feeling?," is the preferred method to inquire about AE occurrences.  Adverse events may also be 
detected when they are volunteered by the participant during the screening process or between 
visits or through physical examinations, laboratory tests, or other assessments.  The definition, 
reporting, and recording requirements for AEs are described in Section 9. 

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All SAEs will be reported to the sponsor or designee within 24 hours.  The investigator will 
submit any updated SAE data to the sponsor within 24 hours of it being available. 
After the initial AE/SAE report, the investigator is required to proactively follow each participant 
at subsequent visits/contacts.  All SAEs, and nonserious AEs of special interest (as defined in 
Section 9.5), will be followed until resolution, stabilization, the event is otherwise explained, or 
the participant is lost to follow-up (as defined in Section 7.3). 
8.3.2. 
Physical Examinations 
Physical examinations must be performed by a medically qualified individual, such as a licensed 
physician, physician assistant, or an advanced registered nurse practitioner, as local law permits.  
Abnormalities identified after the first dose of study treatment constitute an AE if they are 
considered clinically meaningful, induce clinical signs or symptoms, require concomitant 
therapy, or require changes in study treatment.  Investigators should pay special attention to 
clinical signs related to previous serious illnesses. 
At the screening and EOT visits, a comprehensive physical examination should be conducted.  
The comprehensive physical examination will include height (screening only) and body weight 
and assessment(s) of the following organ or body systems:  skin; head, eyes, ears, nose, and 
throat; thyroid; lungs; cardiovascular system; abdomen (liver, spleen); extremities; and lymph 
nodes; as well as a brief neurological examination.  The comprehensive examination should also 
include an assessment of body fluid abnormalities, including ascites and edema. 
Targeted physical examinations will be a symptom-directed evaluation and will include 
assessment of the body systems or organs as indicated by participant symptoms, AEs, or other 
findings as determined by the investigator or designee.  The targeted examination will include 
measurement of body weight and assessment of fluid abnormalities, including ascites and edema. 
8.3.3. 
Vital Signs 
Vital sign measurements (to be taken before blood collection for laboratory tests) include blood 
pressure, pulse, respiratory rate, body weight, and body temperature and will be measured at 
study visits as shown in the SoA.  If vital signs cannot be taken before blood collection for 
laboratory tests, there must be a minimum of 30 minutes from the completion of the blood 
collection procedures to the beginning of the vital signs collection.  Blood pressure and pulse 
will be taken with the participant in the recumbent, semirecumbent, or sitting position after 
5 minutes of rest.  Abnormal vital sign results identified after the first dose of study treatment 
constitute an AE if they are considered clinically meaningful, induce clinical signs or symptoms, 
require concomitant therapy, or require changes in study treatment. 
8.3.4. 
Electrocardiograms 
Twelve-lead ECGs will be obtained as outlined in the SoA (see Table 3) using an ECG machine 
that automatically calculates the heart rate and measures PR, QRS, QT, and QTc intervals.  All 
12-lead ECGs will be performed with the participant in a recumbent or semirecumbent position 
after 5 minutes of rest. 
The 12-lead ECGs will be interpreted by the investigator at the site to be used for immediate 
participant management.  Additional 12-lead ECGs may be performed as clinically indicated to 

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manage participant safety.  The decision to include or exclude a participant or withdraw a 
participant from study treatment based on an ECG flagged as "Abnormal, Clinically Significant" 
is the responsibility of the investigator, in consultation with the sponsor's medical monitor as 
appropriate.  Clinically notable abnormalities that are considered clinically significant in the 
judgment of the investigator are to be reported as AEs. 
8.3.5. 
Laboratory Assessments 
See Table 5 for the schedule of laboratory assessments and Table 14 for the laboratory tests that 
will be performed.  All Protocol-required laboratory assessments must be conducted in 
accordance with the Laboratory Manual and the SoA.   Information regarding collection, 
processing, and shipping of laboratory assessments for the central laboratory is provided in the 
Laboratory Manual. 
Clinically significant abnormal laboratory findings are those that are not associated with the 
underlying disease, unless judged by the investigator to be more severe than expected for the 
participant's condition.  All laboratory tests with values considered clinically significantly 
abnormal during participation in the study or within 30 days after the last dose of study treatment 
should be repeated until the values return to normal or baseline or are no longer considered 
clinically significant by the investigator or medical monitor. 
See Section 9.1 for information regarding laboratory abnormalities that should be recorded as an 
AE in the eCRF.  Additionally, if laboratory values from laboratory assessments performed at the 
institution's local laboratory require a change in participant management (eg, require treatment) 
or are considered clinically significant by the investigator, then the result(s) of the specific 
laboratory assessment(s) must be recorded in the eCRF. 
Blood samples for hematology and serum chemistry analysis for baseline should be taken as 
close as possible to Day 1 but may be drawn up to 3 days before the first dose of parsaclisib.  
This blood sample will serve as the pre-parsaclisib baseline sample; a Day 1 sample is not 
required as long as the baseline sample is obtained within 3 days of the first dose of parsaclisib. 
8.3.5.1. 
Chemistry 
Serum chemistry assessments will be performed by a local laboratory using institutional best 
practices.  Results and normal ranges will be entered in the eCRF. 
8.3.5.2. 
Hematology 
Hematology assessments, including complete blood count with differential, and blast percentage 
will be performed at a local laboratory using institutional best practices.  Results and normal 
reference ranges will be entered in the eCRF. 
8.3.5.3. 
Urinalysis 
Urinalysis will be performed by a central laboratory. 

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8.3.5.4. 
Serology and Virology 
Serology and virology assessments will be performed by the central laboratory.  Assessments 
will include HBV DNA, HIV RNA, CMV DNA, and HCV RNA measurement; hepatitis B 
surface antigen; anti–hepatitis B surface antigen antibody; and anti–hepatitis B core antibody. 
8.3.5.5. 
Lipid Panel 
Lipid panel assessment will be performed by the central laboratory.  Overnight fast (no food or 
liquid except water) is required for these samples.  If the participant arrives for the study visit 
without an overnight fast of at least 8 hours or since midnight, the lipid blood draw must be 
rescheduled for a date when the participant can arrive in the fasted state. 
8.3.5.6. 
Pregnancy Testing 
A serum pregnancy test will be required for all women of childbearing potential during screening 
and at the safety follow-up visit.  This assessment will be performed by the central laboratory.  
Urine pregnancy tests will be conducted as outlined in Table 5, as medically indicated, or per 
country-specific requirement.  Urine pregnancy tests will be performed locally.  If a urine 
pregnancy test is positive, then the results should be confirmed with a serum pregnancy test to be 
performed at the local laboratory. 
If the serum pregnancy test is negative after a urine test was positive, the investigator will assess 
the potential benefit/risk to the participant and determine whether it is in the participant's best 
interest to resume study treatment and continue participation in the study. 
Follicle-stimulating hormone levels will be determined only at screening to verify hormonal 
menopause in relevant participants. 
If a pregnancy is confirmed by a serum pregnancy test, see Section 9.7 for reporting 
requirements. 
8.3.5.7. 
Coagulation Panel 
Coagulation parameters (PT, aPTT or PTT and INR) will be determined at a local laboratory 
using institutional best practices.  Results and normal reference ranges will be entered in the 
eCRF. 

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Table 14: 
Required Laboratory Analytes 
Serum Chemistries 
Hematology 
Urinalysis With Microscopic 
Examination 
Serology 
Coagulation 
Albumin 
Alkaline phosphatase 
ALT 
AST 
Amylase 
Bicarbonate (not applicable in 
Japan) 
Blood urea nitrogen 
Calcium 
Chloride 
Creatinine 
Glucose 
Lactate dehydrogenase 
Phosphate 
Potassium 
Sodium 
Total bilirubin 
Direct bilirubin  
Total protein 
Uric acid 
Complete blood count, 
including: 
• 
Hemoglobin 
• 
Hematocrit 
• 
Platelet count 
• 
RBC count 
• 
WBC count 
• 
Blasts 
 
Differential count, including: 
• 
Basophils 
• 
Eosinophils 
• 
Lymphocytes 
• 
Monocytes 
• 
Neutrophils 
• 
Blasts 
Absolute values must be 
provided for: 
• 
WBC differential results 
• 
Platelet count 
Color and appearance 
pH and specific gravity 
Bilirubin 
Glucose 
Ketones 
Leukocytes 
Nitrite 
Occult blood 
Protein 
 
Hepatitis B surface antigen 
Hepatitis B surface antigen 
antibody 
Hepatitis B core antibody 
HBV DNA 
HCV RNA 
CMV DNA 
HIV RNA 
PT 
PTT or aPTT 
INR 
Lipid Panel 
MF Specifica 
Pregnancy Testing 
Total cholesterol 
Triglycerides 
LDL 
HDL 
Bone marrow aspirate and 
biopsy 
JAK2 mutation status 
 
 
Female participants of 
childbearing potential only 
require a serum test at 
screening and follow-up 
and a urine pregnancy test 
before the first dose on 
Day 1. 
Pregnancy tests (serum or 
urine) should be repeated if 
required by local 
regulations. 
FSH only required if 
hormonal menopause must 
be verified. 
Note:  Additional tests may be required, as agreed upon by the investigator and sponsor, based on emerging safety data or to rule out a diagnosis.  
Note:  Alternative tests are also allowed as per regional standard of care. 
a Certain samples will only be collected in designated countries.

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8.5. 
Pharmacodynamic and Translational Assessments 
8.5.1. 
Timing of Biomarker Assessments 
Bone marrow, 
 
 
  
 
 
 
For information regarding handling/shipping of specimens, please refer to the Laboratory 
Manual for the study. 
8.5.2. 
Biomarker Assessments 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   

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• Samples of bone marrow biopsy and aspirate will be collected at screening/baseline 
(if applicable) and every 24 weeks thereafter 
 
  
These samples for central analysis will only be collected in designated countries. 
Sample collection for local pathology laboratory assessments at screening/baseline (if 
applicable) and every 24 weeks thereafter is required in all countries.  
8.6. 
Unscheduled Visits 
Unscheduled visits or laboratory assessments may be conducted at the investigator's discretion.  
All assessments and laboratory findings will need to be entered in the eCRF using an 
unscheduled visit page. 
8.7. 
End of Treatment and/or Early Termination 
There is no predefined EOT.  When the participant permanently discontinues parsaclisib/placebo 
and ruxolitinib, the EOT visit should be conducted.  If the EOT visit coincides with a regular 
study visit, then the EOT evaluations will supersede those of that scheduled visit, and the data 
should be entered in the EOT visit in the CRF.  The participant should be encouraged to return 
for the follow-up visit. 
8.8. 
Follow-Up 
8.8.1. 
Safety Follow-Up 
The safety follow-up period is the interval between the EOT visit and the scheduled follow-up 
visit, which should occur 30 to 35 days after the EOT visit (or after the last dose of study 
treatment (parsaclisib/matching placebo and ruxolitinib) if the EOT visit was not performed).  
Adverse events and SAEs must be reported up until at least 30 days after the last dose of study 
treatment, the date of the follow-up visit, or until toxicities resolve, return to baseline, or are 
deemed irreversible, whichever is longer.  Reasonable efforts should be made to have the 
participant return for the follow-up visit and report any AEs that may occur during this period.  
If the participant cannot return to the site for the safety follow-up visit (eg, lives far away), then 
the participant should be contacted by telephone for assessment of AEs and SAEs.  Sites must 
document this contact in the source. 
Participants are required to remain on PJP prophylaxis for at least 2 to 6 months after the last 
dose of study drug (see Section 6.8.2) and should be reminded of this at the safety follow-up 
visit.  Sites should follow up with participants to confirm that they have been compliant with the 
prophylactic treatment for the duration of this period. 
8.8.2. 
Survival Follow-Up 
Once a participant has received the last dose of study treatment, has confirmed disease 
progression, or starts a new MF therapy, the participant moves into the survival follow-up period 
and should be contacted by telephone, e-mail, or visit at least every 12 weeks (± 2 weeks) to 
assess for subsequent MF treatments and survival status until death, withdrawal of consent, or 
the end of the study, whichever occurs first. 

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9. 
ADVERSE EVENTS:  DEFINITIONS AND PROCEDURES FOR 
RECORDING, EVALUATING, FOLLOW-UP, AND REPORTING 
9.1. 
Definition of Adverse Event 
Adverse Event Definition 
• An AE is any untoward medical occurrence associated with the use of a drug in humans, whether or 
not it is considered drug-related. 
• An AE can therefore be any unfavorable or unintended sign (including an abnormal laboratory 
finding), symptom, or disease (new or exacerbated) temporally associated with the use of study 
treatment. 
Additional Guidance for Events Meeting the Adverse Event Definition 
• Any safety assessments (eg, ECG, vital signs measurements), including those that worsen from 
baseline, considered clinically significant in the medical and scientific judgment of the investigator 
(ie, not related to progression of underlying disease) are to be reported as an AE. 
• Abnormal laboratory test results are to be reported as an AE if they are considered clinically 
meaningful, induce clinical signs or symptoms, require concomitant therapy, or require changes in 
study treatment.  Whenever possible, a diagnosis (eg, anemia, thrombocytopenia) should be recorded 
in the eCRF rather than the abnormal laboratory test result (eg, low hemoglobin, platelet count 
decreased). 
• Exacerbation of a chronic or intermittent pre-existing condition/disease, including either an increase 
in the frequency and/or intensity of the condition, is to be reported as an AE. 
• New conditions detected or diagnosed after the start of study treatment administration are to be 
reported as an AE. 
• Signs, symptoms, or the clinical sequelae of a suspected drug-drug interaction are to be reported as an 
AE. 
• Signs and/or symptoms from dosing errors of a study treatment (eg, overdose) or a concomitant 
medication are to be reported as an AE. 
• "Lack of efficacy," "disease progression," or "failure of expected pharmacological action" will not be 
reported as an AE or SAE.  Such instances will be captured in the efficacy assessments.   
• A condition that leads to a medical or surgical procedure (eg, endoscopy, appendectomy) will be 
reported as an AE if it occurs after obtaining informed consent.  If the condition is present before 
entering the study, then it should be captured as medical history.  
• Pre-existing diseases or conditions with expected fluctuations in signs or symptoms should be 
reported as an AE only if the investigator judges the fluctuation to have worsened more than expected 
during study participation. 
9.2. 
Definition of Serious Adverse Event 
If an event is not an AE per the definition above, then it cannot be an SAE even if serious 
conditions are met (eg, hospitalization for signs/symptoms of the disease under study, death due 
to progression of disease). 

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A serious adverse event is defined as any untoward medical occurrence that, at any dose: 
a. Results in death 
b. Is life-threatening 
The term "life-threatening" in the definition of "serious" refers to an adverse drug experience that 
places the participant, in the opinion of the initial reporter, at immediate risk of death from the adverse 
experience as it occurs.  This does not include an adverse drug experience that, had it occurred in a 
more severe form, might have caused death. 
c. Requires inpatient hospitalization or prolongation of existing hospitalization 
In general, hospitalization signifies that the participant has been detained (involving at least an 
overnight stay) at the hospital or emergency ward for observation and/or treatment that would not have 
been appropriate in the physician's office or outpatient setting.  Complications that occur during 
hospitalization are AEs.  If a complication prolongs hospitalization or fulfills any other serious criteria, 
the event is serious.  When in doubt as to whether hospitalization occurred or was necessary, the AE 
should be considered serious. 
Hospitalization for elective treatment or planned surgery (eg, stent replacement, hip surgery) is not 
considered an SAE. 
Hospitalization for medical interventions in which no unfavorable medical occurrence occurred 
(ie, elective procedures or routine medical visits) are not considered SAEs.  
d. Results in persistent or significant disability/incapacity 
• The term "disability" means a substantial disruption of a person's ability to conduct normal life 
functions.   
• This definition is not intended to include experiences of relatively minor medical significance, such 
as uncomplicated headache, nausea, vomiting, diarrhea, influenza, and accidental trauma 
(eg, sprained ankle), that may interfere with or prevent everyday life functions but do not constitute a 
substantial disruption. 
e. Is a congenital anomaly/birth defect 
f. Is an important medical event 
An important medical event is an event that may not result in death, be immediately life-threatening, or 
require hospitalization but may be considered serious when, based on appropriate medical judgment, 
the event may jeopardize the participant and may require medical or surgical intervention to prevent 
one of the outcomes listed in the above definition.  Examples of such events include new invasive or 
malignant cancers, intensive treatment in an emergency department or at home for allergic 
bronchospasm, blood dyscrasias, or convulsions that do not result in hospitalization, or development of 
drug dependency or drug abuse.  Secondary malignancies should always be considered SAEs. 
An event that may lead to disability is also considered an important medical event.  It includes a case 
that is exposed to a risk of dysfunction to an extent that interferes with daily life when the adverse drug 
reaction occurs.  It does not include an adverse drug reaction that, had the reaction been more severe, 
may have caused disability. 

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9.3. 
Recording and Follow-Up of Adverse Events and/or Serious Adverse 
Events 
Adverse Event and Serious Adverse Event Recording 
• An AE/SAE that begins or worsens after informed consent is signed should be recorded on the 
Adverse Event Form in the eCRF.  Conditions that were present at the time informed consent was 
given should be recorded on the Medical History Form in the eCRF.   
• When an AE/SAE occurs, it is the responsibility of the investigator to review all documentation 
(eg, hospital progress notes, laboratory reports, and diagnostic reports) related to the event. 
• The investigator (or delegate) will then record all relevant AE/SAE information in the eCRF. 
• It is not acceptable for the investigator to send photocopies of the participant's medical records 
in lieu of completing the Adverse Event Form in the eCRF. 
• There may be rare instances when copies of medical records for certain cases are requested.  In this 
case, all participant identifiers, with the exception of the participant number, will be redacted by the 
site staff on the copies of the medical records before submission.  These records can be submitted to 
Incyte Pharmacovigilance by email/fax per the contact information listed in the Study Binder. 
• The investigator will attempt to establish a diagnosis of the event based on signs, symptoms, and/or 
other clinical information.  Whenever possible, the diagnosis (not the individual signs/symptoms) 
will be documented as the AE/SAE.  When a clear diagnosis cannot be identified, each sign or 
symptom should be reported as a separate AE/SAE. 
To the extent possible, each AE/SAE should be evaluated to determine the following: 
• The severity grade (CTCAE v5.0 Grade 1 to 5).  See below for further instructions on the assessment 
of intensity. 
• Whether there is at least a reasonable possibility that the AE is related to the study treatment:  
suspected (yes) or not suspected (no).  See below for further instructions on the assessment of 
causality. 
• The start and end dates, unless unresolved at the final safety follow-up visit. 
• The action taken with regard to parsaclisib/matching placebo and ruxolitinib as a result of the 
AE/SAE(s). 
• The event outcome (eg, not recovered/not resolved, recovered/resolved, recovering/resolving, 
recovered/resolved with sequelae, fatal, unknown). 
• The seriousness, as per the SAE definition provided in Section 9.2. 
• The action taken with regard to the event.  Note:  If an AE is treated with a concomitant medication 
or nondrug therapy, this action should be recorded on the Adverse Event Form and the treatment 
should be specified on the appropriate eCRF (eg, Prior/Concomitant Medications, Procedures and 
Non-Drug Therapy). 
Assessment of Intensity 
The severity of AEs will be assessed using CTCAE v5.0 Grades 1 through 5.  If an event is not 
classified by CTCAE, the severity of the AE will be graded according to the scale below to estimate the 
grade of severity. 

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The investigator will make an assessment of intensity for each AE and SAE reported during the study 
and assign it to 1 of the following categories: 
• Grade 1:  Mild; asymptomatic or mild symptoms; clinical or diagnostic observations only; treatment 
not indicated. 
• Grade 2:  Moderate; minimal, local, or noninvasive treatment indicated; limiting age-appropriate 
activities of daily living. 
• Grade 3:  Severe or medically significant but not immediately life-threatening; hospitalization or 
prolongation of hospitalization indicated; disabling; limiting self-care activities of daily living. 
• Grade 4:  Life-threatening consequences; urgent treatment indicated. 
• Grade 5:  Fatal. 
Assessment of Causality 
• The investigator is obligated to assess the relationship between parsaclisib/matching placebo and 
ruxolitinib to each AE/SAE.  The relationship of AEs and SAEs to the combination may be assessed 
as well. 
• A "reasonable possibility" of a relationship conveys that there are medical facts, evidence, and/or 
arguments to suggest a causal relationship, rather than that a relationship cannot be ruled out. 
• The investigator will use clinical judgment to determine the possibility of a relationship. 
• The investigator will also consult the RSI in the IB (for parsaclisib or ruxolitinib) or Product 
Information (for ruxolitinib) in making his/her assessment. 
• Alternative causes, such as underlying or concurrent disease(s), concomitant therapy, and other risk 
factors, as well as the temporal relationship of the event to study treatment administration, will be 
considered and investigated. 
• For each AE/SAE, the investigator must document in the medical notes that he/she has reviewed the 
AE/SAE and has provided an assessment of causality. 
• With regard to assessing causality of SAEs: 
− There may be situations in which an SAE has occurred and the investigator has minimal 
information to include in the initial report.  However, the causality assessment is one of the criteria 
used when determining regulatory reporting requirements.  Therefore, it is very important that 
the investigator always make an assessment of causality based on the available information 
for every event before the initial transmission of the SAE. 
− The investigator may change his/her opinion of causality in light of follow-up information and 
submit the updated causality assessment. 
Follow-Up of Adverse Events and Serious Adverse Events 
• The investigator is obligated to perform or arrange for the conduct of supplemental measurements 
and/or evaluations as medically indicated or as requested by the sponsor to elucidate the nature 
and/or causality of the AE or SAE as fully as possible.  This may include additional laboratory tests 
or investigations, histopathological examinations, or consultation with other health care 
professionals. 
• Once an AE is detected, it should be followed in the AE eCRF until it has resolved or until it is 
judged to be permanent; assessment should be made at each visit (or more frequently if necessary) of 
any changes in severity, the suspected relationship to the study treatment, the interventions required 
to treat the event, and the outcome. 

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• Updated SAE information will be recorded in the originally completed eCRF and reported to Incyte
Pharmacovigilance or its designee as directed in the Study Binder until resolution, stabilization, the
event is otherwise explained, or the participant is lost to follow-up.
• Any updated SAE data (including SAEs being downgraded to nonserious) will be submitted to the
sponsor (or designee) within 24 hours of receipt of the information.
9.4. 
Reporting of Serious Adverse Events 
Regardless of suspected causality (eg, relationship to study drug, reference therapy, or study 
procedure[s]), all SAEs occurring after the participant has signed the ICF through 30 to 35 days 
after the last dose of study treatment or until the participant starts a new MF therapy, whichever 
occurs earlier, must be reported to the sponsor (or designee) within 24 hours of learning of its 
occurrence, unless otherwise specified by the Protocol.  The investigator will submit any updated 
SAE data to the sponsor (or designee) within 24 hours of it being available.  For Japan, this 
information must also be reported immediately to the head of the study site. 
Investigators are not obligated to actively seek SAE information after the safety follow-up visit 
or 30-35 days after the last dose of study treatment.  If the investigator learns of any SAE, 
including death, at any time after this period, and he/she considers the event to be reasonably 
related to the study treatment or study participation, then the investigator must notify the sponsor 
(or designee) within 24 hours of becoming aware of the event.   
After the initial AE/SAE report, the investigator is required to proactively follow each participant 
at subsequent visits/contacts.  All SAEs and AESIs (as defined in Section 9.5) will be followed 
until resolution, stabilization, the event is otherwise explained, or the participant is lost to 
follow-up (as defined in Section 7.3). 
Prompt notification by the investigator to the sponsor regarding an SAE is essential so that legal 
obligations and ethical responsibilities toward the safety of participants and the safety of a study 
treatment under clinical investigation are met. 
If the SAE is not documented in the parsaclisib IB or ruxolitinib IB (or Jakafi package 
insert [2021]) and is thought to be related to the study treatment, the sponsor or its designee may 
urgently require further information from the investigator for expedited reporting to health 
authorities.  The sponsor or its designee may need to issue an Investigator Notification to inform 
all investigators involved in any study with the same drug that this SAE has been reported.  
Suspected unexpected serious adverse reactions will be collected and reported to the competent 
authorities and relevant ethics committees in accordance with Directive 2001/20/EC or as per 
national regulatory requirements in participating countries.  For Japan, the sponsor will report 
suspected expected deaths and life-threatening events to the PMDA as per local regulatory 
requirements. 
The sponsor has a legal responsibility to notify both the local regulatory authority and other 
regulatory agencies about the safety of a study treatment under clinical investigation.  The 
sponsor will comply with country-specific regulatory requirements relating to safety reporting to 
the regulatory authority, IRB/IEC, and investigators. 
Investigator safety reports must be prepared for suspected unexpected serious adverse reactions 
according to local regulatory requirements and sponsor policy and forwarded to investigators as 
necessary. 

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An investigator who receives an investigator safety report describing an SAE or other specific 
safety information (eg, summary or listing of SAEs) from the sponsor will review and then file it 
along with the IB and will notify the IRB/IEC, if appropriate, according to local requirements. 
Serious Adverse Event Reporting 
• Information about all SAEs is collected and recorded on the Adverse Event Form in the eCRF. 
• The investigator must report within 24 hours of learning of its occurrence any SAE via the EDC 
system (primary method) or by completing the Serious Adverse Event Report Form in English (only 
if the EDC system is not available.  The contact information for Incyte Pharmacovigilance by 
email/fax is listed in the Study Binder). 
• In circumstances where the EDC system is not accessible for reporting SAE information (initial 
and/or follow-up SAE information) to the sponsor within 24 hours, refer to the Incyte Reference 
Guide for Completing the Serious Adverse Report Form in the Study Binder.  Once the EDC system 
is functional, the SAE report should be retrospectively added to the EDC system and follow-up 
should be completed through the EDC.  The original copy of the Serious Adverse Event Report Form 
and the email or facsimile confirmation sheet must be kept at the study site. 
• Follow-up information is also recorded in the eCRF and transmitted to Incyte Pharmacovigilance via 
the EDC system.  The follow-up report should include information that was not provided previously, 
such as the outcome of the event, treatment provided, action taken with study treatment because of 
the SAE (eg, dose reduced, interrupted, or discontinued), or participant disposition (eg, continued or 
withdrew from study participation).  Each recurrence, complication, or progression of the original 
event should be reported as follow-up to that event, regardless of when it occurs. 
• Contacts for SAE reporting can be found in the Study Binder.   
9.5. 
Adverse Events of Special Interest 
The principal toxicity of inhibiting both PI3Kδ and JAK pathways is expected to be reversible 
effects on immune function.  Combined inhibition may adversely affect both B-cell and T-cell 
immune function, with resultant increased risk of a variety of infections or other immune-related 
events.  Specific AEs or groups of AEs will be followed as part of standard safety monitoring 
activities.  An AE of special interest does not require rapid communication by an investigator to 
Incyte unless it meets criteria for rapid communication as an SAE (see Section 9.4) and consists 
of the following based on terms coded per MedDRA v19.0: 
• Colitis 
• Diarrhea of Grade 2 or higher 
• Rash of Grade 2 or higher 
• Pneumonitis 
• Dermatitis exfoliative 
• Intestinal perforation 
• Cytomegalovirus infection 
• Herpes simplex infection 
• Herpes (varicella) zoster virus infection 

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• Pneumocystis jirovecii infection 
• Alanine aminotransferase increased ≥ 5 × ULN 
• Aspartate aminotransferase increased ≥ 5 × ULN 
Adverse events of special interest should be captured in the eCRF. 
9.6. 
Emergency Unblinding of Treatment Assignment 
In a medical emergency, if knowledge of the treatment assignment is necessary to determine 
optimal medical management of the participant, the procedure for emergency unblinding is 
provided in the IXRS/Study Reference Manual.  The decision to break the treatment code in an 
emergency situation resides at the sole discretion of the investigator.  This option may be used 
only if the participant's well-being requires the investigator to be aware of the participant's 
treatment assignment.  If a participant's treatment assignment is unblinded, the sponsor or its 
designee must be notified immediately by telephone. 
If an investigator, the site personnel performing assessments, or a participant is emergency 
unblinded, the participant must discontinue study treatment unless there are ethical reasons to 
have the participant remain on the study treatment.  In these cases, the investigator must obtain 
specific approval from the sponsor's (or its designee's) medical monitor for the participant to 
continue in the study. 
9.7. 
Pregnancy 
Pregnancy, in and of itself, is not regarded as an AE unless there is suspicion that the study 
treatment may have interfered with the effectiveness of a contraceptive medication or method.  
When a pregnancy has been confirmed in a participant during maternal or paternal exposure to 
study treatment, the following procedures should be followed in order to ensure safety: 
• The study treatment must be discontinued immediately (female participants only). 
• The investigator must complete and submit the Incyte Clinical Trial Pregnancy Form 
to the sponsor or its designee within 24 hours of learning of the pregnancy. 
Data on fetal outcome are collected for regulatory reporting and drug safety evaluation.  
Follow-up should be conducted for each pregnancy to determine outcome, including spontaneous 
or voluntary termination, details of the birth, and the presence or absence of any birth defects, 
congenital abnormalities, or maternal and/or newborn complications, by following until the first 
well-baby visit.  Pregnancy should be recorded on a Clinical Trial Pregnancy Form and reported 
by the investigator to the sponsor or its designee.  Pregnancy follow-up information should be 
recorded on the same form and should include an assessment of the possible causal relationship 
to the sponsor's study drug to any pregnancy outcome, as well as follow-up to the first well-baby 
visit or the duration specified in local regulations, whichever is later.  Refer to the Incyte 
Reference Guide for Completing the Clinical Trial Pregnancy Form in the Study Binder. 
Any SAE occurring during pregnancy of a study participant must be recorded on the 
Serious Adverse Event Report Form and submitted to the sponsor or its designee. 
Abnormal pregnancy outcomes (eg, spontaneous abortion, fetal death, stillbirth, congenital 
anomalies, or ectopic pregnancy) are considered SAEs (if occurring in the study participant) and 

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must be reported as described in Section 9.4.  If an abnormal pregnancy outcome is reported in a 
study participant's partner, the event should be reported to the sponsor on the Clinical Trial 
Pregnancy Form. 
9.8. 
Warnings and Precautions 
Special warnings or precautions for the study treatment, derived from safety information 
collected by the sponsor or its designee, are presented in the parsaclisib IB and ruxolitinib IB.  
Additional safety information collected between IB updates will be communicated in the form of 
Investigator Notifications.  Any important new safety information should be discussed with the 
participant during the study as necessary.  If new significant risks are identified, they will be 
added to the ICF. 
9.9. 
Product Complaints 
The sponsor collects product complaints on study drugs and drug delivery systems used in 
clinical studies in order to ensure the safety of study participants, monitor quality, and facilitate 
process and product improvements. 
All product complaints associated with material packaged, labeled, and released by the sponsor 
or its designee will be reported to the sponsor.  All product complaints associated with other 
study material will be reported directly to the respective manufacturer. 
The investigator or his/her designee is responsible for reporting a complete description of the 
product complaint via e-mail or other written communication to the sponsor contact or respective 
manufacturer as noted in the packaging information.  Any AE associated with a product 
complaint should be recorded as described in Section 9.3. 
If the investigator is asked to return the product for investigation, he/she will return a copy of the 
product complaint communication with the product. 
9.10. 
Treatment of Overdose 
There has been no clinical experience with overdose of parsaclisib.  Treatment of overdose 
should consist of general supportive measures. 
Refer to the approved product label of ruxolitinib for advice on overdose. 

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10. 
STATISTICS 
10.1. 
Sample Size Determination 
The primary endpoint of this study is the proportion of participants with ≥ 35% spleen volume 
reduction from baseline to Week 24 as measured by MRI (or CT scan in applicable participants).  
The primary endpoint will be analyzed by CMH test stratified by DIPSS (intermediate-1 vs 
intermediate-2 vs high) and baseline (or screening, if applicable) platelet count (≥ 100 × 109/L vs 
50 to < 100 × 109/L inclusive; note that if a participant's platelet count is < 50 × 109/L at 
baseline, the platelet count at screening will be used for stratification/randomization).  Assuming 
a 58.2% (29.4%) response rate for participants with normal (low) platelet count for the 
ruxolitinib plus parsaclisib group versus 41.0% (17.2%) response rate for participants with 
normal (low) platelet count for the ruxolitinib plus placebo group, to achieve 83.67% power to 
detect a statistically significant difference with a 2-sided Type I error of 5%, a sample size of 
440 participants is required to be randomized equally between treatment groups.  
For the key secondary endpoint of proportion of participants who have a ≥ 50% in MFSAF TSS 
from baseline to Week 24, assuming a response rate of 61.7% (50.0%) for participants with 
normal (low) platelet count for the ruxolitinib plus parsaclisib group and a response rate of 
45.9% (34.5%) for participants with normal (low) platelet count for the ruxolitinib plus placebo 
group, a sample size of 440 will provide 80.02% power using CMH test given a 2-sided Type I 
error of 5%.  
A test for OS will be performed when 85 deaths are observed using the log-rank test stratified by 
platelet count and DIPSS at baseline at a 2-sided Type I error level of 0.05.  The log-rank test 
will provide 80% power to detect a hazard ratio of 0.54.  Assuming a median survival time of 
5.3 years for ruxolitinib plus placebo and enrollment duration is 1.5 years, the expected time to 
analysis from the first participant randomized is 3 years. 
10.2. 
Populations for Analysis 
The populations for analysis are provided in Table 16. 
Table 16: 
Populations for Analysis 
Population 
Description 
ITT 
All randomized participants.  The ITT population will be used for the summary of 
demographics, baseline characteristics, participant disposition, and analyses of all efficacy 
data.  Participants will be analyzed according to the treatment group to which they were 
randomized regardless of the treatment received during the study. 
Safety 
All randomized participants who received at least 1 dose of parsaclisib, placebo, or 
ruxolitinib.  Treatment groups for this population will be determined according to the actual 
treatment the participant received regardless of assigned study drug treatment.  All safety 
analyses will be conducted using the safety population. 
PP  
Participants in the ITT population who are considered to be sufficiently compliant with the 
Protocol. 

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10.3. 
Level of Significance 
This study defines a single primary endpoint with a single primary analysis.  The study will be 
claimed to have achieved the primary efficacy objective when the primary endpoint shows a 
significant result at a 2-sided alpha level of 0.05 at final analysis.  The secondary efficacy 
endpoints will be analyzed only when the study has reached the efficacy objective in the primary 
endpoint.  The key secondary efficacy variables will be tested following a fixed-sequence-testing 
procedure with each at the 2-sided alpha level of 0.05 in the order below:   
1. The proportion of participants who have a ≥ 50% reduction from baseline to Week 24 in 
the MFSAF TSS. 
2. OS.  
Other secondary 
 endpoints will be tested using a 2-sided, 5% significance level 
but are not considered alpha-controlled hypotheses. 
10.4. 
Statistical Analyses 
10.4.1. 
Primary and Secondary Analyses 
The methods and populations for primary and secondary analyses are provided in Table 17. 
Table 17: 
Primary and Secondary Analyses Methods and Populations 
Endpoint 
Statistical Method 
Analysis 
Population 
Primary (P) or 
Supportive (S) 
Primary endpoint 
Proportion of participants 
achieving ≥ 35% reduction in 
spleen volume from baseline to 
Week 24 as measured by MRI (or 
CT scan in applicable 
participants) 
CMH test stratified by baseline (or 
screening, if applicable) platelet count 
(≥ 100 × 109/L vs 50 to < 100 × 109/L 
inclusive) and DIPSS category 
(intermediate-1 vs intermediate-2 vs 
high) at randomization 
ITT 
P 
PP 
S 
Secondary endpoints 
Proportion of participants who 
have a ≥ 50% reduction in TSS 
from baseline to Week 24 as 
measured by the MFSAF v4.0 
diary 
CMH test stratified by baseline (or 
screening, if applicable) platelet count 
(≥ 100 × 109/L vs 50 to < 100 × 109/L 
inclusive) and DIPSS category 
(intermediate-1 vs intermediate-2 vs 
high) at randomization  
ITT 
P 
PP 
S 
Time to the first ≥ 50% reduction 
in TSS as measured by the 
MFSAF v4.0 diary 
Inference:  Log-rank test with 
stratification of baseline (or screening, if 
applicable) platelet count (≥ 100 × 109/L 
vs 50 to < 100 × 109/L inclusive) and 
DIPSS category (intermediate-1 vs 
intermediate-2 vs high) at randomization 
Estimation:  Kaplan-Meier 
ITT 
P 

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Table 17: 
Primary and Secondary Analyses Methods and Populations (Continued) 
Endpoint 
Statistical Method 
Analysis 
Population 
Primary (P) or 
Supportive (S) 
OS determined from the date of 
randomization until death due to 
any cause   
Inference:  Log-rank test stratified by 
baseline (or screening, if applicable) 
platelet count (≥ 100 × 109/L vs 50 to 
< 100 × 109/L inclusive) and DIPSS 
category (intermediate-1 vs 
intermediate-2 vs high) at randomization 
Estimation:  Kaplan-Meier 
ITT 
P 
PP 
S 
Inference:  Cox regression model 
including treatment group, baseline (or 
screening, if applicable) platelet count 
(≥ 100 × 109/L vs 50 to < 100 × 109/L 
inclusive), and DIPSS category 
(intermediate-1 vs intermediate 2 vs 
high) at randomization 
ITT 
S 
OS adjusted for crossover using 
rank preserving structural failure 
time  
Inference:  Cox regression model 
including treatment group, baseline (or 
screening, if applicable) platelet count 
(≥ 100 × 109/L vs 50 to < 100 × 109/L 
inclusive), and DIPSS category 
(intermediate-1 vs intermediate 2 vs 
high) at randomization 
ITT 
S 
Time to the first ≥ 35% reduction 
in spleen volume  
Inference:  Log-rank test with 
stratification of baseline (or screening, if 
applicable) platelet count (≥ 100 × 109/L 
vs 50 to < 100 × 109/L inclusive) and 
DIPSS (intermediate-1 vs intermediate-
2 vs high) at randomization 
Estimation:  Kaplan-Meier 
ITT 
P 
Duration of maintenance of a 
≥ 35% reduction in spleen 
volume 
Estimation:  Kaplan-Meier 
ITT with 
spleen 
response 
P 
Other secondary endpoints, including change and percentage change in MFSAF TSS over time 
from baseline to Week 24 as measured by the MFSAF v4.0 diary, will be summarized 
descriptively by treatment group. 
For the stratifications of platelet and DIPSS, within a platelet category, in the event that a 
particular DIPSS stratification level has fewer than 30 participants randomized, it will be 
combined with the nearest adjacent DIPSS level (eg, Intermediate-1 vs Intermediate-2 vs High).  
For example, if too small, Intermediate-1 or High risk will be merged with Intermediate-2.  If 
Intermediate-2 has too few participants, then it will be merged with the smaller of the 2 adjacent 
strata. 
In the event that 2 DIPSS stratification levels are combined, a sensitivity analysis for the primary 
endpoint without combining levels will be conducted. 

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The primary endpoint will also be compared between treatment groups within each of the 
following subgroups: 
• Baseline platelet count (≥ 100 × 109/L vs 50 to <100 × 109/L inclusive) (Note that if a 
participant's platelet count is < 50 × 109/L at baseline, the platelet count at screening 
will be used instead)  
• DIPSS category (Intermediate-1 vs Intermediate-2 vs High) 
• Sex:  male and female 
• Age group:  ≤ 65 years or > 65 years 
• MF type:  PMF or PPV-MF/PET-MF 
• Presence/absence of V617F mutation at baseline 
• Presence/absence of HMR mutations at baseline 
• Baseline spleen volume group:  ≤ median or > median 
• Baseline spleen palpation size group: ≤ 10 cm or > 10 cm 
• Race:  white/Caucasian, black/African American, Asian, American Indian/Alaska 
Native, Native Hawaiian/Pacific Islander, or other 
• Ethnicity:  Hispanic/Latino, not Hispanic/Latino, or other 
10.4.2. 
Safety Analyses 
Safety analyses will be conducted for the safety population.  Adverse events will be coded by the 
MedDRA dictionary, and TEAEs (ie, AEs reported for the first time or worsening of a 
pre-existing event after first dose of study treatment) will be tabulated by preferred term and 
system organ class for all events, related events, and events of Grade 3 or higher.  Quantitative 
safety variables and their changes from baseline (laboratory, vital signs, etc) will be summarized 
with descriptive statistics.  Clinically notable abnormal values will be flagged and tabulated 
based on predefined criteria.  Treatment-emergent AEs of clinical interest (see Section 9.5) will 
be summarized descriptively by treatment group. 
The clinical laboratory data will be analyzed using summary statistics; no formal treatment group 
comparisons are planned.  In addition, distributions of key laboratory parameters may be plotted 
over time; these values will also be classified into CTCAE toxicity grades and tabulated.  
Descriptive statistics and mean change from baseline will be determined for vital signs at each 
assessment time.  Vital sign results will be reviewed for clinically notable abnormalities. 
Descriptive statistics and mean change from baseline will be determined for each ECG parameter 
at each assessment time.  Electrocardiogram results will be reviewed for clinically notable 
abnormalities according to predefined criteria (see Table 18).  Participants exhibiting clinically 
notable ECG abnormalities will be listed. 

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Table 18: 
Criteria for Clinically Notable Electrocardiogram Abnormalities 
Parameter 
High Threshold 
Low Threshold 
QTc 
> 450 ms 
< 295 ms 
PR 
> 220 ms 
< 75 ms 
QRS 
> 120 ms 
< 50 ms 
QT 
> 500 ms 
< 300 ms 
RR 
> 1330 ms 
< 600 ms 
Measures of exposure (eg, days of exposure, duration of treatment,  average daily dose, and total 
daily dose) of parsaclisib, placebo, or ruxolitinib will be summarized by means of summary 
statistics. 
 
 

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10.5. 
Interim Analysis 
There are 2 planned interim analyses for this study.  The first interim analysis will be conducted 
when the first 100 of the planned randomized participants (approximately 50 in each treatment 
group) reach Week 12 assessments of spleen volume and MFSAF TSS or discontinue treatment.  
The first interim analysis is to test Week 12 spleen volume and MFSAF TSS for futility.  An 
HSD (Hwang et al 1990) with γ = 0 will be used to determine the nonbinding futility boundary 
for spleen volume and MFSAF TSS. The study will be terminated early for futility if either the 
spleen volume or the MFSAF TSS endpoints cross the futility boundary.  Based on the results of 
this interim analysis, the DMC may recommend to terminate the study, continue the study with 
no changes to enrollment, or continue the study with no further enrollment permitted until review 
of the second interim analysis. 

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The second interim analysis will be conducted when the first 220 randomized participants 
(approximately 110 in each treatment group) reach Week 12 assessments of spleen volume and 
MFSAF TSS or discontinue from treatment.  The second interim analysis is for the efficacy 
check at 1-sided alpha of 10%.  The study will continue if both spleen volume and MFSAF TSS 
endpoints are positive.  The DMC may recommend to either terminate the study for lack of 
efficacy or continue the study, based on the results of this analysis.  
At both interim analyses, MFSAF TSS will be tested only if spleen volume passes the 
futility/efficacy check.  Table 19 and Table 20 provide the projected stopping rules if the interim 
analyses are conducted at the projected number of participants. 
Table 19: 
Interim Analysis for Spleen Volume With HSD(0) 
 
Interim Analysis 1 
Interim Analysis 2 
Final Analysis 
Number of Participants 
100 
220 
440 
Decision Outcome 
Stop for 
Futility 
Continue 
to Test 
MFSAF 
TSS 
Stop for  
Lack of 
Efficacy 
Continue 
to Test 
MFSAF 
TSS 
Do Not 
Reject Null 
Hypothesis 
Reject Null 
Hypothesis 
Z-statistic 
≤ 0.18 
> 0.18 
≤ 1.28 
> 1.28 
≤ 1.96 
> 1.96 
One-sided p-value 
≥ 0.43 
< 0.43 
≥ 0.10 
< 0.10 
≥ 0.025 
< 0.025 
Parsaclisib plus ruxolitinib 
response ratea 
≤ (17.8%, 
42.0%) 
> (17.8%, 
42.0%) 
≤ (23.0%, 
50.0%) 
> (23.0%, 
50.0%) 
≤ (23.4%, 
50.5%) 
> (23.4%, 
50.5%) 
a Assumes spleen volume response rate for 50 to < 100 × 109/L inclusive and  ≥ 100 × 109/L platelet count is 17.2% and 41.0%, 
respectively, in the ruxolitinib plus placebo group. 
Table 20: 
Interim Analysis for MFSAF TSS With HSD(0) 
 
Interim Analysis 1 
Interim Analysis 2 
Final Analysis 
Number of Participants 
100 
220 
440 
Decision Outcome 
Stop for 
Futility 
Continue to 
Interim 
Analysis 2 
Stop for 
Lack of 
Efficacy 
Continue 
to the 
Final 
Analysis 
Do Not 
Reject Null 
Hypothesis 
Reject Null 
Hypothesis 
Z-statistic 
≤ 0.18 
> 0.18 
≤ 1.28 
> 1.28 
≤ 1.96 
> 1.96 
One-sided p-value 
≥ 0.43 
< 0.43 
≥ 0.10 
< 0.10 
≥ 0.025 
< 0.025 
Parsaclisib plus ruxolitinib 
response ratea 
≤ (35.4%, 
46.9%) 
> (35.4%, 
46.9%) 
≤ (42.8%, 
54.6%) 
> (42.8%, 
54.6%) 
≤ (43.6%, 
55.5%) 
> (43.6%, 
55.5%) 
a Assumes TSS response rate for 50 to < 100 × 109/L inclusive and  ≥ 100 × 109/L platelet count is 34.5% and 45.9%, 
respectively, in the ruxolitinib plus placebo group. 
Preplanned analyses of safety and efficacy will be provided to an independent DMC as specified 
in the DMC charter.  The process by which the DMC will review data and make 
recommendations and decisions will be documented in the DMC charter. 

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11. 
SUPPORTING DOCUMENTATION AND OPERATIONAL 
CONSIDERATIONS 
11.1. 
Investigator Responsibilities 
• The Protocol, Protocol Amendments, ICF, IB, and other relevant documents (eg, 
advertisements) must be submitted to an IRB/IEC by the investigator and reviewed 
and approved by the IRB/IEC and health authorities before the study is initiated. 
• The investigator is responsible for ensuring that the safety reports provided by the 
sponsor are reviewed and processed in accordance with regulatory requirements, the 
policies and procedures established by the IRB/IEC, and institutional requirements. 
• Any amendments to the Protocol will require approval from both health authorities 
and the IRB/IEC before implementation of changes made to the study design, except 
for changes necessary to eliminate an immediate hazard to study participants. 
• The investigator will be responsible for the following: 
− Providing written summaries of the status of the study to the IRB/IEC annually or 
more frequently in accordance with the requirements, policies, and procedures 
established by the IRB/IEC. 
− Notifying the IRB/IEC of SAEs or other significant safety findings as required by 
IRB/IEC procedures. 
− Providing oversight of the conduct of the study at the site and adherence to GCP, 
IRB/IEC requirements, institutional requirements, and applicable laws and 
country-specific regulations. 
• Adhering to the Protocol as described in this document and agreeing that changes to 
the Protocol procedures, with the exception of medical emergencies, must be 
discussed and approved, first, by the sponsor or its designee and, second, by the 
IRB/IEC.  Each investigator is responsible for enrolling participants who have met 
the specified eligibility criteria. 
• Retaining records in accordance with all local, national, and regulatory laws but for a 
minimum period of at least 2 years after the last marketing application approval in an 
ICH region and until there are no pending or contemplated marketing applications in 
an ICH region, or if not approved, 2 years after the termination of the test article for 
investigation to ensure the availability of study documentation should it become 
necessary for the sponsor or a regulatory authority to review. 
− The investigator must not destroy any records associated with the study during the 
retention period without receiving approval from the sponsor.  The investigator 
must notify the sponsor or its designee in the event of accidental loss or 
destruction of any study records.  If the investigator leaves the institution where 
the study was conducted, the sponsor or its designee must be contacted to arrange 
alternative record storage options. 

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− All eCRF data entered by the site (including audit trail), as well as computer 
hardware and software (for accessing the data), will be maintained or made 
available at the site in compliance with applicable record retention regulations.  
The sponsor will retain the original eCRF data and audit trail. 
• For Japan:  The record retainer (delegated by the head of the study site) will retain the 
J-GCP–defined essential documentation at the site until the regulatory approval of the 
study drug/treatment or at least 3 years after the discontinuation or completion of the 
study conduct, whichever is later.  If the sponsor requires retention of these 
documents for a longer period of time, the duration and method of retention will be 
decided upon through discussion between the sponsor and the study site.  It is the 
responsibility of the sponsor to inform the head of the study site as to when the 
documents no longer need to be retained. 
11.1.1. 
Identification of the Coordinating Principal Investigator 
A coordinating principal investigator will be appointed by the sponsor before the end of the 
study.  As part of their responsibilities, the coordinating principal investigator will review the 
final CSR.  Agreement with the final CSR will be documented by the dated signature of the 
coordinating principal investigator. 
11.2. 
Data Management 
Data management will be performed in a validated EDC system.  The investigator will be 
provided with access to an EDC system so that an eCRF can be completed for each participant. 
The site will be provided with eCRF completion guidelines for instructions on data entry in the 
eCRF.  The study monitor will reference the Monitoring Plan in order to ensure that each issue 
identified is appropriately documented, reported, and resolved in a timely manner in accordance 
with the plan's requirements.  Other data outside the EDC system required in the study conduct 
of the Protocol, such as documents or results transmitted to the sponsor via a central laboratory 
or specialized technical vendors and as designated by the sponsor, will have their own data flow 
management plans, study charters, or biomarker plans, as applicable. 
The sponsor (or designee) will be responsible for the following: 
• Managing the integrity of the data and the quality of the conduct of the study, such as  
ensuring that study monitors perform ongoing source data verification to confirm that 
data entered into the eCRF by authorized site personnel are accurate, complete, and 
verifiable from source documents; that the safety and rights of participants are being 
protected; and that the study is being conducted in accordance with the currently 
approved Protocol and any other study agreements, ICH GCP, and all applicable 
regulatory requirements. 
• Managing and reconciling the data generated and/or collected, including documents 
and results such as laboratory or imaging data analyzed centrally by a designated 
vendor of the sponsor. 

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The investigator will be responsible for the following: 
• Recording, or ensuring the recording of, all relevant data relating to the study in the 
eCRF.  
• Delivering, or ensuring the delivery of, all other results, documents, data, know-how, 
or formulas relating to the study to the sponsor or designee electronically and/or 
centrally (eg, laboratory data, imaging data, biomarker data, photographs, diary data) 
or as otherwise specified in the Protocol.   
• Maintaining adequate and accurate source documents and trial records that include all 
pertinent observations on each of the site's trial participants.  Source data should be 
attributable, legible, contemporaneous, original, accurate, and complete.  Changes to 
source data should be traceable, should not obscure the original entry, and should be 
explained if necessary (eg, via an audit trail).  Source data are, in general, all 
information in original records and certified copies of original records of clinical 
findings, observations, or other activities in a clinical trial necessary for the 
reconstruction and evaluation of the trial.  Source data are contained in source 
documents (original records or certified copies). 
• Verifying that data entries are accurate and correct by physically or electronically 
signing the eCRF. 
• Maintaining accurate documentation (source data) that supports the information 
entered in the eCRF, or sent to a central vendor designated by the sponsor, or as 
described in other study and data flow manuals. 
− Source documents provide evidence for the existence of the participant and 
substantiate the integrity of the data collected.  Source documents are filed and 
available at the investigator's site.  Examples of source documents are original 
documents, data, and records (eg, hospital records; electronic hospital records; 
clinical and office charts; laboratory notes; memoranda; participants' diaries or 
evaluation checklists; pharmacy dispensing records; recorded data from 
automated instruments; copies or transcriptions certified after verification as 
being accurate copies; microfiches; photographic negatives; microfilm or 
magnetic media; x-rays; participants' files; and e-records/records kept at the 
pharmacy, at the laboratories, and at medico-technical departments involved in 
the clinical trial). 
− Data entered in the eCRF that are transcribed from source documents must be 
consistent with the source documents or the discrepancies must be explained.  The 
investigator may need to request previous medical records or transfer records, 
depending on the study.  Current applicable medical records must be available. 
• Sending participants' data, either as unique samples, or copies, or photographs, to be 
evaluated centrally or analyzed centrally, or both, by a qualified vendor designated by 
the sponsor.  

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− As required by privacy and data protection regulations and Incyte's privacy 
policies, if any photographs of participants are to be taken, the photographs must 
be limited to the area of the face or the body that is strictly necessary and the 
photographs should be masked (ie, identifying features such as eyes, mouth, scars, 
tattoos, or unique markings or features should be either obscured with a black bar 
or digitally pixelated so as to not permit the reidentification of the participants and 
preserve their confidentiality) by a specially designated photography vendor prior 
to sending the photographs to Incyte or any other third-party vendors for analysis 
or further processing. 
− If France is a participating country include the following: In accordance with 
French regulations, sites in France must perform the masking before the 
photographs are transferred, including to any specially designated photography 
vendor, Incyte, or any other third-party vendors for analysis or further processing. 
In addition, the participant's specific consent for photographs shall be collected. 
• Permitting study-related monitoring, sponsor audits, IRB/IEC review, and regulatory 
inspections by providing direct access to source data and other relevant clinical study 
documents. 
− Monitoring:  Qualified representatives of the sponsor or its designee, study 
monitors, will monitor the study according to a predetermined plan.  The 
investigator must allow the study monitors to review any study materials and 
participant records at each monitoring visit. 
− Auditing:  Qualified representatives of the sponsor or its designee may audit the 
clinical study site and study data to evaluate compliance with the Protocol, 
applicable local clinical study regulations, and overall study conduct.  The 
investigator must allow the auditors to review original source records and study 
documentation for all participants. 
− Regulatory inspection:  Regulatory authorities may conduct an inspection of the 
study and the site at any time during the development of an investigational 
product.  The investigator and staff are expected to cooperate with the inspectors 
and allow access to all source documents supporting the eCRFs and other 
study-related documents.  The investigator must immediately notify the sponsor 
when contacted by any regulatory authority for the purposes of conducting an 
inspection. 
11.3. 
Data Quality Assurance 
The sponsor assumes accountability for actions delegated to other individuals (eg, contract 
research organizations). The sponsor or designee is responsible for the data management of this 
study, including quality checking of the data. Further, monitoring details describing strategy, 
including definition of study-critical data items and processes (eg, risk-based initiatives in 
operations and quality such as risk management and mitigation strategies and analytical 
risk-based monitoring), methods, responsibilities, and requirements, including handling of 
noncompliance issues, Protocol deviations, and monitoring techniques (eg, central, remote, or 

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on-site monitoring) are provided in the Clinical Monitoring Plan, Integrated Quality Risk 
Management Plan, and other study plan as applicable. 
Quality tolerance limits will be predefined in the Integrated Quality Risk Management Plan to 
identify systematic issues that can impact participants' safety, efficacy results and analysis, 
and/or reliability of study results. These predefined parameters will be monitored during the 
study and can be adjusted during the study upon data review. Important deviations from the 
quality tolerance limits and remedial actions taken, including reporting to IRBs/IECs and health 
authorities if applicable, will be summarized in the CSR. 
11.4. 
Data Privacy and Confidentiality of Study Records 
The investigator and the sponsor or its designee must adhere to applicable data protection laws 
and regulations.  The investigator and the sponsor or its designee are responsible for ensuring 
that personal information is handled in accordance with local data protection laws (including but 
not limited to HIPAA and GDPR) as applicable, and the sponsor operates comprehensive data 
privacy and data security programs that are applicable to this study.  Appropriate notice, or 
notice and consent (as may be required by each applicable jurisdiction), for collection, use, 
disclosure, and/or transfer (if applicable) of personal information must be obtained in accordance 
with local data protection laws.  Appropriate data protection terms that comply with applicable 
laws will be included in relevant study agreements.  
To ensure confidentiality of records and protect personal data, participant names will not be 
supplied to the sponsor or its designee.  Only the participant number will be recorded in the 
eCRF; if the participant's name appears on any other document (eg, laboratory report), it must be 
obliterated on the copy of the document to be supplied to the sponsor or its designee.  Study 
findings stored on a computer will be stored in accordance with appropriate technical and 
organizational measures as required by local data protection laws. 
In the event of a data breach involving participant data, the sponsor or its designee will follow 
the sponsor's incident response procedures.  The precise definition of a data breach varies in 
accordance with applicable law but may generally be understood as a breach of security leading 
to the accidental or unlawful destruction, loss, alteration, unauthorized disclosure of, or access to, 
personal data.  In accordance with its incident response procedures, the sponsor will assess the 
breach to consider its notification and remediation obligations under applicable law. 
11.5. 
Financial Disclosure 
Before study initiation, all clinical investigators participating in clinical studies subject to FDA 
Regulation Title 21 CFR Part 54 – Financial Disclosure by Clinical Investigators (ie, "covered 
studies") are required to submit a completed Clinical Investigator Financial Disclosure Form that 
sufficiently details any financial interests and arrangements that apply.  For the purpose of this 
regulation, "clinical investigator" is defined as any investigator or subinvestigator who is directly 
involved in the treatment or evaluation of research participants, including the spouse and each 
dependent child of the clinical investigator or subinvestigator.  These requirements apply to both 
US and foreign clinical investigators conducting covered clinical studies. 

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Any new clinical investigators added to the covered clinical study during its conduct must also 
submit a completed Clinical Investigator Financial Disclosure Form.  During a covered clinical 
study, any changes to the financial information previously reported by a clinical investigator 
must be reported to the sponsor or its designee.  At the conclusion of the covered clinical study, 
the clinical investigators will be reminded of their obligations.  In the event that the clinical 
investigator is not reminded, they nevertheless will remain obligated to report to the sponsor or 
its designee any changes to the financial information previously reported, as well as any changes 
in their financial information for a period of 1 year after completion of the covered clinical study. 
11.6. 
Publication Policy 
By signing the study Protocol, the investigator and their institution agree that the results of the 
study may be used by the sponsor, Incyte Corporation, for the purposes of national and 
international registration, publication, and information for medical and pharmaceutical 
professionals.  Study results will be published in accordance with applicable local and national 
regulations.  If necessary, the authorities will be notified of the investigator's name, address, 
qualifications, and extent of involvement.  The terms regarding the publication of study results 
are contained in the agreement signed with the sponsor or its designee.  A signed agreement will 
be retained by the sponsor or its designee. 
The results of this study may be published or presented at scientific meetings.  If this is foreseen, 
the investigator agrees to submit all manuscripts or abstracts to the sponsor before submission.  
This allows the sponsor to protect proprietary information and to provide comments. 
The sponsor will comply with the requirements for publication of study results.  In accordance 
with standard editorial and ethical practice, the sponsor will generally support publication of 
multicenter studies only in their entirety and not as individual site data.  In this case, a 
coordinating investigator will be designated by mutual agreement. 
Authorship will be determined in line with International Committee of Medical Journal Editors 
authorship requirements. 
11.7. 
Study and Site Closure 
The sponsor or designee reserves the right to close the study site or terminate the study at any 
time for any reason at the sole discretion of the sponsor.  Study sites will be closed upon study 
completion.  A study site is considered closed when all required documents and study supplies 
have been collected and a study-site closure visit has been performed.   
For Japan:  When the trial is completed, the investigator should inform the head of the study site 
of the completion in writing and submit a written summary of the trial's outcome, and then the 
head of the study site should promptly inform the IRB and sponsor or designee of the completion 
in writing. 
The investigator may initiate study-site closure at any time, provided there is reasonable cause 
and sufficient notice is given in advance of the intended termination. 

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Reasons for the early closure of a study site by the sponsor or investigator may include but are 
not limited to: 
• Failure of the investigator to comply with the Protocol, the requirements of the 
IRB/IEC or local health authorities, the sponsor's procedures, or GCP guidelines. 
• Inadequate recruitment of participants by the investigator. 
• Discontinuation of further study treatment development. 

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12. 
REFERENCES 
Aliqopa (copanlisib) [prescribing information]. Bayer HealthCare Pharmaceuticals Inc; 
December 2019. 
Bartalucci N, Tozzi L, Bogani C, et al. Co-targeting the PI3K/mTOR and JAK2 signalling 
pathways produces synergistic activity against myeloproliferative neoplasms. J Call Mol Med 
2013;17:1385-1396. 
Bose P, Verstovsek S. The evolution and clinical relevance of prognostic classification systems 
in myelofibrosis. Cancer 2016;122:681-692. 
Cervantes F, Dupriez B, Pereira A, et al. New prognostic scoring system for primary 
myelofibrosis based on a study of the International Working Group for Myelofibrosis Research 
and Treatment. Blood 2009;113:2895-2901. 
Cervantes F, Vannucchi AM, Kiladjian JJ, et al. Three-year efficacy, safety, and survival 
findings from COMFORT-II, a phase 3 study comparing ruxolitinib with best available therapy 
for myelofibrosis [published correction appears in Blood 2016;128:3013]. Blood 
2013;122:4047-4053. 
Cheson BD. Death and clinical trials in the plague years. Accessed July 21, 2022. 
https://ascopost.com/issues/july-10-2022/death-and-clinical-trials-in-the-plague-years 
Clinical Trials Facilitation and Coordination Group. Recommendations related to contraception 
and pregnancy testing in clinical trials. 2014. 
Copiktra (duvesilib) [prescribing information]. Verastem, Inc; July 2019. 
Coutré S, Barrientos JC, Brown JR, et al. Management of adverse events associated with 
idelalisib treatment: expert panel opinion. Leuk Lymphoma 2015;56:2779-2786. 
Deeg HJ, Gooley TA, Flowers ME, et al. Allogeneic hematopoietic stem cell transplantation for 
myelofibrosis. Blood 2003;102:3912-3918. 
Durrant ST, Nagler A, Guglielmelli P, et al. Results from HARMONY: an open-label, 
multicenter, 2-arm, phase 1b, dose-finding study assessing the safety and efficacy of the oral 
combination of ruxolitinib and buparlisib in patients with myelofibrosis. Haematologica 
2019;104:e551-e554. 
 
 
 
Flinn IW, O'Brien S, Kahl B, et al. Duvelisib, a novel oral dual inhibitor of PI3K-δ,γ, is clinically 
active in advanced hematologic malignancies. Blood 2018;131:877-887. 
Harrison C, Kiladjian JJ, Al-Ali HK, et al. JAK inhibition with ruxolitinib versus best available 
therapy for myelofibrosis. N Engl J Med 2012;366:787-798. 
Hermouet S, Bigot-Corbel E, Gardie B. Pathogenesis of myeloproliferative neoplasma: role and 
mechanisms of chronic inflammation. Mediators Inflamm 2015;2015:145293. 
Hwang IK, Shih WJ, De Cani JS. Group sequential designs using a family of Type I error 
probability spending functions. Stat Med 1990;9:1439-1445. 

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Jakafi (ruxolitinib) [package insert]. Incyte Corporation; September 2021. 
Jakavi (ruxolitinib) [summary of product characteristics]. Novartis Europharma Limited; May 
2022. 
Jee J, Foote MB, Lumish M, et al. Chemotherapy and COVID-19 outcomes in patients with 
cancer. J Clin Oncol 2022;38:3538-3546. 
Khan I, Huang Z, Wen Q, et al. AKT is a therapeutic target in myeloproliferative neoplasms. 
Leukemia 2013;27:1882-1890. 
Lee CY, Shah MK, Hoyos D, et al. Prolonged SARS-CoV-2 infection in patients with lymphoid 
malignancies. Cancer Discov 2022;12:62-73. 
Lyudovyk O, Kim JY, Qualls D, et al. Impaired humoral immunity is associated with prolonged 
COVID-19 despite robust CD8 T cell responses. Cancer Cell 2022;40:738-753. 
Masarova L, Bose P, Daver N, et al. Patients with post-essential thrombocythemia and post 
polycythemia vera differ from patients with primary myelofibrosis. Leuk Res 2017;59:110-116. 
Meadows SA, Nguyen HM, Queva C, et al. PI3Kδ inhibitor idelalisib inhibits AKT signaling in 
myelofibrosis patients on chronic JAK inhibitor therapy. Blood 2013;122:4065. 
Mesa RA, Gotlib J, Gupta V, et al. Effect of ruxolitinib therapy on myelofibrosis-related 
symptoms and other patient-reported outcomes in COMFORT-I: a randomized, double-blind, 
placebo-controlled trial. J Clin Oncol 2013a;31:1285-1292. 
Mesa RA, Shields A, Hare T, et al. Progressive burden of myelofibrosis in untreated patients: 
assessment of patient-reported outcomes in patients randomized to placebo in the COMFORT-I 
study. Leuk Res 2013b;37:911-916. 
National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology. Prevention 
and Treatment of Cancer-Related Infections Version 2. 2017. 
Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern 
Cooperative Oncology Group. Am J Clin Oncol 1982;5:649-655. 
Pardanani A, Harrison C, Cortes JE, et al. Safety and efficacy of fedratinib in patients with 
primary or secondary myelofibrosis: a randomized clinical trial. JAMA Oncol 2015;1:643-651. 
Parsaclisib Investigator's Brochure. Wilmington, DE: Incyte Corporation. 
 
 
 
Robin M, de Wreede LC, Wolschke C, et al. Long-term outcome after allogeneic hematopoietic 
cell transplantation for myelofibrosis. Haematologica 2019;104:1782-1788. 
Ruxolitinib Investigator's Brochure. Wilmington, DE: Incyte Corporation. 
Shree T, Shankar V, Lohmeyer JJK, et al. CD20-targeted therapy ablates de novo antibody 
response to vaccination but spares preestablished immunity. Blood Cancer Discov 
2022;3:95-102. 

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Stein BL, Gotlib J, Arcasoy M, et al. Historical views, conventional approaches, and evolving 
management strategies for myeloproliferative neoplasms. J Natl Compr Canc Netw 
2015;13:424-434. 
Talpaz M, Paquette R, Afrin L, et al.  Interim analysis of safety and efficacy of ruxolitinib in 
patients with myelofibrosis and low platelet counts. J Hematol Oncol 2013;6:81-90 
 
 
 
 
 
 
Tefferi A, Guglielmelli P, Nicolosi M, et al. GIPSS: genetically inspired prognostic scoring 
system for primary myelofibrosis. Leukemia 2018;32:1631-1642. 
 
 
Thorpe LM, Yuzugullu H, Zhao JJ. PI3K in cancer: divergent roles of isoforms, modes of 
activation and therapeutic targeting. Nat Rev Cancer 2015;15:7-24. 
Tzenaki N, Papakonstanti EA. p110δ PI3 kinase pathway: emerging roles in cancer. Front Oncol 
2013;3:40. 
Vannucchi AM, Kantarjian HM, Kiladjian JJ, et al. A pooled analysis of overall survival in 
COMFORT-I and COMFORT-II, 2 randomized phase III trials of ruxolitinib for the treatment of 
myelofibrosis. Haematologica 2015;100:1139-1145. 
Verstovsek S, Mesa RA, Gotlib J, et al. A double-blind, placebo-controlled trial of ruxolitinib for 
myelofibrosis. N Engl J Med 2012;366:799-807. 
Verstovsek S, Mesa RA, Gotlib J, et al. Efficacy, safety, and survival with ruxolitinib in patients 
with myelofibrosis: results of a median 3-year follow-up of COMFORT-I. Haematologica 
2015;100:479-488. 
Yacoub A, Borate U, Rampal R, et al. Add-on parsaclisib (a PI3K-delta inhibitor) in patients 
with myelofibrosis and suboptimal response to ruxolitinib: interim analysis from a phase 2 study. 
HemaSphere 2021;5(suppl 2):512. Abstract EP1075. 
Zydelig (idelalisib) [prescribing information]. Gilead Sciences, Inc; September 2018. 

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APPENDIX A. INFORMATION REGARDING EFFECTIVENESS OF 
CONTRACEPTIVE METHODS 
For male participants in the study: 
Male participants should use a condom from screening through 93 days after the end of systemic 
exposure.  If the male participant has a partner that is of child-bearing potential, the partner should also 
use contraception through 93 days after the end of relevant systemic exposure.  In addition, male 
participants must refrain from donating sperm from screening through 93 days after the end of relevant 
systemic exposure.  Males who have had a vasectomy clinically designated as successful qualify as 
having met the requirement for a highly effective birth control method. 
For female participants in the study: 
The following methods that can achieve a failure rate of less than 1% per year when used consistently 
and correctly are considered as highly effective birth control methods: 
• 
Combined (estrogen and progestogen containing) hormonal contraception associated with 
inhibition of ovulationa 
− 
oral 
− 
intravaginalb 
− 
transdermalb  
• 
Progestogen-only hormonal contraception associated with inhibition of ovulationa 
− 
oralb 
− 
injectableb  
− 
implantableb,c  
• 
Intrauterine devicec  
• 
Intrauterine hormone-releasing systemc  
• 
Bilateral tubal occlusionc  
• 
Vasectomized partnerc,d 
• 
Sexual abstinencee (not applicable in Japan) 
a Hormonal contraception may be susceptible to interaction with the investigational medicinal product, which may 
reduce the efficacy of the contraception method. 
b Administration route not approved in Japan. 
c Contraception methods that in the context of this guidance are considered to have low user dependency. 
d Vasectomized partner is a highly effective method of avoiding pregnancy provided that partner is the sole sexual 
partner of the woman of childbearing potential study participant and that the vasectomized partner has received 
medical assessment of the surgical success. 
e In the context of this guidance, sexual abstinence is considered a highly effective method only if defined as 
refraining from heterosexual intercourse during the entire period of risk associated with the study treatments.  The 
reliability of sexual abstinence needs to be evaluated in relation to the duration of the clinical study and the 
preferred and usual lifestyle of the participant. 
Source:  Clinical Trials Facilitation and Coordination Group 2014.                             

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APPENDIX B. WORSENING SYMPTOMATIC SPLENOMEGALY 
FORM 
Date of additional MRI  _______________ 
 
Did the imaging vendor report an increase in SV of 25% or more relative to baseline?    Yes/No 
 
Ask the patient the following 3 questions and record scores here: 
 
1. During the past 7 days, how severe 
was your worst abdominal discomfort 
(feeling pressure or bloating)? 
 
0 (Absent)  1    2    3    4    5    6    7    8    9    10 (Worst Imaginable) 
2. During the past 7 days, how severe 
was the worst pain under your ribs on 
the left side? 
 
0 (Absent)  1    2    3    4    5    6    7    8    9    10 (Worst Imaginable) 
3. During the past 7 days, what was the 
worst feeling of fullness you had after 
beginning to eat? 
 
0 (Absent)  1    2    3    4    5    6    7    8    9    10 (Worst Imaginable) 

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APPENDIX C. SCREENING SYMPTOM FORM 
Instructions to participants:  Please answer all questions to the best of your ability, based on your 
memory over the past 7 days (1 week).  There is no right or wrong answer. 
1. During the past 7 days, how 
severe was your worst fatigue 
(weariness, tiredness)? 
 
0 (Absent)  1   2   3   4   5   6   7   8   9   10 (Worst Imaginable) 
2. During the past 7 days, how 
severe were your worst night 
sweats (or feeling hot or flushed)? 
 
0 (Absent)  1   2   3   4   5   6   7   8   9   10 (Worst Imaginable) 
3. During the past 7 days, how 
severe was your worst itching? 
 
0 (Absent)  1   2   3   4   5   6   7   8   9   10 (Worst Imaginable) 
4. During the past 7 days, how 
severe was your worst abdominal 
discomfort (feeling pressure or 
bloating)? 
 
0 (Absent)  1   2   3   4   5   6   7   8   9   10 (Worst Imaginable) 
5. During the past 7 days, how 
severe was the worst pain under 
your ribs on your left side? 
 
0 (Absent)  1   2   3   4   5   6   7   8   9   10 (Worst Imaginable) 
6. During the past 7 days, what was 
the worst feeling of fullness you 
had after beginning to eat? 
 
0 (Absent)  1   2   3   4   5   6   7   8   9   10 (Worst Imaginable) 
7. During the past 7 days, how 
severe was your worst bone pain 
(not joint or arthritis pain)? 
 
0 (Absent)  1   2   3   4   5   6   7   8   9   10 (Worst Imaginable) 
Investigators/Site Staff: 
Please complete the table below to confirm the criterion used to confirm the participant's 
eligibility in the trial based on an assessment of his/her active symptoms of myelofibrosis. 
ELIGIBILITY CRITERION 
CONFIRMATION 
Total Symptom Score of at least 10 (for the 7 items above) 
□ Yes □ No 

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APPENDIX D. EASTERN COOPERATIVE ONCOLOGY GROUP 
PERFORMANCE STATUS 
Grade 
Performance Status 
0 
Fully active, able to carry on all predisease performance without restriction. 
1 
Restricted in physically strenuous activity but ambulatory and able to carry out work of a 
light or sedentary nature, eg, light house work, office work. 
2 
Ambulatory and capable of all self-care but unable to carry out any work activities.  Up and 
about more than 50% of waking hours. 
3 
Capable of only limited self-care, confined to bed or chair more than 50% of waking hours. 
4 
Completely disabled.  Cannot carry on any self-care.  Totally confined to bed or chair. 
5 
Dead. 
Source:  Oken et al 1982. 

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APPENDIX G. INHIBITORS AND INDUCERS OF CYTOCHROME P450 
CYP 3A4 Inhibitors 
Inhibitor 
Therapeutic Class 
Potent CYP3A Inhibitors 
VIEKIRA PAK 
Antivirals 
Indinavir/RIT 
Protease inhibitors 
Tipranavir/RIT 
Protease inhibitors 
Ritonavir 
Protease inhibitors 
Cobicistat (GS-9350) 
None 
Ketoconazole 
Antifungals 
Indinavir 
Protease inhibitors 
Troleandomycin 
Antibiotics 
Telaprevir 
Antivirals 
Danoprevir/RIT 
Antivirals 
Elvitegravir/RIT 
Treatments of AIDS 
Saquinavir/RIT 
Protease inhibitors 
Lopinavir/RIT 
Protease inhibitors 
Itraconazole 
Antifungals 
Voriconazole 
Antifungals 
Mibefradil 
Calcium channel blockers 
LCL161 
Cancer treatments 
Clarithromycin 
Antibiotics 
Posaconazole 
Antifungals 
Telithromycin 
Antibiotics 
Grapefruit juice DS 
Food products 
Conivaptan 
Diuretics 
Nefazodone 
Antidepressants 
Nelfinavir 
Protease inhibitors 
Saquinavir 
Protease inhibitors 
Ribociclib 
Kinase inhibitors 
Idelalisib 
Kinase inhibitors 
Boceprevir 
Antivirals 
 

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Inhibitor 
Therapeutic Class 
Moderate CYP3A Inhibitors 
Erythromycin 
Antibiotics 
Fluconazole 
Antifungals 
Atazanavir/RIT 
Protease inhibitors 
Darunavir 
Protease inhibitors 
Diltiazem 
Calcium channel blockers 
Darunavir/RIT 
Protease inhibitors 
Dronedarone 
Antiarrhythmics 
Crizotinib 
Kinase inhibitors 
Atazanavir 
Protease inhibitors 
Letermovir 
Antivirals 
GSK2647544 
Alzheimer's disease & dementia treatments 
Aprepitant 
Antiemetics 
Casopitant 
Antiemetics 
Amprenavir 
Protease inhibitors 
Faldaprevir 
Antivirals 
Imatinib 
Antineoplastic agents 
Verapamil 
Calcium channel blockers 
Netupitant 
Antiemetics 
Nilotinib 
Kinase inhibitors 
Grapefruit juice 
Food products 
Tofisopam 
Benzodiazepines 
Cyclosporine 
Immunosuppressants 
ACT-178882 
Renin inhibitors 
Ciprofloxacin 
Antibiotics 
Magnolia vine (Schisandra sphenanthera) 
Herbal medications 
Isavuconazole 
Antifungals 
Cimetidine 
H-2 receptor antagonists 
FK1706 
Central nervous system agents 
 

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Inhibitor 
Therapeutic Class 
Weak CYP3A Inhibitors 
Tabimorelin 
Hormone replacement 
Amlodipine 
Calcium channel blockers 
Ranolazine 
Cardiovascular drugs 
Breviscapine 
Herbal medications 
Lomitapide 
Other antilipemics 
Fosaprepitant (IV) 
Antiemetics 
Seville orange (Citrus aurantium) juice 
Food products 
Amiodarone 
Antiarrhythmics 
Diosmin 
Herbal medications 
Chlorzoxazone 
Muscle relaxants 
M100240 
Antihypertensive agents 
Fluvoxamine 
Antidepressants 
Ranitidine 
H-2 receptor antagonists 
Goldenseal 
Herbal medications 
Clotrimazole 
Antifungals 
Tacrolimus 
Immunosuppressants 
Palbociclib 
Kinase inhibitors 
Cilostazol 
Antiplatelets 
Ticagrelor 
Antiplatelets 
Peppermint oil 
Food products 
Ivacaftor 
Cystic fibrosis treatments 
GSK2248761 
Transcriptase inhibitors 
Guan Mai Ning 
Herbal medications 
Osilodrostat 
Adrenal steroidogenesis inhibitors 
AZD2327 
Depression treatments 
Piperine 
Food products 
Resveratrol 
Food products 
Roxithromycin 
Antibiotics 
Suvorexant 
Hypnotics - sedatives 
Propiverine 
Anticholinergics 
Isoniazid 
Antibiotics 
Berberine 
Herbal medications 
Oral contraceptives 
Oral contraceptives 
Delavirdine 
NNRTIs 
Daclatasvir 
Antivirals 

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Inhibitor 
Therapeutic Class 
Weak CYP3A Inhibitors 
Simeprevir 
Protease inhibitors 
Atorvastatin 
HMG CoA reductase inhibitors (statins) 
Tolvaptan 
Vasopressin antagonists 
Almorexant 
Hypnotics - sedatives 
GSK1292263 
Other antilipemics 
Evacetrapib 
CETP inhibitors 
Linagliptin 
Dipeptidyl peptidase 4 inhibitors 
Grazoprevir (ingredient of Zepatier) 
Antivirals 
Lacidipine 
Calcium channel blockers 
Cranberry juice 
Food products 
Pazopanib 
Kinase inhibitors 
Fostamatinib 
Other 
Everolimus 
Immunosuppressants 
Blueberry juice 
Food products 
Flibanserin 
Central nervous system agents 
Lapatinib 
Kinase Inhibitors 
Brodalumab 
Immunomodulators biologics 
AMD070 
Fusion inhibitors 
Alprazolam 
Benzodiazepines 
Tong Xin Luo 
Herbal medications 
Glecaprevir and pibrentasvir 
Antivirals 
Bicalutamide 
Antiandrogens 
Sitaxentan 
Endothelin receptor antagonists 
Azithromycin 
Antibiotics 
Obeticholic acid 
Miscellaneous agents 
Ginkgo 
Herbal medications 
Teriflunomide 
Other immunomodulators 
 

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CYP 3A4 Inducers 
Inducers 
Therapeutic Class 
Potent CYP3A Inducers 
Rifampin 
Antibiotics 
Mitotane 
Other antineoplastics 
Avasimibe 
Other antilipemics 
Rifapentine 
Antibiotics 
Apalutamide 
Antiandrogens 
Phenytoin 
Anticonvulsants 
Carbamazepine 
Anticonvulsants 
Enzalutamide 
Antiandrogens 
St John's wort extract 
Herbal medications 
Lumacaftor 
Cystic fibrosis treatments 
Rifabutin 
Antibiotics 
Phenobarbital 
Anticonvulsants 
Moderate CYP3A Inducers 
Ritonavir and St John's wort 
None 
Semagacestat 
Alzheimer's treatments 
Efavirenz 
NNRTIs 
Tipranavir and ritonavir 
Protease inhibitors 
Dabrafenib 
Kinase inhibitors 
Lesinurad 
Antigout and uricosuric agents 
Bosentan 
Endothelin receptor antagonists 
Genistein 
Food products 
Thioridazine 
Antipsychotics 
Nafcillin 
Antibiotics 
Talviraline 
NNRTIs 
Lopinavir 
Protease inhibitors 
Modafinil 
Psychostimulants 
Pf-06282999 
Myeloperoxidase inactivators 
Etravirine 
NNRTIs 
Lersivirine 
NNRTIs 
Telotristat ethyl 
Antidiarrheals 
 

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Inducers 
Therapeutic Class 
Weak CYP3A Inducers 
Eslicarbazepine 
Anticonvulsants 
Telaprevir 
Antivirals 
Daclatasvir and asunaprevir and beclabuvir 
Antivirals 
Amenamevir 
Antivirals 
Garlic 
Food products 
Bexarotene 
Other antineoplastics 
Sarilumab 
Immunomodulators biologics 
Artesunate and mefloquine 
Antimalarials 
Amprenavir (fosamprenavir) 
Protease inhibitors 
Raltegravir 
HIV-integrase strand transfer inhibitors 
Vemurafenib 
Kinase inhibitors 
Troglitazone 
Thiazolidinediones 
Dicloxacillin 
Antibiotics 
Sorafenib 
Kinase inhibitors 
Rufinamide 
Anticonvulsants 
Sirukumab 
Immunomodulators biologics 
Pleconaril 
Antivirals 
Ginseng 
Herbal medications 
Boceprevir 
Antivirals 
Sulfinpyrazone 
Antigout and uricosuric agents 
Ginkgo 
Herbal medications 
Vinblastine 
Vinca alkaloids 
Nevirapine 
NNRTIs 
Armodafinil (R-modafinil) 
Psychostimulants 
Ticagrelor 
Anticoagulants and antiplatelets 
LCL161 
Cancer treatments 
Vicriviroc and ritonavir 
Treatments of AIDS 
Ritonavir 
Protease inhibitors 
Prednisone 
Corticosteroids 
Oxcarbazepine 
Anticonvulsants 
Danshen 
Herbal medications 
Clobazam 
Benzodiazepines 
Echinacea 
Herbal medications 
Ticlopidine 
Anticoagulants and antiplatelets 
Isavuconazole 
Antifungals 
Brivaracetam 
Anticonvulsants 
Stribild 
Treatments of AIDS 

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Inducers 
Therapeutic Class 
Weak CYP3A Inducers 
Pioglitazone 
Thiazolidinediones 
VIEKIRA PAK 
Antivirals 
Dexamethasone 
Corticosteroids 
Terbinafine 
Antifungals 
Quercetin 
Food products 
Glycyrrhizin 
Herbal medications 
Aprepitant 
Neurokinin-1 receptor antagonists 
Pretomanid (PA-824) 
Antibiotics 
Safinamide 
MAO-B inhibitors 
Oritavancin 
Antibiotics 
AZD 7325 
Anxiolytics 
Methylprednisolone 
Corticosteroids 
Topiramate 
Anticonvulsants 

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APPENDIX H. INSTRUCTION TO PARTICIPANTS FOR HANDLING 
STUDY DRUG (PARSACLISIB OR PLACEBO) AND 
REFERENCE TREATMENT (RUXOLITINIB) 
The participant must be instructed in the handling of study drug as follows: 
• Store all parsaclisib/matching placebo and ruxolitinib supplies at room temperature. 
• Only remove the number of tablets needed at the time of administration. 
• Not to remove doses in advance of the next scheduled administration. 
• Make every effort to take doses on schedule. 
• Report any missed doses or lost tablets 
• If the participant vomits after taking parsaclisib/matching placebo or ruxolitinib, the 
participant should not take another dose. 
• To keep study drug and reference drug in a safe place and out of reach of children. 
• To bring all used and unused study and reference drug bottles/blister packs/kits to the 
site at each visit. 
• If a dose of parsaclisib/matching placebo or ruxolitinib is missed by more than 
4 hours, that dose should be skipped and the next scheduled dose should be 
administered at the usual time). 

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APPENDIX I. BONE MARROW BIOPSY AND ASPIRATE 
EVALUATION 
• Grading of bone marrow biopsy fibrosis density 
 Fibrosis Grade 
Description 
0 
Scattered linear reticulin with no intersections corresponding to normal 
bone marrow 
1 
Loose network of reticulin with many intersections, especially in 
perivascular areas 
2 
Diffuse and dense increase in reticulin with extensive intersections, 
occasionally with only focal bundles of collagen and/or focal 
osteosclerosis 
3 
Diffuse and dense increase in reticulin with extensive intersections with 
coarse bundles of collagen, often associated with significant osteosclerosis 
Note:  Fibrosis density should be assessed in hematopoietic areas. 
Source:  Tefferi et al 2006. 
•  Bone marrow aspirate evaluation 
The following should be assessed: 
• Cellularity. 
• 500-cell differential of aspirate, correlated, if possible, with data from appropriate 
marrow biopsy section.  Percentage of pronormoblasts, blasts, normoblasts, 
myelocytes, and metamyelocytes. 
• Blast percentage, indicating what cellular types are being considered as blast 
equivalents, and the degree of maturation and dysplastic abnormalities within the 
neoplastic population. 
• Characterization of erythrocyte and megakaryocyte morphology. 
• Characterization and gradation of fibrosis within hematopoietic cellular areas. 
• Diagnostic interpretation with specific mention of (expected) absence of an 
infiltrative or granulomatous process  

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APPENDIX J. PROTOCOL AMENDMENT SUMMARY OF CHANGES 
Document 
Date 
Amendment 1 
11 OCT 2021 
Amendment 2 
14 OCT 2022 
Amendment 2 (14 OCT 2022) 
Overall Rationale for the Amendment:   
The primary purpose of this amendment is to update safety information for parsaclisib, including 
information regarding COVID-19, and the potential impact of parsaclisib therapy on infection 
risk, vaccine effectiveness, and severity of disease.  Additional clarifications are also provided. 
1. Section 1, Protocol Summary (Table 2:  Key Study Design Elements) 
Description of change:  Clarified that certain countries have minimum enrollment 
requirements and added the name of the coordinating principal investigator.  
Rationale for change:  To clarify language around enrollment requirements and add the 
name of the coordinating principal investigator.  
2. Section 2.6.1.2, Potential Risks of Parsaclisib Based on Prior and Ongoing Clinical 
Studies; Section 2.6.2.2, Potential Risks of Parsaclisib Plus Ruxolitinib 
Description of change:  Updated safety language to reflect the updated Investigator's 
Brochure (dated MAY 2022) and added a statement to include COVID-19 in potential 
risks.  
Rationale for change:  To provide updated safety information. 
3. Section 4.1.1, Study Schedule/Procedures 
Description of change:  Added language for location options for local laboratory visits.  
Rationale for change:  To provide options for participants for local laboratory visits.   
4. Section 4.1.4, Early Unblinding/Crossover Process; Section 4.1.5, Study 
Unblinding/Crossover Process 
Description of change:  Clarified processes for database cleaning and freezing.  
Rationale for change:  To clarify what data/visits will be cleaned and frozen. 
5. Section 5, Study Population; Section 5.1, Inclusion Criteria 
Description of change:  Removed requirement for age of 20 years or older for Japan and 
added language for age requirement of 19 years or older for South Korean participants.  
Rationale for change: Age of 20 years or older is no longer a requirement for Japan.  
Age of 19 years or older is a requirement for South Korea.  

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6. Section 6.1, Study Treatments Administered (Table 10:  Study Treatment 
Information); Section 6.2, Preparation, Handling, and Accountability 
Description of change:  Included additional tablet strength for ruxolitinib and replaced 
language regarding storage conditions with reference to the Pharmacy Manual and 
labeling instructions.  
Rationale for change:  To clarify that an additional tablet strength of ruxolitinib is 
available in some countries and to improve consistency for storage condition information 
in the study.  
7. Section 6.7.5, COVID-19 
Description of change:  Added new section describing risks associated with COVID-19 
with regard to participants with hematologic disorders and treatment with parsaclisib.  
Rationale for change:  Informational purposes.  
8. Incorporation of administrative changes.  Other regulatory guidance and 
administrative changes have been incorporated throughout the Protocol and are noted in 
the redline version of the amendment.   

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Amendment 1 (11 OCT 2021) 
Overall Rationale for the Amendment:   
The primary purpose of this amendment is to address changes requested by different national 
regulatory agencies and ethics committees. 
1. Section 1, Protocol Summary (Table 2:  Key Study Design Elements) 
Description of change:  Included a note regarding the minimum enrollment regulatory 
requirement in Japan and need for potential continued enrollment after enrollment in 
other countries ends. 
Rationale for change:  To allow minimum enrollment regulatory requirement in Japan. 
2. Section 1, Protocol Summary (Table 2:  Key Study Design Elements; Table 5:  
Schedule of Laboratory Assessments for All Participants; Section 2.5.2, Justification 
for Dose; Section 4.1, Overall Design; Section 6.1, Study Treatments Administered 
(Table 10:  Study Treatment Information); Section 6.3, Measures to Minimize Bias:  
Randomization and Blinding; Section 8.1.3, Baseline; Section 10.1, Sample Size 
Determination; Section 10.4.1, Primary and Secondary Analyses (Table 17:  
Primary and Secondary Analyses Methods and Populations); Section 10.4.3, 
Exploratory Analysis 
Description of change:  Inserted a statement that if a participant's platelet count is 
< 50 × 109/L at baseline, the platelet count at screening will be used for 
stratification/randomization.  
Rationale for change:  To provide guidance for cases in which the platelet count 
decreases between screening and baseline and to remove discrepancies in the Protocol 
regarding which value should be used. 
3. Section 1, Protocol Summary (Table 3:  Schedule of Activities for Randomized 
Participants in Group A, in Group B, and After Crossover); Section 8.8.2, Survival 
Follow-Up 
Description of change:  Added a 2-week window for survival follow-up. 
Rationale for change:  Administrative error. 
4. Section 1, Protocol Summary (Table 3:  Schedule of Activities for Randomized 
Participants in Group A, Group B, and After Crossover; Table 4:  Schedule of 
Additional Study Visits for Participants Who Cross Over); Section 4.1.1, Study 
Schedule/Procedures 
Description of change:  Specified end date for PJP prophylaxis as at least 2 to 6 months 
after the last dose of study treatment, consistent with other sections of the Protocol. 
Rationale for change:  Administrative error. 

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5. Section 1, Protocol Summary (Table 3:  Schedule of Activities for Randomized 
Participants in Group A, in Group B, and After Crossover; Table 5:  Schedule of 
Laboratory Assessments for All Participants); Section 8.1.2, Screening Procedures; 
Section 8.2.1, Bone Marrow Biopsy and Aspirate 
Description of change:  Removed requirement for 0% blasts at screening for an archived 
biopsy/aspirate to be used for study entry. 
Rationale for change:  Requirement for 0% blasts is not reflective of many high-risk 
patients with MF. 
6. Section 1, Protocol Summary (Table 4:  Schedule of Additional Study Visits for 
Participants Who Cross Over) 
Description of change:  Specified that IXRS needs to be contacted also at the 4 weeks 
post-crossover visit. 
Rationale for change:  Administrative error. 
7. 
 
 
 
 
 
   
 
 
8. Section 1, Protocol Summary (Table 5:  Schedule of Laboratory Assessments for All 
Participants) 
Description of change:  Added window values for different laboratory-only visits. 
Rationale for change:  Administrative error.  
9. Section 1, Protocol Summary (Table 5:  Schedule of Laboratory Assessments for All 
Participants); Section 8.3, Safety Assessments (Table 14:  Required Laboratory 
Analytes); 
 
Description of change:  
 
 
.   
Rationale for change:  To meet regulatory and genetic testing requirements of specific 
countries. 

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10. Section 1, Protocol Summary (Table 5:  Schedule of Laboratory Assessments for All 
Participants); Section 8.2.1, Bone Marrow Biopsy and Aspirate; Section 8.3, Safety 
Assessments (Table 14:  Required Laboratory Analytes); Section 8.5.2, Biomarker 
Assessments 
Description of change:  Inserted statement that samples of bone marrow biopsy and 
aspirate for central analysis will only be collected in designated countries.  
Rationale for change:  To meet regulatory and genetic testing requirements of specific 
countries. 
11. Section 2.6.1.2, Potential Risks of Parsaclisib Based on Prior and Ongoing Clinical 
Trials 
Description of change:  Updated safety information. 
Rationale for change:  To reflect current IB. 
12. Section 2.6.1.4, Potential Benefits of Parsaclisib; Section 2.6.2.2, Potential Risks of 
Parsaclisib Plus Ruxolitinib 
Description of change:  Updated information to reflect the most recent data analysis. 
Rationale for change:  To provide updated information.  
13. Section 2.6.2.1, Potential Risks of Ruxolitinib 
Description of change:  Added risks from US prescribing information and SmPC to 
include risks of infections and added SmPC as a reference.  
Rationale for change:  Request of multiple regulatory authorities and ethics committees. 
14. Section 3, Objectives and Endpoints (Table 7:  Objectives and Endpoints); 
 
 
Description of change:  
 
 
 
Rationale for change:  
 
15. Section 4.1.2, Unblinding and Crossover 
Description of change:  Added statement to clarify that when the study is unblinded, a 
participant found to have been randomized to parsaclisib will continue treatment with 
both parsaclisib and ruxolitinib as long as protocol-defined criteria are met. 
Rationale for change:  Clarity. 
16. Section 4.1.3, Early Unblinding and Crossover 
Description of change:  Modified text to indicate that when a participant is to cross over 
early and either is found to have been on parsaclisib or is on placebo but does not choose 
to cross over, the participant must discontinue treatment with study drugs (parsaclisib and 
ruxolitinib) and have an EOT visit scheduled.  
Rationale for change:  Clarity. 

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17. Section 4.2, Overall Study Duration 
Description of change:  Clarified that end of study is defined as the date of either the last 
visit or the last contact of the last participant in the study. 
Rationale for change:  Clarity. 
18. Section 4.3, Study Termination; Section 11.6, Study and Site Closure 
Description of change:  Specified responsibility of the head of study site concerning 
study termination and study completion in Japan. 
Rationale for change:  Japan requirement. 
19. Section 5.1, Inclusion Criteria 
Description of change:  Specified Japan-specific requirements for participants under 
20 years old. 
Rationale for change:  Japan requirement. 
20. Section 5.2, Exclusion Criteria; Section 6.8.5, Prohibited Medications and 
Procedures 
Description of change:  Change wording to decrease the washout period to 3 weeks for 
hydroxyurea (whether used for MF or another indication). 
Rationale for change:  To modify the washout period for hydroxyurea being used for 
MF or a non-MF condition to a clinically adequate period of 3 weeks. 
21. Section 5.2, Exclusion Criteria 
Description of change:  Clarified that the definition of inadequate bone marrow reserve 
is not limited to the parameters listed in the protocol, clarified that platelet count 
< 50 × 109/L and ANC < 0.5 × 109/L at screening are also exclusionary, modified the 
description of inadequate liver function to clarify the statement about direct bilirubin 
versus total bilirubin, clarified that prophylactic antivirals are allowed, moved the 
exclusion criterion for participants unwilling to receive RBC transfusions as a separate 
criterion, and added exclusion criteria for immediate eligibility for allogenic stem cell 
transplant and sensitivity/allergy to study drugs or excipients.  
Rationale for change:  To provide flexibility to investigators to characterize what 
constitutes an inadequate bone marrow reserve, clarify that screening values are also 
considered in the exclusion/inclusion assessment, remove potentially contradictory 
language regarding bilirubin criteria, provide clarity regarding use of prophylactic 
antivirals, separate the transfusion exclusion criterion from the description of inadequate 
bone marrow reserve for clarity, exclude participants who immediately qualify for 
allogeneic stem cell transplantation, and fulfill the request of multiple regulatory 
agencies/ethics committees to explicitly state that sensitivity/allergy to drug/excipients is 
an exclusion criterion.  

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22. Section 6.1, Study Treatments Administered (Table 10:  Study Treatment 
Information) 
Description of change:  Inserted details concerning storage conditions for the study 
treatments. 
Rationale for change:  To provide additional information regarding storage conditions. 
23. Section 6.2, Preparation, Handling, and Accountability 
Description of change:  Specified responsibility of the investigational drug storage 
manager concerning preparation, handling, and accountability in Japan. 
Rationale for change:  Japan requirement. 
24. Section 6.7.1.2, Dose Increases for Ruxolitinib for Participants Entering the Study 
with a Platelet Count ≥ 100 × 109/L 
Description of change:  Modified dose increase rules.  
Rationale for change:  To better match the labeling for ruxolitinib in the US. 
25. Section 6.7.2, Dose Decreases of Parsaclisib/Placebo for Toxicity  
Description of change:  Specified that individual decisions are in regard to both dose 
reductions and interruptions. 
Rationale for change:  To provide additional clarity to dosing decisions.   
26. Section 6.7.2, Dose Decreases of Parsaclisib/Placebo for Toxicity (Table 11:  
Guidelines for Interruption and Restarting of Parsaclisib/Matching Placebo)  
Description of change:  Removed the requirement for temperature to be measured orally 
in the event of a Grade 3 or higher ANC and fever, added a description of symptoms of 
colitis, and added another step for treatment of Grade 3 or higher diarrhea or 
noninfectious colitis. 
Rationale for change:  To allow body temperature to be measured by any modality for 
neutropenic fever and administrative errors. 
27. Section 6.7.5, Criteria for Permanent Discontinuation of Parsaclisib/Matching 
Placebo 
Description of change:  Removed wording regarding exceptions by sponsor for study 
drug discontinuation because of AEs requiring more than 2 dose reductions. 
Rationale for change:  UK MHRA request. 
28. Section 6.7.6, Dose Decreases of Ruxolitinib for Safety 
Description of change:  Clarified that, at the investigator's discretion, ruxolitinib dose 
interruptions/changes for safety reasons may occur before the end of a 14-day period 
after the parsaclisib dose was modified or interrupted for safety reasons. 
Rationale for change:  UK MHRA request. 

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29. Section 6.8.2, Pneumocystis jirovecii Pneumonia Prophylaxis 
Description of change:  Specified that diaminodiphenylsulfone and pentamidine will not 
be used for PJP prophylaxis in Japan. 
Rationale for change:  Japan requirement. 
30. Section 6.8.3, Use of Growth Factors Such as Erythropoietin 
Description of change:  Added section advising caution on concomitant use of growth 
factors. 
Rationale for change:  To address multiple questions regarding allowance of growth 
factors from investigative sites. 
31. Section 6.8.4, Restricted Medications and Procedures 
Description of change:  Modified text regarding use of nonsteroidal anti-inflammatory 
drugs and added text restricting the dosage of corticosteroids. 
Rationale for change:  To recommend caution when administering nonsteroidal 
anti-inflammatory drugs in general and to provide guidance for steroid therapy, which 
may be used as supportive care, as use of these corticosteroids at high doses may interfere 
with readout of study endpoints. 
32. Section 8, Study Assessments and Procedures 
Description of change:  Clarified that delays in treatment administration will not delay 
mandated visits and assessments, except 
 
 when participant accidentally took morning doses of study drugs 
prior to study visits at week 2 or week 4. 
Rationale for change:  Clarity. 
33. Section 8.1.1, Informed Consent Process 
Description of change:  
 
 
Rationale for change:  
 
34. Section 8.1.2, Screening Procedures; Section 8.3.5.5, Lipid Panel 
Description of change:  Clarified that participants may drink water during the overnight 
fasting period. 
Rationale for change:  Drinking water will not affect lipid panel assessments. 
35. Section 8.1.5, Distribution of Reminder Cards 
Description of change:  Clarified the visits where overnight fasting is required for lipid 
profile sample collection. 
Rationale for change:  Clarity. 

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36. Section 8.1.7.3, Transfusion History Status 
Description of change:  Clarified the time periods during which RBC and platelet 
transfusion history will be collected. 
Rationale for change:  Clarity. 
37. Section 8.2.1, Bone Marrow Biopsy and Aspirate 
Description of change:  Revised the section title to indicate that aspirate is also to be 
collected. 
Rationale for change:  Clarity. 
38. Section 8.3, Safety Assessments (Table 14:  Required Laboratory Analytes) 
Description of change:  Specified that bicarbonate is not analyzed in Japan and that 
direct bilirubin is a required analyte, irrespective of total bilirubin levels, and removed 
HCV antibodies from the analyte list as this will not be analyzed. 
Rationale for change:  Japan requirement, to avoid additional blood draws to determine 
direct bilirubin, and administrative error concerning HCV antibodies. 
39. Section 8.3.5.6, Pregnancy Testing 
Description of change:  Clarified that, in the case of a positive urine pregnancy test, the 
confirmatory serum pregnancy test is to be performed at the local laboratory. 
Rationale for change:  Clarity. 
40. Section 8.4.1, Blood Sample Collection 
Description of change:  
 
 
 
 
Rationale for change:  
 
 
 
41. Section 8.5.2, Biomarker Assessments 
Description of change:  Inserted statement that samples of bone marrow biopsy and 
aspirate for local pathology laboratory assessment will be collected in all countries. 
Rationale for change:  To meet regulatory and genetic testing requirements of specific 
countries. 
42. Section 8.7, End of Treatment and/or Early Termination 
Description of change:  Added "or placebo" to the sentence describing when to conduct 
the EOT visit. 
Rationale for change:  Administrative error. 

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43. Section 8.8.2, Survival Follow-Up 
Description of change:  Added subsequent MF treatments to the information collected 
during follow-up. 
Rationale for change:  Administrative error. 
44. Section 9.2, Definition of Serious Adverse Event 
Description of change:  Added definition to important medical events (risk of 
dysfunction) and clarified that an event that may lead to disability is considered an 
important medical event. 
Rationale for change:  Japan requirement and alignment with protocol template. 
45. Section 9.4, Reporting of Serious Adverse Events 
Description of change:  Specified that SAEs must be reported to the head of the study 
site in Japan and that the sponsor must report suspected expected deaths and 
life-threatening events to PMDA in Japan. 
Rationale for change:  Japan requirement. 
46. Section 9.5, Adverse Events of Special Interest 
Description of change:  Clarified that only AEs of special interest that are also SAEs 
need to follow SAE reporting timelines and modified the terms for certain infections to 
include herpes and infection in each term. 
Rationale for change:  Clarity. 
47. Section 9.6, Emergency Unblinding of Treatment Assignment 
Description of change:  Clarified that the decision to break the treatment code in an 
emergency resides at the sole discretion of the investigator. 
Rationale for change:  UK MHRA request. 
48. Section 11.1, Investigator Responsibilities 
Description of change:  Added language concerning retention of documents in Japan. 
Rationale for change:  Japan requirement. 
49. Appendix A, Information Regarding Effectiveness of Contraceptive Methods 
Description of change:  Specified that certain female contraceptive methods are not 
approved or not applicable in Japan and removed list of birth control methods that have a 
failure rate of more than 1%. 
Rationale for change:  Japan requirement and to remove contraceptive methods that are 
not at least 99% effective in preventing pregnancy. 
50. Incorporation of administrative changes. Other minor, administrative changes have 
been incorporated throughout the Protocol and are noted in the redline version of the 
amendment. 

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