A Phase 3/4 Study to Evaluate the Safety, Immunogenicity, and Effects on the Alpha1-Proteinase Inhibitor (A1PI) Levels in Epithelial Lining Fluid Following Glassia Therapy in A1PI-Deficient Subjects
Phase: PHASE3
Conditions: Alpha1-antitrypsin Deficiency
Sponsor: Baxalta now part of Shire

BAXALTA CONFIDENTIAL – RESTRICTED: DO NOT DISTRIBUTE WITHOUT PRIOR APPROVAL 
CLINICAL STUDY PROTOCOL 
PRODUCT: GLASSIA 
STUDY TITLE: A PHASE 3/4 STUDY TO EVALUATE THE SAFETY, 
IMMUNOGENICITY, AND EFFECTS ON THE ALPHA1-PROTEINASE 
INHIBITOR (A1PI) LEVELS IN EPITHELIAL LINING FLUID FOLLOWING 
GLASSIA THERAPY IN A1PI-DEFICIENT SUBJECTS 
STUDY SHORT TITLE: PH 3/4 GLASSIA SAFETY, IMMUNOGENICITY, 
AND BRONCHOALVEOLAR LAVAGE STUDY 
PROTOCOL IDENTIFIER: 471101 
CLINICAL TRIAL PHASE 3/4 
AMENDMENT 5: 2017 NOV 21 
Replaces: AMENDMENT 4: 2016 JAN 15 
ALL VERSIONS: 
Amendment 5: 2017 NOV 21 
Amendment 4: 2016 JAN 15 
Amendment 3: 2015 AUG 26 
Amendment 2: 2015 MAY 07 
Amendment 1: 2015 JAN 19 
Original: 2011 JUL 05 
OTHER ID(s) 
NCT Number: NCT02525861  
IND NUMBER: 14774 
Study Sponsor(s):  
Baxalta US Inc. 
One Baxter Way 
Westlake Village, CA 91362 
UNITED STATES 
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1. STUDY PERSONNEL 
1.1 Authorized Representative (Signatory)/Responsible Party 
, MD 
  
Global Clinical Development Operations 
Baxalta US Inc. 
1.2 Study Organization 
The name and contact information of the responsible party and individuals involved with 
the study (eg, investigator(s), sponsor’s medical expert and study monitor, sponsor’s 
representative(s), laboratories, steering committees, and oversight committees [including 
ethics committees (ECs)], as applicable) will be maintained by the sponsor and provided 
to the investigator. 
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2. SERIOUS ADVERSE EVENT REPORTING 
The investigator will comply with applicable laws/requirements for reporting serious 
adverse events (SAEs) to the ECs. 
ALL SAEs, INCLUDING SUSARs, ARE TO BE REPORTED ON THE ADVERSE 
EVENT ELECTRONIC CASE REPORT FORM (ECRF) WITHIN 24 HOURS 
AFTER BECOMING AWARE OF THE EVENT. IF THE ECRF IS NOT 
AVAILABLE THEN THE SAE MUST BE REPORTED ON THE SERIOUS 
ADVERSE EVENT REPORT (SAER) FORM AND TRANSMITTED TO THE 
SPONSOR TO MEET THE 24 HOUR TIMELINE REQUIREMENT. 
Drug Safety contact information: see SAE Report form. 
Refer to SAE Protocol Sections and the study team roster for further information. 
 
For definitions and information on the assessment of these events, refer to the following: 
 AE, Section 12.1 
 SAE, Section 12.1.1.1 
 SUSARs, Section 12.1.1.2 
 Assessment of AEs, Section 12.1.2 
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3. SYNOPSIS 
INVESTIGATIONAL PRODUCT 
Name of Investigational Product (IP) 
GLASSIA  
Name of Active Ingredient 
Alpha1-Proteinase Inhibitor (Human) 
CLINICAL CONDITION(S)/INDICATION(S) 
GLASSIA is indicated for chronic augmentation and maintenance therapy in adults with clinically evident 
emphysema due to severe congenital deficiency of alpha1-proteinase inhibitor (A1PI) (also known as 
alpha1-antitrypsin [AAT] deficiency). 
PROTOCOL ID 
471101 
PROTOCOL TITLE 
A Phase 3/4 Study to Evaluate the Safety, Immunogenicity, and 
Effects on the Alpha1-Proteinase Inhibitor (A1PI) Levels in 
Epithelial Lining Fluid Following GLASSIA Therapy in  
A1PI-Deficient Subjects 
Short Title 
Ph 3/4 GLASSIA Safety, Immunogenicity, and Bronchoalveolar 
Lavage Study  
STUDY PHASE 
Ph 3/4 
PLANNED STUDY PERIOD 
Initiation 
Q4 2015 
Primary Completion 
Q3 2017 
Study Completion 
Q3 2017 
Duration 
Approximately 2 years 
STUDY OBJECTIVES AND PURPOSE 
Study Purpose 
The purpose of the study is 2-fold: (1) to further evaluate the safety and potential immunogenicity of 
GLASSIA following IV administration via in-line filtration; and, (2) to assess the effects of GLASSIA 
augmentation therapy on the levels of A1PI and 
 in the epithelial lining fluid (ELF) 
following intravenous (IV) administration at a dosage of 60 mg/kg BW/week active A1PI protein for 
25 weeks in subjects with emphysema due to congenital A1PI deficiency. 
Primary Objectives 
1. To evaluate the effectiveness of the use of 5-micron in-line filter on the safety and potential 
immunogenicity of GLASSIA. 
2. To determine the effects of weekly IV augmentation therapy with GLASSIA at a dosage of 60 mg/kg 
body weight (BW) on antigenic and functional A1PI levels in ELF in subjects with congenital A1PI 
deficiency. 
Secondary Objective 
1. To collect additional safety information for GLASSIA. 
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Exploratory Objective 
 
 
 
 
STUDY DESIGN 
Study Type/ 
Classification/ Discipline 
Safety, Immunogenicity, Efficacy 
Control Type 
Concurrent (active) 
Study Indication Type 
Treatment 
Intervention Model 
Parallel 
Blinding/Masking 
Double-blind 
Study Design 
This is a Phase 3/4, prospective, 2-arm, double-blind, randomized, controlled, 
multicenter study will assess the safety, immunogenicity, and effects on the 
antigenic and functional A1PI levels in the ELF following GLASSIA 
administration via a 5-micron in-line filter at a dosage of 60 mg/kg BW/week 
active A1PI protein (the dosing regimen that is currently approved by the 
Food and Drug Administration [FDA]) for 25 weeks in approximately 
36 A1PI-deficient subjects. Subjects will be required to undergo 
bronchoscopy/bronchoalveolar lavage (BAL) procedures at baseline and 
during augmentation therapy for the evaluation of the effects of GLASSIA 
augmentation therapy on the levels of A1PI and 
 in the 
ELF. A subject will be considered evaluable only if acceptable BAL samples 
(see Section 10.3.4 for definitions) are obtained at both baseline and on-
treatment BAL visits. 
Once the target of 15 to 18 evaluable subjects has been reached, the 
remaining subjects to be enrolled will not be required to undergo baseline and 
on-treatment bronchoscopy/BAL procedures. Subjects with confirmed 
medical history (IC #1a, #9a, EC #20, #21, #22, #23, and #24) known not to 
meet eligibility criteria to undergo bronchoscopy/BAL procedures, may be 
screened with sponsor approval before the target enrollment of BAL 
evaluable subjects is reached.  
A1PI-deficient subjects, who are A1PI treatment-naïve or have been treated 
with A1PI augmentation therapy prior to study entry, will be enrolled. 
Subjects who are receiving or have recently been exposed to A1PI 
augmentation therapy at the time of study enrollment will be required to 
undergo an adequate washout period (minimum of 4 weeks from the time of 
last A1PI treatment) during screening. Screening A1PI measurement may be 
taken at any time during the screening period for treatment-naïve subjects.  
 
 
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For subjects who have previously received alpha-1 augmentation therapy 
however, screening A1PI measurement should be taken after the wash-out 
period. During the washout period, subjects will be allowed to undergo other 
screening procedures for eligibility determination. 
Subjects meeting eligibility criteria will be required to undergo 
bronchoscopy/BAL procedures at baseline to collect BAL samples for the 
evaluation of the effects of GLASSIA augmentation therapy at the approved 
labeled dosage of 60 mg/kg BW/week active A1PI protein on the levels of 
A1PI and 
 in the ELF. Subjects who have completed the 
baseline bronchoscopy/BAL visit and have acceptable BAL samples will be 
randomized in a 1:1 ratio to 1 of the 2 treatment arms as shown in Table 3-1. 
Subjects who are waived from the bronchoscopy/BAL procedures will be 
randomized after completing screening procedures and confirmation of 
eligibility (note that BAL-related eligibility criteria are not applicable for 
these subjects). 
Table 3-1 
Treatment Assignments 
Treatment 
Arm 
No. of Subjects 
Per Arm 
Treatment 
1 
18 
GLASSIA lot with particle loads representing 
the high end within the normal range 
observed in GLASSIA lots manufactured 
2 
18 
GLASSIA lot with particle loads representing 
the low end within the normal range 
observed in GLASSIA lots manufactured 
 
During the treatment period, all subjects will receive weekly IV infusions of 
GLASSIA at 60 mg/kg BW active A1PI protein administered at a rate of 
0.2 mL/kg/min for 25 weeks (ie, 25 planned infusions) via an IV 
administration set that includes a 5-micron in-line filter. The first infusion 
(Week 1), as well as infusions during Week 13 and Week 25, must be 
administered at the study site to facilitate monitoring and reporting of 
potential adverse events (AEs) associated with GLASSIA infusions. At the 
investigator’s discretion, subsequent infusions may be administered at the 
study site or at another suitable location (eg, the subject’s home) by a 
qualified healthcare professional, as acceptable per local regulations and 
standard practices of the study site. The infusion rate may be decreased or the 
infusion may be interrupted or discontinued in an individual subject in the 
event of intolerable moderate to severe infusion-related AEs and/or at the 
discretion of the investigator. 
 
 
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Subjects will be asked to return to the study site every 6 weeks (ie, during 
Weeks 1, 7, 13, 19, and 25) for body weight measurements, as well as 
physical examination, vital sign measurements, and blood draw for plasma 
A1PI and safety laboratory sample collection, as applicable (see Table 20.2-1 
and Table 20.3-1 for detailed list of study procedures/laboratory 
assessments). The on-treatment BAL visit will be conducted between Week 
12 and Week 14 following initiation of GLASSIA augmentation therapy for 
the determination of antigenic and functional A1PI levels in ELF. After 
completing the on-treatment BAL visit, subjects will continue to receive 
weekly GLASSIA infusions until Week 25 (the last infusion visit), followed 
by the study completion visit (Week 26) at 7 (±3) days post-last infusion. 
If a subject experiences a moderate or severe chronic obstructive pulmonary 
disease (COPD) exacerbation and/or lower respiratory tract infection (LRTI) 
during the screening period, baseline BAL visit will be postponed once in 
order for the subject to recover from the exacerbation (ie, any signs and 
symptoms of the COPD exacerbation and/or LRTI are no longer clinically 
evident) and remain stable for at least 4 weeks after the end of exacerbation. 
If a moderate or severe episode of COPD exacerbation and/or LRTI occurs 
during the treatment phase, the subject should continue with the planned 
study visits and to receive weekly infusions of GLASSIA as planned, unless 
deemed medically inappropriate by the investigator. However, the on-
treatment BAL visit will be postponed until clinical resolution of the 
exacerbation (ie, any signs and symptoms of the COPD exacerbation and/or 
LRTI are no longer clinically evident) plus an additional minimum period of 
4 weeks after the end of exacerbation. 
Planned Duration of 
Subject Participation 
The duration of each subject’s participation will be approximately 8 months, 
including: 
 a screening period of up to 6 weeks,  
 a baseline period of up to 2 weeks (for subjects undergoing baseline BAL 
procedure),  
 a treatment period of 25 weeks, and  
 a post-treatment safety follow-up period of 7 (±3) days after the last 
infusion. 
Primary Outcome Measures 
Safety 
1. 
Number (proportion) of AEs considered potentially related to the presence of protein aggregates 
(particle load) in the GLASSIA solution 
2. 
Incidence of treatment-emergent adverse reactions (ARs) plus suspected ARs 
3. 
Number (proportion) of infusions that are discontinued, slowed, or interrupted due to an AE 
4. 
Number (proportion) of subjects who develop binding and/or neutralizing anti-A1PI antibodies 
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Efficacy 
1. 
Antigenic A1PI levels in ELF 
2. 
Functional A1PI (also known as anti-neutrophil elastase capacity [ANEC]) levels in ELF 
Secondary Outcome Measures 
Safety 
1. 
Incidence of treatment-emergent AEs 
2. 
Number (proportion) of subjects who experienced a shift from normal or clinically insignificant 
abnormal laboratory values at baseline to clinically significant abnormal laboratory values 
following GLASSIA administration 
3. 
Number (proportion) of subjects with treatment-emergent seroconversion or positive nucleic acid 
test (NAT) for parvovirus B19 (B19V) 
Exploratory Outcome Measures 
 
 
 
 
 
 
 
 
 
 
INVESTIGATIONAL PRODUCT(S), DOSE AND MODE OF ADMINISTRATION 
Active Product 
GLASSIA 
Dose: 60 mg/kg BW active A1PI protein  
Dosage form: Injection, solution 
Dosage frequency: Weekly 
Mode of Administration: Intravenous 
SUBJECT SELECTION 
Targeted Accrual 
Enrollment will be closed when both conditions are met:  
(a) 15 to 18 evaluable subjects with acceptable BAL samples 
collected from both the baseline and on-treatment BAL visits 
(b) A minimum of 36 randomized subjects. 
Number of Groups/Arms/Cohorts 
2 
Inclusion Criteria 
A subject must meet ALL of the following criteria to be eligible for inclusion in this study: 
1. 
Male or female subjects meeting the following age criteria: 
(a) For subjects who will undergo bronchoscopy/BAL procedures: 18 to 75 years of age at the 
time of screening.  
(b) For subjects who will be waived from undergoing bronchoscopy/BAL procedures -: 18 years 
of age or older at the time of screening. 
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2. 
Documented A1PI genotype of Pi*Z/Z, Pi*Z/Null, Pi*Malton/Z, Pi*Null/Null, or other “at-risk” 
allelic combinations such as SZ (excluding MS and MZ) and an endogenous A1PI plasma levels 
of ≤11 µM. 
3. 
Screening levels of endogenous plasma (antigenic) A1PI of ≤11 µM at any time during the 
screening period for treatment-naïve subjects, or following a 4-week minimum wash-out from 
previous augmentation therapy in treatment-experienced subjects. 
4. 
Subjects must have at least one of the following: clinical diagnosis of emphysema, evidence of 
emphysema on chest X-ray or computerized tomography (CT) scan of the chest, and/or evidence 
of airway obstruction which is not completely reversed with bronchodilator treatment at the time 
of screening. 
5. 
If the subject is being treated with any respiratory medications including inhaled bronchodilators, 
inhaled anticholinergics, inhaled corticosteroids, or low-dose systemic corticosteroids (prednisone 
≤10 mg/day or its equivalent), the doses of the subject’s medications have remained unchanged for 
at least 14 days prior to screening. 
6. 
The subject is a nonsmoker or has ceased smoking for a minimum of 13 weeks prior to screening 
(serum cotinine level at screening within normal range of a nonsmoker) and agrees to refrain from 
smoking throughout the course of the study. Subjects with a positive cotinine test due to nicotine 
replacement therapy (eg, patches, chewing gum), vapor cigarettes, or snuff are eligible. 
7. 
If female of childbearing potential, the subject presents with a negative pregnancy test at screening 
and agrees to employ adequate birth control measures for the duration of the study. 
8. 
The subject is willing and able to comply with the requirements of the protocol. 
9. 
The subject must have pulmonary function at the time of screening which meets both of the 
following: 
(a) Post-bronchodilator forced expiratory volume in 1 second (FEV1) ≥50% of predicted 
(b) If FEV1 is >80% predicted, then FEV1/forced vital capacity (FVC) must be <0.7. 
Note: Inclusion criterion #1a and #9a are not applicable to subjects who are not required to undergo 
the bronchoscopy/BAL procedures. 
Exclusion Criteria 
A subject who meets ANY of the following criteria is NOT eligible for this study: 
1. 
The subject is experiencing or has a history of clinically significant pulmonary disease (other than 
COPD, emphysema, chronic bronchitis, mild bronchiectasis, and stable asthma). 
2. 
The subject is experiencing or has a history of chronic severe cor pulmonale (resting mean 
pulmonary artery pressure ≥40 mm Hg). 
3. 
The subject routinely produces more than 1 tablespoon of sputum per day. 
4. 
The subject has a history of frequent pulmonary exacerbations (greater than 2 moderate or severe 
exacerbations within 52 weeks prior to screening; see Section 10.4 for the definition of moderate 
and severe exacerbations). 
5. 
The subject is experiencing a pulmonary exacerbation at the time of screening (subject may be 
re-screened 4 weeks after the clinical resolution of an exacerbation). 
 
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6. 
The subject has clinically significant abnormalities (other than emphysema, chronic bronchitis, or 
mild bronchiectasis) detected on chest X-ray or CT scan at the time of screening. (Past records 
obtained within 52 weeks prior to screening may be used, if available.) 
7. 
The subject has clinically significant abnormalities detected on a 12-lead electrocardiogram (ECG) 
performed at the time of screening. (Past records obtained within 26 weeks prior to screening may 
be used, if available.) 
8. 
The subject has clinically significant congestive heart failure with New York Heart Association 
(NYHA) Class III/IV symptoms. 
9. 
The subject is experiencing an active malignancy or has a history of malignancy within 5 years 
prior to screening, with the exception of the following: adequately treated basal cell or squamous 
cell carcinoma of the skin, carcinoma in situ of the cervix, or stable prostate cancer not requiring 
treatment. 
10. The subject has a history of lung or other organ transplant, is currently on a transplant list, or has 
undergone major lung surgery. 
11. The subject is receiving long-term around-the-clock oxygen supplementation. (the following are 
allowed: short-term use of oxygen supplementation [eg, for the management of acute COPD 
exacerbation], oxygen supplementation required during night time only, and supplemental O2 with 
continuous positive airway pressure [CPAP] or bi-level positive airway pressure [BiPAP]). 
12. Known history of hypersensitivity following infusions of human blood or blood components. 
13. Immunoglobulin A (IgA) deficiency (<8 mg/dL at screening). 
14. Abnormal clinical laboratory results obtained at the time of screening meeting any of the following 
criteria: 
a. 
Serum alanine aminotransferase (ALT) >3.0 times upper limit of normal (ULN) 
b. Serum total bilirubin >2.0 times ULN 
c. 
>2+proteinuria on urine dipstick analysis 
d. Serum creatinine >2.0 times ULN  
e. 
Absolute neutrophil count (ANC) <1500 cells/mm3 
f. 
Hemoglobin (Hgb) <9.0 g/dL 
g. Platelet count <100,000/mm3 
15. Ongoing active infection with hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus 
(HCV), or human immunodeficiency virus (HIV) Type 1/2 at the time of screening. 
16. The subject has any clinically significant medical, psychiatric, or cognitive illness, or any other 
uncontrolled medical condition (eg, unstable angina, transient ischemic attack) that, in the opinion 
of the investigator, would impede the subject’s ability to comply with the study procedures, pose 
increased risk to the subject’s safety, or confound the interpretation of study results. 
17. The subject has participated in another clinical study involving an investigational product or 
investigational device within 30 days prior to enrollment or is scheduled to participate in another 
clinical study involving an investigational product or device during the course of this study. 
18. The subject is a family member or employee of the investigator. 
19. If female, the subject is nursing at the time of screening. 
 
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20. The subject has contraindication(s) to bronchoscopy such as recent myocardial infarction, unstable 
angina, other cardiopulmonary instability, tracheal obstruction or stenosis, moderate to severe 
hypoxemia or any degree of hypercapnia, unstable asthma, Stage 4 or 5 chronic kidney disease, 
pulmonary hypertension, severe hemorrhagic diathesis, and cervical C1/C2 arthritis. 
21. The subject has had lung surgery which may interfere with bronchoscopy. 
22. Known history of allergic/hypersensitivity reactions to medications used during and for 
perioperative care associated with the bronchoscopy/BAL procedures, such as local anesthetics, 
sedatives, pain control medications. 
23. The subject is receiving and requires long-term (>4 weeks) immunosuppressive therapy, such as 
systemic corticosteroids at doses greater than 10 mg/day of prednisone (or its equivalent), 
mycophenolate mofetil, azathioprine, cyclophosphamide, and rituximab. 
24. If a subject is receiving anticoagulant or anti-platelet therapy (such as warfarin and clopidogrel), 
the subject is unwilling to or unable to safely discontinue anticoagulant or anti-platelet therapy 
within 7 days prior to until at least 24 hours after the BAL procedures. An exception is low-dose 
aspirin alone which is allowed. 
Note: Exclusion criteria #20, #21, #22, #23, and #24 are not applicable to subjects who are not 
required to undergo the bronchoscopy/BAL procedures. 
STATISTICAL ANALYSIS 
Sample Size Calculation 
The sample size calculation for the BAL component of the study was based on the natural log transformed 
primary endpoint data, ELF antigenic A1PI level (nM), generated during a previous clinical study (Clinical 
Protocol 460502; Baxter Healthcare Corporation) for the evaluation of the effects of A1PI augmentation 
therapy with ARALAST NP on the levels of A1PI and other analytes in the ELF. In Clinical Study 460502, 
a mean difference from pre- to post-treatment in ELF antigenic A1PI of 1.32 with standard deviation of 
0.96 on natural log scale was observed. Using this variance estimate, a sample size of 15 evaluable subjects 
should be sufficient to detect a mean difference in the natural log transformed ELF antigenic A1PI of 
approximately 0.87 with 90% power, using a paired t-test and a 1-sided significance level of 0.025.  
A sample size of 15 evaluable subjects will also be sufficient to detect a mean difference in the natural log 
transformed ELF functional A1PI (ANEC) of approximately 1.04, with 90% power, assuming a standard 
deviation in the differences between pre- and post-treatment ANEC values to be 20% higher than that for 
antigenic A1PI. 
Based on the experience from Clinical Study 460502, it is estimated that approximately 26 to 32 subjects 
will be needed in order to achieve 15 to 18 BAL evaluable subjects, respectively. Thus, an overall study 
enrollment target of 36 subjects should be adequate to meet the target sample size for the BAL component 
of the study. 
Planned Statistical Analysis 
ELF antigenic and functional A1PI levels, as well as changes from baseline, will be summarized 
descriptively and displayed graphically (data permitting) based on data pooled across both treatment arms. 
These changes will be analyzed in 1-sided paired t-tests at an alpha level of 0.025. 
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Plasma trough antigenic and functional A1PI levels, as well as changes from baseline, will be summarized 
descriptively and displayed graphically (data permitting) based on data pooled across both treatment arms. 
Plasma antigenic and functional A1PI levels obtained at the baseline and on-treatment BAL visits will be 
summarized separately and, data permitting, to be correlated with the corresponding values in the ELF. 
 
 
 
Changes from baseline in ELF and plasma antigenic and functional A1PI levels will be summarized in the 
following subgroups: by sex, age (≤65; >65), race, and ethnicity. 
 
 
The safety outcome measures, including AEs of interest that may be immune-mediated, treatment-emergent 
ARs plus suspected ARs (see Section 12.1.1.3 for definitions), and treatment-emergent incidence of 
immunogenicity and seroconversion, will be summarized descriptively with 95% confidence intervals (CIs) 
as appropriate. In the event of any clinically significant trends in treatment-emergent AE(s) of interest, 
further analysis including potential correlation with the presence of particulates in the GLASSIA solution 
will be performed. In the event of treatment-emergent immunogenicity, any potential temporal relationship 
of anti-A1PI antibody formation with the occurrence of potentially immune-mediated AEs will be 
examined. Additionally, in the event of any clinically significant trends in treatment-emergent AE(s) of 
interest, further analysis including potential correlation with the presence of particulates in the GLASSIA 
solution will be performed. 
Any clinically significant laboratory values that are considered as clinically significant by the investigator 
(ie, reported as AEs), as well as in accordance with the thresholds provided in Section 20.4, will be 
analyzed and reported, including shift tables. 
Safety parameters will be summarized descriptively by sex, age  (≤65; >65) race, and ethnicity. No 
hypothesis tests are planned; however, 
 
 
 
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4. TABLE OF CONTENTS 
1. STUDY PERSONNEL ................................................................................................. 2 
1.1 Authorized Representative (Signatory)/Responsible Party ................................ 2 
1.2 Study Organization ................................................................................................. 2 
2. SERIOUS ADVERSE EVENT REPORTING ........................................................... 3 
3. SYNOPSIS ..................................................................................................................... 4 
4. TABLE OF CONTENTS ........................................................................................... 13 
5. LIST OF ABBREVIATIONS .................................................................................... 18 
6. BACKGROUND INFORMATION .......................................................................... 21 
6.1 Description of Investigational Product ............................................................... 24 
6.1.1 Rationale for the Selection of Dosing Regimen ........................................... 24 
6.1.2 Rationale for the Selection of Route of Administration and Infusion Rate
 ......................................................................................................................... 24 
6.2 Clinical Condition/Indication .............................................................................. 25 
6.3 Population To Be Studied ..................................................................................... 25 
6.4 Findings From Nonclinical and Clinical Studies ............................................... 25 
6.4.1 Summary of Nonclinical Data ....................................................................... 25 
6.4.2 Summary of Clinical Data ............................................................................. 25 
6.5 Evaluation of Anticipated Risks and Benefits of the Investigational Product(s) 
to Human Subjects ................................................................................................ 26 
6.6 Compliance Statement .......................................................................................... 26 
7. STUDY PURPOSE AND OBJECTIVES ................................................................. 27 
7.1 Study Purpose ....................................................................................................... 27 
7.2 Primary Objectives ............................................................................................... 27 
7.3 Secondary Objective ............................................................................................. 27 
7.4 Exploratory Objective .......................................................................................... 27 
8. STUDY DESIGN ......................................................................................................... 28 
8.1 Brief Summary ...................................................................................................... 28 
8.2 Study Design .......................................................................................................... 28 
8.3 Duration of Study Period(s) and Subject Participation .................................... 30 
8.4 Outcome Measures ............................................................................................... 30 
8.4.1 Primary Outcome Measures ......................................................................... 30 
8.4.2 Secondary Outcome Measures ..................................................................... 31 
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8.4.3 Exploratory Outcome Measures .................................................................. 31 
8.5 Randomization and Blinding ............................................................................... 31 
8.5.1 Unblinding Procedures at Study Sites ......................................................... 32 
8.6 Study Stopping Rules ............................................................................................ 32 
8.7 Investigational Product(s) .................................................................................... 32 
8.7.1 Packaging, Labeling, and Storage ................................................................ 32 
8.7.2 Preparation of Infusion Solution .................................................................. 32 
8.7.3 Administration ............................................................................................... 33 
8.7.4 Description of Treatment .............................................................................. 33 
8.7.5 Investigational Product Accountability ....................................................... 33 
8.8 Source Data ........................................................................................................... 34 
9. SUBJECT SELECTION, WITHDRAWAL, AND DISCONTINUATION .......... 35 
9.1 Inclusion Criteria .................................................................................................. 35 
9.2 Exclusion Criteria ................................................................................................. 36 
9.3 Withdrawal and Discontinuation ........................................................................ 38 
10. STUDY PROCEDURES .......................................................................................... 40 
10.1 Informed Consent and Enrollment ................................................................... 40 
10.2 Subject Identification Code ................................................................................ 40 
10.3 Screening and Study Visits ................................................................................. 40 
10.3.1 Screening Visit ............................................................................................. 40 
10.3.1.1 Confirmation of Severe Congenital A1PI Deficiency ........................ 41 
10.3.1.2 Pulmonary Function Tests ................................................................... 41 
10.3.1.3 Rescreening ........................................................................................... 42 
10.3.2 Infusion Visits ............................................................................................... 42 
10.3.2.1 IP Administration ................................................................................. 42 
10.3.2.2 Management of Treatment-Emergent (S)AEs ................................... 43 
10.3.2.3 Pre-Medications .................................................................................... 45 
10.3.2.4 Post-Infusion Follow-Up ...................................................................... 45 
10.3.3 Clinical Assessment Visits ........................................................................... 45 
10.3.4 BAL Visits ..................................................................................................... 45 
10.4 COPD Exacerbation and Lower Respiratory Tract Infection ....................... 47 
10.5 Medications and Non-Drug Therapies .............................................................. 49 
10.6 Subject Completion/Discontinuation ................................................................ 50 
10.7 Procedures for Monitoring Subject Compliance ............................................. 51 
11. ASSESSMENT OF EFFICACY .............................................................................. 52 
11.1 ELF Antigenic and Functional A1PI Levels ..................................................... 52 
11.2 
 .................................................................................... 52 
12. ASSESSMENT OF SAFETY ................................................................................... 53 
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12.1 Adverse Events .................................................................................................... 53 
12.1.1 Definitions ..................................................................................................... 53 
12.1.1.1 Serious Adverse Event .......................................................................... 53 
12.1.1.2 Non-Serious Adverse Event ................................................................. 54 
12.1.1.3 Adverse Reactions Plus Suspected Adverse Reactions ..................... 54 
12.1.1.4 Unexpected Adverse Events ................................................................. 54 
12.1.1.5 Adverse Events Potentially Associated with Protein Aggregates ..... 55 
12.1.1.6 Preexisting Diseases .............................................................................. 55 
12.1.2 Assessment of Adverse Events .................................................................... 55 
12.1.2.1 Severity .................................................................................................. 56 
12.1.2.2 Causality ................................................................................................ 57 
12.1.2.3 Safety Reporting ................................................................................... 58 
12.2 Urgent Safety Measures ..................................................................................... 59 
12.3 Untoward Medical Occurrences ........................................................................ 60 
12.4 Non-Medical Complaints ................................................................................... 60 
12.5 Medical, Medication, and Non-Drug Therapy History ................................... 61 
12.6 Physical Examinations ........................................................................................ 61 
12.7 Clinical Laboratory Parameters ........................................................................ 61 
12.7.1 Hematology and Clinical Chemistry .......................................................... 61 
12.7.2 Complement Activation and Immune Complex Panel ............................. 62 
12.7.3 Viral Serology and Nucleic Acid Tests ....................................................... 63 
12.7.4 Urine Tests .................................................................................................... 63 
12.7.5 Assessment of Clinical Laboratory Values ................................................ 64 
12.7.5.1 Assessment of Abnormal Laboratory Values .................................... 64 
12.7.6 Biobanking .................................................................................................... 64 
12.8 Plasma Antigenic and Functional A1PI Levels ................................................ 65 
12.9 Immunogenicity .................................................................................................. 66 
12.10 Vital Signs .......................................................................................................... 66 
13. STATISTICS ............................................................................................................. 68 
13.1 Sample Size and Power Calculations ................................................................ 68 
13.2 Datasets and Analysis Cohorts .......................................................................... 68 
13.2.1 Full Analysis Set ........................................................................................... 68 
13.2.2 Per-Protocol Analysis Set ............................................................................ 68 
13.2.3 BAL Analysis Set ......................................................................................... 69 
13.2.4 Safety Analysis Set ....................................................................................... 69 
13.3 Handling of Missing, Unused, and Spurious Data ........................................... 69 
13.4 Methods of Analysis ............................................................................................ 69 
13.4.1 Efficacy Outcome Measures ....................................................................... 69 
13.4.2 Exposure ....................................................................................................... 70 
13.4.3 Safety Outcome Measures ........................................................................... 71 
13.5 Planned Interim Analysis of the Study ............................................................. 72 
14. DIRECT ACCESS TO SOURCE DATA/DOCUMENTS .................................... 73 
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15. QUALITY CONTROL AND QUALITY ASSURANCE ...................................... 73 
15.1 Investigator’s Responsibility .............................................................................. 73 
15.1.1 Final Clinical Study Report ........................................................................ 73 
15.2 Training ............................................................................................................... 73 
15.3 Monitoring ........................................................................................................... 73 
15.3.1 Safety Monitoring ........................................................................................ 74 
15.4 Auditing ............................................................................................................... 74 
15.5 Non-Compliance with the Protocol ................................................................... 74 
15.6 Laboratory and Reader Standardization ......................................................... 74 
16. ETHICS ..................................................................................................................... 75 
16.1 Subject Privacy ................................................................................................... 75 
16.2 Ethics Committee and Regulatory Authorities ................................................ 75 
16.3 Informed Consent ............................................................................................... 75 
16.4 Data Monitoring Committee .............................................................................. 76 
17. DATA HANDLING AND RECORD KEEPING ................................................... 77 
17.1 Confidentiality Policy ......................................................................................... 77 
17.2 Study Documents and Case Report Forms ....................................................... 77 
17.3 Document and Data Retention ........................................................................... 77 
18. FINANCING AND INSURANCE ........................................................................... 78 
19. PUBLICATION POLICY ........................................................................................ 78 
20. SUPPLEMENTS ....................................................................................................... 79 
20.1 Study Flow Chart ................................................................................................ 79 
20.2 Schedule of Study Procedures and Assessments .............................................. 80 
20.3 Schedule of Clinical Laboratory Assessments .................................................. 83 
20.4 Thresholds for Clinically Significant Laboratory Abnormalities .................. 86 
21. REFERENCE LIST .................................................................................................. 88 
22. SUMMARY OF CHANGES .................................................................................... 91 
 
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Tables 
Table 3-1 Treatment Assignments ...................................................................................... 6 
Table 8-1 Treatment Assignments .................................................................................... 29 
Table 20.2-1 Schedule of Study Procedures and Assessments ......................................... 80 
Table 20.3-1 Clinical Laboratory Assessments ................................................................ 83 
 
Figures 
Figure 10-1 Exacerbation of COPD .................................................................................. 48 
Figure 20-1 Study Flow Chart for Baxalta Clinical Study 471101 .................................. 79 
 
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5. LIST OF ABBREVIATIONS 
Abbreviation 
Definition 
°C 
Degree Celsius 
°F 
Degree Fahrenheit 
A1PI 
Alpha1-Proteinase Inhibitor 
AAT 
Alpha1-antitrypsin 
AE/AEs 
Adverse event/adverse events 
ALP 
Alkaline phosphatase 
ALT 
Alanine aminotransferase 
ANC 
Absolute neutrophil count 
ANEC 
Anti-neutrophil elastase capacity 
APE 
Acute pulmonary exacerbation 
AR/ARs 
Adverse reaction/adverse reactions 
AST 
Aspartate aminotransferase 
ATS 
American Thoracic Society 
BAL 
Bronchoalveolar lavage 
B19V 
Parvovirus B19 
BiPAP 
Bi-level positive airway pressure 
BUN 
Blood urea nitrogen 
BW 
Body weight 
C3 
Complement component 3 
C4 
Complement component 4 
CFR 
Code of Federal Regulations 
CH50 
50% hemolytic complement activity of serum 
Cis 
Confidence intervals 
Cm 
Centimeter(s) 
COPD 
Chronic obstructive pulmonary disease 
CPAP 
Continuous positive airway pressure 
CPK 
Creatine phosphokinase 
CRF(s) 
Case Report Form(s) 
CT 
Computerized tomography 
dL 
Deciliter(s) 
DMC 
Data Monitoring Committee 
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Abbreviation 
Definition 
EC 
Ethics Committee 
ECG 
Electrocardiogram 
eCRF 
Electronic case report form 
EDC 
Electronic data capture 
EDTA 
Ethylenediaminetetraacetic acid 
ELF 
Epithelial lining fluid 
EP 
European Pharmacopeia 
ERS 
European Respiratory Society 
FAS 
Full analysis set 
FDA 
United States Food and Drug Administration 
FEV1 
Forced expiratory volume in 1 second 
FVC 
Forced vital capacity 
GCP 
Good Clinical Practice 
GGT 
Gamma-glutamyl-transferase 
HAV 
Hepatitis A virus 
HBV 
Hepatitis B virus 
Hct 
Hematocrit 
HCV 
Hepatitis C virus 
HEV 
Hepatitis E virus 
Hgb 
Hemoglobin 
HIV 
Human immunodeficiency virus 
Hpf 
High power field 
ICF 
Informed consent form 
ICH 
International Council for Harmonisation 
IgA 
Immunoglobulin A 
In 
Inch(es) 
IP 
Investigational product 
IRT 
Interactive response technology 
IV 
Intravenous 
IWRS 
Interactive Web Response System 
kD 
Kilodalton(s) 
Kg 
Kilogram(s) 
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Abbreviation 
Definition 
Lb 
Pound(s) 
LDH 
Lactic dehydrogenase 
LRT 
Lower respiratory tract 
LRTI 
Lower respiratory tract infection 
μM 
Micromolar 
MDI 
Metered dose inhaler 
MedDRA 
Medical Dictionary for Regulatory Activities 
Mg 
Milligram(s) 
Min 
Minute (s) 
mL 
Milliliter(s) 
mm3 
Cubic millimeter 
mm Hg 
Millimeter(s) of mercury 
NAT 
Nucleic acid test 
NE 
Neutrophil elastase 
nM 
Nanomolar(s) 
NMC 
Non-medical complaint 
NYHA 
New York Heart Association  
O2 
Oxygen 
PCR 
Polymerase chain reaction 
PP 
Per protocol 
Ppm 
Parts per million 
RBC 
Red blood cell 
SAE 
Serious adverse event 
SAER 
Serious adverse event report 
S/D 
Solvent/detergent 
SIC 
Subject identification code 
ULN 
Upper limit of normal 
US 
United States 
USP 
United States Pharmacopeia 
WBC 
White blood cell 
 
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6. BACKGROUND INFORMATION 
Alpha1-Proteinase Inhibitor (A1PI), also known as alpha1-antitrypsin (AAT), is a 
serum glycoprotein of molecular mass 52 kD. The protein is synthesized in the liver 
and is reported to be present in the serum at levels between 20 and 53 μM (104 to 
275.6 mg/dL).1  
Severe A1PI deficiency (also known as AAT deficiency) is an autosomal recessive 
hereditary disorder affecting an estimated 34,395 to 48,904 individuals in the United 
States (US), with 91.6% being Caucasian Americans, 7.8% Hispanic Americans, and 
0.5% African Americans.2,3 Individuals with a severe deficiency are defined as those with 
serum A1PI levels less than 35% of the average normal level 4,5, or less than 11 μM.6,7,8 
Severely affected individuals may have no detectable A1PI protein in their serum. In 
addition, genetic variants associated with reduced A1PI levels also produce an altered 
form of A1PI, the capacity of which to inhibit neutrophil elastase (NE) is reduced.9 In 
clinical practice, the majority (96%) of A1PI deficiency related diseases are linked to 
Pi*ZZ genotype, with the remaining 4% to Pi*SZ and other rare or null genotypes. 
Individuals with Pi*ZZ show a significant intracellular polymerization of their A1PI in 
the liver, often resulting in liver damage with a variable clinical presentation. In addition, 
the profound suppression of A1PI secretion into the systemic circulation significantly 
increases the risk of developing panacinar emphysema.10 The threshold level of A1PI 
in the lower respiratory tract (LRT) needed to provide clinical benefit is not known; 
however, emphysema in A1PI-deficient subjects has been thought to develop because 
the level of A1PI in the LRT is insufficient to inhibit serine proteases. Serine proteases, 
such as NE, are present in the LRT in higher than normal concentrations as a result of 
inflammation or infection.11 If left unchecked, due to insufficient A1PI, the proteolytic 
activity of these proteases can destroy the connective tissue framework of the lung 
parenchyma.12,13  
Therapy for A1PI-deficient subjects is directed towards replacement or augmentation 
of serum A1PI levels.6,8,11,13,14,15,16,17,18 This therapy is based on the concept that an 
increase in the serum level of A1PI will lead to higher A1PI concentrations in the 
lung parenchyma, which in turn, may mitigate the A1PI protease imbalance, thereby 
preventing or slowing the destruction of lung tissue and thus the clinical course of the 
disease.6,11  Wewers et al. showed that, at steady-state, augmentation therapy with once a 
week dosing of A1PI (60 mg/kg body weight [BW]/week) resulted in trough circulating 
A1PI levels to >11 µM in subjects with A1PI deficiency of Pi*Z/Z genotype.11  
 
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Historically, it was believed that 11 µM is the protective threshold level, based on the 
assumption that subjects with Pi*Z/Z, Pi*Null/Null, or Pi*Z/Null genotypes had severe 
A1PI deficiency (circulating A1PI levels below 11 µM) and emphysema; whereas 
subjects with Pi*S/Z genotype, who at that time were considered to have an average 
A1PI level of 11 µM, were protected from emphysema.  
GLASSIA is the only sterile, ready-to-use, liquid preparation of purified human A1PI 
indicated for chronic augmentation and maintenance therapy in adults with clinically 
evident emphysema due to severe congenital deficiency of A1PI. The product was 
approved by the US Food and Drug Administration (FDA) in 2010, on the basis of safety 
and biochemical demonstration in a Phase 1 dose-escalation and a Phase 2/3 pivotal 
clinical trial in a total of 65 individual subjects with severe A1PI deficiency. 
The clinical lots used in the GLASSIA Phase 2/3 trial contained small amounts of visible 
protein particulates which were aggregates of A1PI. GLASSIA A1PI functional activity 
is independent of the particulate load of the solution for infusion. Protein aggregation is a 
known phenomenon with protein therapeutics and has been shown to be present in the 
active comparator used in the Phase 2/3 trial, as well as in other commercially available 
A1PI products upon reconstitution of the lyophilized powder. During the Phase 2/3 
clinical trial, no safety signals of concern were reported. The most common adverse 
reactions (ARs) (>0.5% of infusions) reported were headache and upper respiratory tract 
infection. These adverse events (AEs) were consistent with those reported for other 
licensed A1PI products. Potential immunogenicity following repeated administration of 
GLASSIA was evaluated in the Phase 2/3 trial, where 50 subjects received weekly 
infusions of either GLASSIA or PROLASTIN (active comparator) from Week 1 to Week 
12 and then weekly infusions of GLASSIA (all subjects) from Week 13 to Week 24. 
Immunogenicity was monitored at baseline, Week 12, and Week 24. All samples were 
negative for the presence of anti-A1PI antibodies, with the exception of a single sample 
(Week 12) with a low titer of 2 in 1 subject. The Week 24 sample from this subject was 
negative, suggesting a low level, transient immunogenic response. Nevertheless, as an 
added precautionary measure, it is recommended that GLASSIA be filtered twice before 
product administration: through a 5 micron filter needle during product pooling and then 
through a 5 micron in-line filter during product administration (see GLASSIA package 
insert and/or investigator's brochure [IB]). 
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The effectiveness of the in-line filtration procedure in removing visible and subvisible 
particles in GLASSIA was examined in a recent in vitro study. GLASSIA lots with at 
least a factor of 2 fold differential were chosen to represent the high and low ends of 
the range of particle counts normally observed for GLASSIA manufactured.  
(Note that all GLASSIA lots must meet the requirements for visible and subvisible 
particulates set forth by the United States Pharmacopeia [USP] and the European 
Pharmacopeia [EP] prior to release for use in humans). The use of a 5-micron in-line 
filter has been shown to effectively remove visible particles (from several to >10 particles 
in unfiltered solution to no more than 2 particles per 50-mL vial after filtration) and 
subvisible particles (by 12- to 76-fold for particles across all particle size categories 
ranging from 2 to >100 micron) (data on file). In fact, the 5-micron in-line filter is 
also effective in reducing the number of particles that are smaller (2 to 5-micron in 
diameter) than the nominal 5-micron pore-size of the filter from an average of 23227 to 
489 particles per 50-mL vial, representing a 49-fold reduction. The filtration process did 
not alter the A1PI potency, as demonstrated by a lack of difference in the elastase 
inhibitory activity measurements in unfiltered and filtered GLASSIA solution. 
Nevertheless, given a lack of clear understanding and the paucity of direct clinical 
evidence correlating parenteral administration of protein aggregates to clinical AEs and 
risk of immunogenicity, there have been theoretical concerns raised about protein 
aggregates in a therapeutic product regarding the potential safety risks to humans. To 
address these concerns, a key goal of this study is to evaluate the clinical safety profile of 
GLASSIA with a focus on AEs of interest that have been suggested to be potentially 
associated with protein aggregates and visible/subvisible particles, such as pulmonary 
embolism particularly of non-thrombotic or microvascular origin, unexplained chest pain, 
dyspnea, or cardiopulmonary arrest of non-cardiac etiology, interstitial pneumonitis, 
injection site reactions, granuloma, hypersensitivity or anaphylactic reactions, and 
immunogenicity incidence. GLASSIA lots containing particles of ≥2 micron in diameter 
representative of the high and low ends of the range normally observed in GLASSIA 
manufacturing will be selected for evaluation in this study. All GLASSIA administrations 
will follow the 2-step filtration process (through a 5 micron filter needle during product 
pooling and then through a 5 micron in-line filter during product administration) as 
outlined in the GLASSIA package insert and/or IB. 
The second goal of this study is to obtain additional safety data, and to evaluate 
the effects of GLASSIA augmentation therapy on the levels of A1PI and 
 
 in the ELF following weekly intravenous (IV) augmentation therapy 
with GLASSIA in subjects with emphysema due to congenital A1PI deficiency.  
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In the pivotal Phase 2/3 study, there were fewer subjects (7 subjects in the GLASSIA 
group and 2 subjects in the active comparator group) than planned (15 subjects) having 
ELF analyte results available for evaluation. Additionally, effect of GLASSIA 
augmentation therapy on ELF functional A1PI (ie, anti-neutrophil elastase capacity 
[ANEC]) could not be examined due to missing data. Thus, this study is designed to 
include bronchoscopy/bronchoalveolar lavage (BAL) visits to collect data for the 
assessments of change from baseline in the antigenic and functional A1PI levels in the 
ELF following 13 weeks of weekly IV administration of GLASSIA at the approved dose 
of 60 mg/kg BW. 
6.1 Description of Investigational Product 
GLASSIA is a sterile, ready-to-use, liquid preparation of purified human A1PI. The 
solution contains 2% active A1PI in a phosphate-buffered saline solution. The specific 
activity of GLASSIA is at least 0.7 mg functional A1PI per mg of total protein (the 
specific activity of a particular lot will be provided in the certificate of analysis). The 
product is clear and colorless to yellow-green and may contain a few particles (ie, protein 
filaments). 
GLASSIA supplied in the US is prepared from human plasma obtained from US-licensed 
plasma collection centers by a modified version of the cold ethanol fractionation process 
and the A1PI is then purified using chromatographic methods. GLASSIA does not 
contain stabilizers or any other added substances (such as sucrose, albumin or mannitol). 
GLASSIA contains no preservatives and no latex. 
Further information can be found in the GLASSIA package insert and/or IB. 
6.1.1 Rationale for the Selection of Dosing Regimen 
The dosing regimen of GLASSIA chosen for this study, 60 mg/kg given intravenously 
once per week, is the standard FDA-approved dosing regimen for GLASSIA, as well as 
all other plasma-derived A1PI products in the same class. At this dosage, GLASSIA has 
been demonstrated to be safe and well tolerated in a total of 65 subjects with congenital 
A1PI-deficiency, and was shown to increase and maintain circulating through antigenic 
and functional A1PI levels to 14.7 µM (median; range: 11.6-18.5 µM) and 11.9 µM 
(median; range: 8.2-16.9 µM), respectively (see GLASSIA package insert and/or IB). 
6.1.2 Rationale for the Selection of Route of Administration and Infusion Rate 
The route of administration (intravenous infusion), as well as the infusion rate  
(0.2 mL/kg BW/min), selected for this study are in accordance with the FDA-approved 
package insert. 
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6.2 Clinical Condition/Indication 
GLASSIA is indicated for chronic augmentation and maintenance therapy in adults with 
clinically evident emphysema due to severe congenital deficiency of A1PI (AAT 
deficiency). 
6.3 Population To Be Studied 
Subjects with severe congenital A1PI-deficiency and emphysema are planned for 
enrollment into this study.  
6.4 Findings From Nonclinical and Clinical Studies 
6.4.1 Summary of Nonclinical Data 
GLASSIA was evaluated in 2 single dose general toxicology studies in Sprague-Dawley 
rats and New Zealand White rabbits, and 2 repeated dose study in New Zealand White 
rabbits.  
In single dose studies, a single dose of 0, 60 and 600 mg/kg (rabbits) or 640 mg/kg (rats) 
was administered intravenously and the animals were observed for 14 days. There were 
no changes in body weight, clinical chemistry, hematology and gross pathology that 
could be attributed to GLASSIA administration. 
In a repeated dose study, New Zealand White rabbits received GLASSIA (300 mg/kg) 
once daily for 5 consecutive days. Animals were monitored for changes in clinical signs, 
body weight, clinical chemistry, hematology, necropsy and histopathology on Day 1 or 
14 after the last administration. A minor increase in group mean neutrophils was 
measured on Day 1 after the last GLASSIA administration. Recovery was observed after 
14 days. 
Long-term studies in animals to evaluate carcinogenesis, mutagenesis or impairment of 
fertility have not been conducted. 
Animal reproduction studies have not been conducted with GLASSIA. 
No toxicological effects due to the solvent/detergent reagents, tri-(n)-butyl phosphate, 
and polysorbate 80 (Tween 80), used in the virus inactivation procedure are expected 
since the residual levels are less than 5 and 20 ppm, respectively. 
6.4.2 Summary of Clinical Data 
Findings from clinical studies are provided in the GLASSIA package insert and/or IB. 
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6.5 Evaluation of Anticipated Risks and Benefits of the Investigational Product(s) to 
Human Subjects 
Transmission of blood-borne diseases is a theoretical risk since GLASSIA is derived 
from pooled human plasma. To decrease the potential contamination with blood-borne 
viruses, stringent procedures have been employed in the manufacture of this product from 
the screening of plasma donors through plasma collection and preparation. To further 
reduce the risk of viral transmission, the manufacturing process includes 2 steps of viral 
removal or inactivation: (1) treatment with a solvent/detergent (S/D) mixture of tri-n-
butyl phosphate and polysorbate 80 (Tween 80) which inactivates enveloped viral agents 
such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C 
virus (HCV); and, (2) a nanofiltration step through a 15 nm filter which can remove both 
enveloped and non-enveloped viral agents (such as hepatitis A virus [HAV]). In vitro 
virus clearance studies demonstrated a virus log reduction factor of 4 or greater. To date, 
no seroconversion for hepatitis B or C (HBV or HCV) or human immunodeficiency virus 
(HIV) or any other known infectious agent have been reported with the use of GLASSIA 
during the clinical studies. 
GLASSIA is contraindicated in subjects with a history of anaphylactic or severe 
hypersensitivity reactions to human A1PI preparations. 
GLASSIA may contain trace amounts of immunoglobulin A (IgA). GLASSIA is 
contraindicated in subjects with known antibodies to IgA, and in subjects with selective 
or severe IgA deficiency who may develop anti-IgA antibodies that can result in severe 
hypersensitivity and anaphylactic reactions. IF ANAPHYLACTIC OR SEVERE 
ANAPHYLACTOID REACTIONS OCCUR, THE INFUSION MUST BE 
DISCONTINUED IMMEDIATELY. Epinephrine, antihistamines, and other appropriate 
supportive therapy should be available for the treatment of any acute anaphylactic or 
anaphylactoid reactions. 
6.6 Compliance Statement 
This study will be conducted in accordance with this protocol, the International Council 
For Harmonisation Guideline for Good Clinical Practice E6 (ICH GCP, April 1996), 
Title 21 of the US Code of Federal Regulations (US CFR), the (EU Directives 
2001/20/EC and 2005/28/EC), and applicable national and local regulatory requirements. 
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7. STUDY PURPOSE AND OBJECTIVES 
7.1 Study Purpose 
The purpose of the study is 2-fold: (1) to further evaluate the safety and potential 
immunogenicity of GLASSIA following IV administration via in-line filtration; and, 
(2) to assess the effects of GLASSIA augmentation therapy on the levels of A1PI and 
 in the ELF following IV administration at a dosage of 60 mg/kg 
BW/week for 25 weeks in subjects with emphysema due to congenital A1PI deficiency. 
7.2 Primary Objectives 
1. To evaluate the effectiveness of the use of 5-micron in-line filter on the safety and 
potential immunogenicity of GLASSIA. 
2. To determine the effects of weekly IV augmentation therapy with GLASSIA at a 
dosage of 60 mg/kg BW on antigenic and functional A1PI levels in ELF in 
subjects with congenital A1PI deficiency. 
7.3 Secondary Objective 
 To collect additional safety information for GLASSIA. 
7.4 Exploratory Objective 
 
 
 
 
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8. STUDY DESIGN 
8.1 Brief Summary 
This Phase 3/4, prospective, 2-arm, double-blind, randomized, controlled, multicenter 
study will assess the safety, immunogenicity, and effects on the antigenic and functional 
A1PI levels in the ELF following GLASSIA administration via a 5-micron in-line filter at 
a dosage of 60 mg/kg BW/week (the dosing regimen that is currently approved by the 
Food and Drug Administration [FDA]) for 25 weeks in A1PI-deficient subjects who are 
A1PI-treatment naïve, who are currently receiving A1PI treatment at the time of 
enrollment, or who have previously received A1PI treatment. 
8.2 Study Design 
A1PI-deficient subjects, who are A1PI treatment naïve or have previously been treated 
with A1PI augmentation therapy, will be enrolled. Subjects who are receiving or have 
recently been exposed to A1PI augmentation therapy at the time of study enrollment will 
be required to undergo an adequate washout period (minimum of 4 weeks from the time 
of last A1PI treatment) during screening. Screening A1PI measurement may be taken at 
any time during the screening period for treatment-naïve subjects. For subjects who have 
previously received alpha-1 augmentation therapy, screening A1PI measurement should 
be taken at the end of the wash-out period. During the washout period, subjects will be 
allowed to undergo other screening procedures for eligibility determination. 
Subjects meeting eligibility criteria will be required to undergo bronchoscopy/BAL 
procedures at baseline and following IP treatment for the evaluation of the effects of 
GLASSIA augmentation therapy at the labeled dosage of 60 mg/kg BW/week on the 
levels of A1PI and 
 in the ELF.  
Once the target of 15 to 18 evaluable subjects has been reached, the remaining subjects to 
be enrolled will not be required to undergo baseline and on-treatment bronchoscopy/BAL 
procedures. Subjects with confirmed medical history (IC #1a, #9a, EC #20, #21, #22, 
#23, and #24) known not to meet eligibility criteria to undergo bronchoscopy/BAL 
procedures, may be screened with sponsor approval before the target enrollment of BAL 
evaluable subjects is reached.   
Enrollment will be closed when both conditions are met:  
(a) 15 to 18 evaluable subjects with acceptable BAL samples collected from both 
the baseline and on-treatment BAL visits 
(b) A minimum of 36 randomized subjects. 
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If for any reasons the target of 15 to 18 evaluable subjects have not been achieved with 
initial 36 randomized subjects, additional subjects will be enrolled to meet the BAL 
enrollment target. 
Subjects who have completed the baseline bronchoscopy/BAL visit and have acceptable 
BAL samples will be randomized in a 1:1 ratio to 1 of the 2 treatment arms as shown in 
Table 8-1. Subjects who are waived from the bronchoscopy/BAL procedures will be 
randomized after completing screening procedures and confirmation of eligibility (note 
that BAL-related eligibility criteria are not applicable for these subjects). 
Table 8-1 
Treatment Assignments 
Treatment 
Arm 
No. of Subjects Per 
Arm 
Treatment 
1 
18 
GLASSIA lot with particle loads representing the high end within 
the normal range observed in GLASSIA lots manufactured 
2 
18 
GLASSIA lot with particle loads representing the low end within 
the normal range observed in GLASSIA lots manufactured 
 
During the treatment period, subjects in both treatment arms will receive weekly IV 
infusions of GLASSIA at 60 mg/kg BW administered at a rate of 0.2 mL/kg/min for 
25 weeks (ie, 25 planned infusions) via an IV administration set that includes a 5-micron 
in-line filter. The first infusion (Week 1), as well as infusions during Week 13 and 
Week 25, must be administered at the study site to facilitate monitoring and reporting of 
potential AEs associated with GLASSIA infusions. At the investigator’s discretion, 
subsequent infusions may be administered at the study site or at another suitable location 
(eg, the subject’s home) by a qualified healthcare professional, as acceptable per local 
regulations and standard practices of the study site. 
Subjects will be asked to return to the study site every 6 weeks (ie, during Weeks 1, 7, 13, 
19, and 25) for body weight measurements, as well as physical examination, vital sign 
measurements, and blood draws for plasma A1PI and safety laboratory sample collection, 
as applicable (see Table 20.2-1 and Table 20.3-1 for detailed list of study 
procedures/laboratory assessments). The on-treatment BAL visit will be conducted 
between Week 12 and Week 14 following initiation of GLASSIA augmentation therapy 
for the determination of antigenic and functional A1PI levels and 
 in 
ELF. After completing the on-treatment BAL visit, subjects will continue to receive 
weekly GLASSIA infusions until Week 25 (the last infusion visit), followed by the study 
completion visit (Week 26) at 7 (±3) days post-last infusion. 
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The overall study design is illustrated in Figure 20-1 (Supplement 20.1). 
8.3 Duration of Study Period(s) and Subject Participation 
The overall duration of the study will be approximately 2 years from study initiation (ie, 
first subject enrolled) to study completion (ie, last subject last visit).  
The recruitment period is expected to be approximately 16 months. The duration of each 
subject’s participation from enrollment to subject completion (ie, last study visit) is 
anticipated to be approximately 8 months (unless the subject withdraws or is prematurely 
discontinued from the study), including: 
 
a screening period of up to 6 weeks, 
 
a baseline period of up to 2 weeks (for subjects undergoing baseline BAL 
procedure), 
 
a treatment period of 25 weeks, and  
 
a post-treatment safety follow-up period of 7 (±3) days after the last infusion. 
8.4 Outcome Measures 
8.4.1 Primary Outcome Measures 
Safety 
1. Number (proportion) of AEs considered potentially related to the presence of 
particle load in the GLASSIA solution. 
2. Incidence of treatment-emergent ARs plus suspected ARs. 
3. Number (proportion) of infusions that are discontinued, slowed, or interrupted due 
to an AE. 
4. Number (proportion) of subjects who develop binding and/or neutralizing anti-
A1PI antibodies. 
Efficacy 
1. Antigenic A1PI levels in ELF. 
2. Functional A1PI (also known as ANEC) levels in ELF. 
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8.4.2 Secondary Outcome Measures 
Safety 
1. Incidence of treatment-emergent AEs. 
2. Number (proportion) of subjects who experienced a shift from normal or 
clinically insignificant abnormal laboratory values at baseline to clinically 
significant abnormal laboratory values following GLASSIA administration. 
3. Number (proportion) of subjects with treatment-emergent seroconversion or 
positive viral nucleic acid test (NAT) for parvovirus B19 (B19V). 
8.4.3 Exploratory Outcome Measures 
 
 
 
 
 
 
 
 
 
 
 
8.5 Randomization and Blinding 
This is a 2-arm, double-blind, randomized, controlled clinical study. In order to 
minimize/avoid bias, subjects meeting all eligibility criteria (Section 9.1 and Section 9.2) 
will be randomly assigned to 1 of 2 treatment arms at a ratio of 1:1. Note that 
randomization is to take place only after the subject has successfully completed the 
baseline BAL visit with verification of having evaluable BAL samples collected. For 
those subjects to be enrolled after the target of 15 to 18 evaluable BAL subjects have 
been achieved and thus exempted from BAL procedures, randomization will take place 
upon confirmation of the main study eligibility criteria (Section 9.1 and Section 9.2) 
being met. 
Randomization codes will be generated and maintained by an Interactive Response 
Technology (IRT) via an Interactive Web Response System (IWRS). Treatment 
assignment will not be revealed to the subject, investigators, study site personnel or the 
sponsor, except for unblinded study personnel such as the unblinded biostatistician. 
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8.5.1 Unblinding Procedures at Study Sites 
The randomization assignment is not to be revealed before the study is terminated, except 
in emergency cases when unblinding is necessary for the clinical management of an SAE. 
In such events, every attempt must be made to inform the sponsor before breaking the 
blind or immediately when unblinding has been performed. The investigator may request 
for the treatment assignment of the specific individual subject involved in the emergency 
event via the centralized randomization service or the unblinded biostatistician. 
8.6 Study Stopping Rules 
The study may be terminated by the sponsor in the event of unexpected safety or medical 
concerns. Specific stopping rules will not be established for this study, as GLASSIA is an 
approved product (in the US) with a demonstrated record of safety at the approved 
dosage of 60 mg/kg BW/week which is to be employed in this study. 
8.7 Investigational Product(s) 
8.7.1 Packaging, Labeling, and Storage 
Packaging: GLASSIA will be supplied as a sterile, non-pyrogenic, ready-to-use solution 
in single use vials containing 1 gram of functional A1PI in 50 mL of solution.  
Dosage Form: Injection, solution 
Labeling: The product will be labeled according to the valid regulatory requirements for 
clinical studies. 
Storage: GLASSIA must be stored at 2-8 °C (36 to 46 °F). Do not freeze the product. Do 
not use past the expiration date. 
8.7.2 Preparation of Infusion Solution 
The dose (in mg) will be calculated based on the subject’s body weight at screening and 
at each subsequent study visit. Dose adjustments based on body weight changes from 
screening or previous visit will be made if the subject’s body weight changes by >5%. 
Only body weight measurements taken using standardized procedures during study visits 
(Weeks 1, 7, 13, 19, or 25) will be used for dose calculations. 
The volume of infusion solution (in mL) will be calculated based on the content of 
functional A1PI (potency) in GLASSIA vials, as specified in the certificate of analysis to 
be provided with a particular GLASSIA lot and as printed on the product carton and vial. 
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For instructions for the preparation and administration of GLASSIA infusion solution, 
please refer to the GLASSIA package insert and/or IB. 
8.7.3 Administration 
GLASSIA is for intravenous use only. 
Route of administration: IV infusion via a 5-micron in-line filter 
Rate of administration: 0.2 mL/kg BW/min  
(The rate of infusion will be regulated by an ambulatory infusion pump.) 
8.7.4 Description of Treatment 
Treatment: GLASSIA (Alpha1-Proteinase Inhibitor [Human]) 
Dose: 60 mg/kg BW/week 
Dosage frequency: Once every week (±2 days) 
Treatment period: 25 weeks (ie, 25 planned infusions), to be followed by a 7 (±3 days) 
post-treatment safety follow-up period 
8.7.5 Investigational Product Accountability 
The investigator will ensure that the IP(s) is stored as specified in the protocol and that 
the storage area is secured, with access limited to authorized study personnel. The 
investigator will maintain records that the IP(s) was received, including the date received, 
drug identity code, date of manufacture or expiration date, amount received and 
disposition. IP(s) must be dispensed only at the study site or other suitable location 
(eg, infusion center; home, as applicable per study design). Records will be maintained 
that include the subject identification code (SIC), dispensation date, and amount 
dispensed. All remaining partially used and/or unused IP(s) will be returned to the 
sponsor or sponsor’s representative after study completion/termination, or destroyed with 
the permission of the sponsor in accordance with applicable laws and study site 
procedures. If IP(s) is to be destroyed, the investigator will provide documentation in 
accordance with sponsor’s specifications. 
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8.8 Source Data 
Per ICH GCP, source data are defined as all information in original records and certified 
copies of original records of clinical findings, observations, or other activities in a clinical 
trial that are necessary for the reconstruction and evaluation of the trial. Source data are 
contained in source documents (original records or certified copies), which may be in 
paper and/or electronic format. Source data for this study comprise the following: 
hospital records, medical records, clinical and office charts, laboratory notes, 
memoranda, evaluation checklists, outcomes reported by subjects, 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, subject files, records entered into web and/or phone IRT system 
and/or any direct data capture system, and records kept at the pharmacy, at the 
laboratories and at medico-technical departments involved in the clinical study. 
No data will be entered directly onto the case report form (CRF). 
For additional information on study documentation and case report forms (CRFs), see 
Section 17.2. 
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9. SUBJECT SELECTION, WITHDRAWAL, AND DISCONTINUATION 
9.1 Inclusion Criteria 
A subject must meet ALL of the following criteria to be eligible for inclusion in this 
study: 
1. Male or female subjects meeting the following age criteria: 
(a) For subjects who will undergo bronchoscopy/BAL procedures: 18 to 75 years 
of age at the time of screening. 
(b) For subjects who will be waived from undergoing bronchoscopy/BAL 
procedures: 18 years of age or older at the time of screening. 
2. Documented A1PI genotype of Pi*Z/Z, Pi*Z/Null, Pi*Malton/Z, Pi*Null/Null, or 
other “at-risk” allelic combinations such as SZ (excluding MS and MZ) and an 
endogenous A1PI plasma levels of ≤11 µM. 
3. Screening levels of endogenous plasma (antigenic) A1PI of ≤11 µM may be 
collected at any time during the screening period for treatment-naïve subjects, or 
following a 4 week minimum wash-out from previous augmentation therapy in 
treatment-experienced subjects. 
4. Subjects must have at least one of the following: clinical diagnosis of emphysema, 
evidence of emphysema on computerized tomography (CT) scan of the chest, 
and/or evidence of airway obstruction which is not completely reversed with 
bronchodilator treatment at the time of screening. 
5. If the subject is being treated with any respiratory medications including inhaled 
bronchodilators, inhaled anticholinergics, inhaled corticosteroids, or low-dose 
systemic corticosteroids (prednisone ≤10 mg/day or its equivalent), the doses of 
the subject’s medications have remained unchanged for at least 14 days prior to 
screening. 
6. The subject is a nonsmoker or has ceased smoking for a minimum of 13 weeks 
prior to screening (serum cotinine level at screening within normal range of a 
nonsmoker) and agrees to refrain from smoking throughout the course of the 
study. Subjects with a positive cotinine test due to nicotine replacement therapy 
(eg, patches, chewing gum), vapor cigarettes, or snuff are eligible. 
7. If female of childbearing potential, the subject presents with a negative pregnancy 
test at screening and agrees to employ adequate birth control measures for the 
duration of the study. 
8. The subject is willing and able to comply with the requirements of the protocol. 
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9. The subject must have pulmonary function at the time of screening meeting both 
of the following: 
(a) Post-bronchodilator forced expiratory volume in 1 second (FEV1) ≥50% of 
 
predicted. 
(b) If FEV1 is >80% predicted, then FEV1/forced vital capacity (FVC) must  
 
be <0.7. 
Note: Inclusion criterion #1a and #9a are not applicable to subjects who are not required 
to undergo the bronchoscopy/BAL procedures. 
9.2 Exclusion Criteria 
A subject who meets ANY of the following criteria is NOT eligible for this study: 
1. The subject is experiencing or has a history of clinically significant pulmonary 
disease (other than COPD, emphysema, chronic bronchitis, mild bronchiectasis, 
and stable asthma). 
2. The subject is experiencing or has a history of chronic severe cor pulmonale 
(resting mean pulmonary artery pressure ≥40 mm Hg). 
3. The subject routinely produces more than 1 tablespoon of sputum per day.  
4. The subject has a history of frequent pulmonary exacerbations (greater than 
2 moderate or severe exacerbations within 52 weeks prior to screening; see 
Section 10.4 for the definition of moderate and severe exacerbations). 
5. The subject is experiencing a pulmonary exacerbation at the time of screening 
(subject may be re-screened 4 weeks after the clinical resolution of an 
exacerbation). 
6. The subject has clinically significant abnormalities (other than emphysema, 
chronic bronchitis, or mild bronchiectasis) detected on chest X-ray or CT scan at 
the time of screening. (Past records obtained within 52 weeks prior to screening 
may be used, if available.) 
7. The subject has clinically significant abnormalities detected on a 12-lead 
electrocardiogram (ECG) performed at the time of screening. (Past records 
obtained within 26 weeks prior to screening may be used, if available.) 
8. The subject has clinically significant congestive heart failure with New York 
Heart Association (NYHA) Class III/IV symptoms. 
9. The subject is experiencing an active malignancy or has a history of malignancy 
within 5 years prior to screening, with the exception of the following: adequately 
treated basal cell or squamous cell carcinoma of the skin, carcinoma in situ of the 
cervix, or stable prostate cancer not requiring treatment. 
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10. The subject has a history of lung or other organ transplant, is currently on a 
transplant list, or has undergone major lung surgery. 
11. The subject is receiving long-term around-the-clock oxygen supplementation. 
(The following are allowed: short-term use of oxygen supplementation [eg, for the 
management of acute COPD exacerbation], oxygen supplementation required 
during night time only, and supplemental O2 with continuous positive airway 
pressure [CPAP] or bi-level positive airway pressure [BiPAP]). 
12. Known history of hypersensitivity following infusions of human blood or blood 
components. 
13. Immunoglobulin A (IgA) deficiency (<8 mg/dL at screening). 
14. Abnormal clinical laboratory results obtained at the time of screening meeting any 
of the following criteria: 
a. 
Serum alanine aminotransferase (ALT) >3.0 times upper limit of normal 
(ULN) 
b. 
Serum total bilirubin >2.0 times ULN 
c. 
>2+proteinuria on urine dipstick analysis 
d. 
Serum creatinine >2.0 times ULN 
e. 
Absolute neutrophil count (ANC) <1500 cells/mm3 
f. 
Hemoglobin (Hgb) <9.0 g/dL 
g. 
Platelet count <100,000/mm3 
15. Ongoing active infection with hepatitis A virus (HAV), hepatitis B virus (HBV), 
hepatitis C virus (HCV), or human immunodeficiency virus (HIV) Type 1/2 
infection at the time of screening. 
16. The subject has any clinically significant medical, psychiatric, or cognitive illness, 
or any other uncontrolled medical condition (eg, unstable angina, transient 
ischemic attack) that, in the opinion of the investigator, would impede the 
subject’s ability to comply with the study procedures, pose increased risk to the 
subject’s safety, or confound the interpretation of study results. 
17. The subject has participated in another clinical study involving an investigational 
product or investigational device within 30 days prior to enrollment or is 
scheduled to participate in another clinical study involving an investigational 
product or device during the course of this study. 
18. The subject is a family member or employee of the investigator. 
19. If female, the subject is nursing at the time of screening. 
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20. The subject has contraindication(s) to bronchoscopy such as recent myocardial 
infarction, unstable angina, other cardiopulmonary instability, tracheal obstruction 
or stenosis, moderate to severe hypoxemia or any degree of hypercapnia, unstable 
asthma, Stage 4 or 5 chronic kidney disease, pulmonary hypertension, severe 
hemorrhagic diathesis, and cervical C1/C2 arthritis. 
21. The subject has had lung surgery which may interfere with bronchoscopy. 
22. Known history of allergic/hypersensitivity reactions to medications used during 
and for perioperative care associated with the bronchoscopy/BAL procedures, 
such as local anesthetics, sedatives, pain control medications. 
23. The subject is receiving or requires long-term (>4 weeks) immunosuppressive 
therapy, such as systemic corticosteroids at doses greater than 10 mg/day of 
prednisone (or its equivalent), mycophenolate mofetil, azathioprine, 
cyclophosphamide, and rituximab. 
24. If a subject is receiving anticoagulant or anti-platelet therapy (such as warfarin 
and clopidogrel), the subject is unwilling to or unable to safely discontinue 
anticoagulant or anti-platelet therapy within 7 days prior to until at least 24 hours 
after the BAL procedures. An exception is low-dose aspirin alone which is 
allowed. 
Note: Exclusion criteria #20, #21, #22, #23, and #24 are not applicable to subjects who 
are not required to undergo the bronchoscopy/BAL procedures. 
9.3 Withdrawal and Discontinuation 
Any subject may voluntarily withdraw (ie, reduce the degree of participation in the study) 
consent for continued participation and data collection. The reason for withdrawal will be 
recorded on the appropriate CRF. Assessments to be performed at the termination visit 
(including in cases of withdraw or discontinuation) are described in Section 10.6, 
Section 20.2, and Section 20.3. 
Discontinuation (ie, complete withdrawal from study participation) may be due to 
dropout (ie, active discontinuation by subject) or loss to follow-up (ie, discontinuation by 
subject without notice or action). Additionally, the investigator and sponsor have the 
discretion to discontinue any subject from the study if, in their judgment, continued 
participation would pose an unacceptable risk for the subject.  
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Subjects also will be withdrawn from treatment or discontinued from further study 
participation for the following reasons: 
1. The subject becomes pregnant. IP exposure will be discontinued. Attempts will be 
made to follow the subject through completion of the pregnancy and up to 1 year 
post-delivery, if feasible. The investigator will record a narrative description of 
the course of the pregnancy and its outcome. 
2. The subject begins nursing. IP exposure will be discontinued. The investigator 
will record a narrative description of the course of the baby’s development. 
3. The subject develops a serious AE, which, based on the medical judgment of the 
investigator, prevents completion of participation in the study. 
4. The subject fails to comply with protocol requirements or procedures that may 
include, but are not limited to: 
 The subject frequently misses scheduled administration of the IP, defined as 
missing a total of >20% (ie, >5) of planned infusions, or 4 or more 
consecutive weekly infusions. 
 The subject is treated with any A1PI product (including commercially 
available GLASSIA) other than IP. 
 The subject participates in another clinical study and/or receives an 
investigational product/device other than IP. 
5. If a subject experiences >1 moderate or severe COPD exacerbation and/or lower 
respiratory tract infection (LRTI) during the screening period (Rescreening may 
be permitted as defined in Section 10.3.1.3). 
6. The sponsor terminates the study. 
For subjects undergoing BAL procedures, if no acceptable BAL samples can be obtained 
from any of the 3 lobes attempted during the baseline BAL visit, the subject will not be 
randomized and will be discontinued from the study. These subjects may be re-screened 
after the target enrollment of BAL evaluable subjects is completed. If acceptable 
BAL samples can be obtained during the baseline BAL visit but not from the on-
treatment BAL visit (between Week 12 to Week 14), the subject will continue to 
complete the remaining infusion visits and the study completion visit. These subjects 
would not be considered as a BAL evaluable subject. 
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10. STUDY PROCEDURES 
The overall study flow chart is illustrated in Figure 20-1 (Supplement 20.1). Details on 
the procedures to be performed at each study visit, including screening, can be found in 
Supplement 20.2 Schedule of Study Procedures and Assessments and Supplement 20.3 
Schedule of Clinical Laboratory Assessments. 
10.1 Informed Consent and Enrollment 
Any patient who provides informed consent (ie, signs and dates the informed consent 
form [ICF]) is considered enrolled in the study. 
10.2 Subject Identification Code 
The following series of numbers will comprise the subject identification code (SIC): 
protocol identifier (eg, 471101) to be provided by the sponsor, 2- or 3-digit number study 
site number (eg, 02) to be provided by the sponsor, and 3- or 4-digit subject number 
(eg, 0003) reflecting the order of enrollment (ie, signing the ICF). For example, the third 
subject who signed an ICF at study site 02 will be identified as Subject 471101-020003. 
All study documents (eg, CRFs, clinical documentation, sample containers, drug 
accountability logs, etc.) will be identified with the SIC. Additionally, a uniquely coded 
SIC(s) is permitted as long as it does not contain a combination of information that 
allows personal identification of a subject (eg, collection of a subject’s initials and birth 
date would not be permitted), in compliance with laws governing data privacy. 
10.3 Screening and Study Visits 
10.3.1 Screening Visit 
After informed consent has been obtained from the subject and/or their legally authorized 
representative, subjects will be screened on-site for eligibility based on the Inclusion and 
Exclusion Criteria defined in Section 9.1 and Section 9.2, respectively. Randomization is 
to take place after the subject has met all eligibility criteria and, as applicable, the subject 
has successfully undergone the baseline BAL visit with evaluable BAL samples 
collected. 
The study site is responsible for maintaining an enrollment/screening log that includes all 
subjects who provided informed consent. The log also will serve to document the reason 
for screening failure. All screening data will be collected and reported in CRFs, 
regardless of screening outcome. If a subject is re-screened, the End of Study CRF should 
be completed, and a new ICF, new SIC and new CRF are required for that subject. 
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10.3.1.1 Confirmation of Severe Congenital A1PI Deficiency 
To establish eligibility for participation in the study, the subject’s diagnosis of severe 
congenital A1PI deficiency must be confirmed during screening by measurement of 
endogenous plasma A1PI levels. The plasma level must be ≤11 µM, and the plasma 
sample can be collected any time during screening for treatment-naïve A1PI deficient 
subjects, but only following a wash-out from previous A1PI augmentation therapy in 
treatment-experienced subjects. The presence of exogenously-administered A1PI may 
interfere with the verification of endogenous plasma A1PI levels in treatment-
experienced subjects; therefore, they will be required to have their pre-study A1PI 
therapy withdrawn for a minimum of 4 weeks to allow A1PI levels to return to the 
subject’s pre-augmentation levels. Screening A1PI measurement may be repeated in the 
event of suspected inadequate washout resulting in initial screening A1PI level of 
>11 µM. 
Subjects must have a diagnosis of A1PI deficiency (ie, genotype of Pi*Z/Z, Pi*Z/Null, 
Pi*Malton/Z, or Pi*Null/Null, or other “at-risk” allelic combinations such as SZ 
[excluding MS and MZ]) AND plasma antigenic A1PI level of ≤11 µM in order to meet 
eligibility criteria. Results of these screening tests will be used to establish the subject’s 
eligibility for participation in the study. 
During the washout period, these subjects will be allowed to undergo other screening 
procedures (Supplement 20.2 and Supplement 20.3). 
10.3.1.2 Pulmonary Function Tests 
10.3.1.2.1 Spirometry 
Spirometry tests are to be conducted according to standard guidelines published by the 
American Thoracic Society and European Respiratory Society.19,20 Whenever possible, 
all measurements should be performed with the same equipment around the same time of 
the day (±2 hours) during site visits to minimize equipment and diurnal variability. All 
spirometric measurements (FEV1 and FVC) are to be measured 30±5 minutes following 
administration of a short-acting β-2 agonist bronchodilator (eg, a total of 400 µg of 
salbutamol [2 × 200 µg or 4 × 100 µg] or its equivalent). Spirometric measurements 
(FEV1 and FVC) are to be performed in triplicate, and the highest value at each time 
point for each variable is to be used for analyses. The spirometry equipment is to be 
calibrated according to the manufacturer’s recommendation and documented in a 
maintenance log. The same method for the calculation of predicted normal values will be 
applied for all subjects and assessment time points to maintain standardization. 
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10.3.1.3 Rescreening 
Subjects may be rescreened once for study eligibility. Subjects who have failed screening 
for any of the following reasons may be rescreened: 
1. Circulating antigenic A1PI level of ≥11 µM that is suspected to be due to 
inadequate washout of the prior A1PI therapy 
2. Erroneous screening results 
3. Pulmonary exacerbation at the time of initial screening (Note: subjects may be 
re-screened 4 weeks after the clinical resolution of an exacerbation.) 
4. Ineligibility due to failure to meet protocol pre-specified time intervals 
(eg, inclusion criteria #5 and #6, and exclusion criteria #5 and #17)  
Subjects who were discontinued early from the study due to failure to yield adequate 
baseline BAL samples or failure to meet the eligibility criteria required to undergo the 
bronchoscopy/BAL procedure will be allowed to be rescreened before the target 
enrollment of BAL evaluable subjects is completed. 
If a subject is to be re-screened, the study completion/termination CRF should be 
completed. The subject or his/her legally authorized representative must sign a new ICF 
prior to rescreening procedures. A new SIC will be assigned, and new CRFs will be used 
for the subject upon re-enrollment.  
10.3.2 Infusion Visits 
GLASSIA will be administered as IV infusions at 60 mg/kg BW every week (±2 days) 
for a total of 25 infusions. Scheduling of all infusion or study visits will be based on the 
date of the first IP infusion visit (Week 1, Day 1). 
10.3.2.1 IP Administration 
Description of GLASSIA treatment including treatment period, dose and dosing 
frequency, mode of administration, as well as preparation of infusion solution are detailed 
in Section 8.7. 
The first infusion (Week 1), as well as infusions during Week 13 and Week 25, must be 
administered at the study site to facilitate monitoring and reporting of potential AEs 
associated with GLASSIA infusions. At the investigator’s discretion, all other infusions 
may be administered at the study site or at another suitable location (eg, the subject’s 
home) by a qualified healthcare professional, as acceptable per local regulations and 
standard practices of the study site. 
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During Weeks 1, 7, 13, 19, and 25 infusion visits, vital signs (ie, body temperature, 
respiratory rate, pulse rate, and systolic and diastolic blood pressure; see Section 12.10 
and Table 20.3-1 for additional details) are to be taken on the day of infusion at any time 
prior to the start of an infusion, at each rate reduction due to AE(s) and/or infusion 
interruption/discontinuation due to AE(s), and at 30 (±15) minutes after the completion of 
an infusion. The investigator should be contacted to determine appropriate action to be 
taken, as necessary, if vital signs meet any of the following criteria: 
 
Systolic blood pressure ≤80 mm Hg or ≥180 mm Hg and/or diastolic blood 
pressure: ≤50 mm Hg or ≥110 mm Hg 
 
Pulse rate ≤48 beats/min or ≥110 beats/min 
 
Respiratory rate ≤8 breaths/min or ≥24 breaths/min 
 
Body temperature ≥38.2 ºC (101 ºF)  
For each infusion, the following IP administration information will be recorded in the 
appropriate CRF(s): 
 
Date, start and end time of the infusion 
 
Planned infusion volume 
 
Actual volume infused 
 
Infusion rate, including each infusion rate change (if any) and reason 
 
Infusion interruptions or early discontinuation (if any), including the time of 
infusion interruption (or early stop) and restart  
 
AE(s) 
 
Concomitant use of any medications and any non-drug therapies, including those 
used to treat AE(s) 
10.3.2.2 Management of Treatment-Emergent (S)AEs 
Mild-to-moderate non-serious AEs or other constitutional symptoms that developed 
during an infusion may be treated by standard-of-care medical interventions appropriate 
for the AE at the investigator’s discretion. In the event that the AE continues or increase 
in severity despite interventions, the infusion rate may be decreased by 0.04 mL/kg 
BW/min or the infusion may be temporarily interrupted at the investigator’s discretion. If 
the AE is not resolving, the infusion rate may be further decreased in a stepwise manner 
by 0.04 mL/kg BW/min or discontinued. Once an AE resolves, the infusion may be 
resumed or continued at an infusion rate as tolerated by the subject (but not to exceed 
0.2 mL/kg BW/min) at the discretion of the investigator. 
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If a severe, non-serious AE or SAE occurs during an infusion, the infusion should be 
interrupted pending assessment by the investigator, and appropriate action is to be taken 
to treat the AE. The infusion may be restarted if the AE resolves in response to 
interventions and/or reduction in infusion rate and if it’s deemed safe by the investigator. 
In the event of a life-threatening SAE, study personnel should take immediate steps to 
preserve the subject’s well-being and call for emergency assistance, as well as contact the 
investigator and report the SAE as described in Section 2. 
For moderate-to-severe hypersensitivity reactions (ie, urticaria, low blood pressure, 
angioedema, or wheezing), the infusion should be stopped immediately and the subject 
should be treated according to the standard of care at the discretion of the investigator. 
Prior to further IP administrations, the investigator should consult the sponsor’s Medical 
Monitor. 
In the event a subject develops a rash at any time during the study, the nature, severity, 
extent of the eruption, its temporal relationship to the last IP administration, and the 
likely cause(s) should be examined prior to the next scheduled infusion. Management of 
rashes includes, but is not limited to, the following: 
 
Minor rashes are those involving 10% of body surface or less without bleeding or 
signs of secondary infection. Minor rashes may be treated as indicated with 
topical medications, including anti-pruritic and corticosteroid creams. Infusions 
can be continued if the rash is confirmed to be minor and/or deemed unrelated to 
IP. 
 
Major rashes are those that involve more than 10% of the body surface, are 
progressive, are associated with hemorrhage and/or secondary infection, or 
require systemic corticosteroid treatment. These should be treated appropriately 
and infusions should be discontinued immediately until the condition has resolved 
completely or is judged to be not clinically significant. Procedures (eg, biopsy of 
the lesion) may be performed to investigate the pathophysiology of the rash. At 
the discretion of the investigator, IP treatment may be resumed only after the rash 
has resolved and the subject’s condition is deemed medically safe and 
appropriate. Pre-medications such as oral or topical corticosteroid treatment may 
be administered for the subsequent 2 infusions, as applicable, at the discretion of 
the investigator in accordance with the standard of care at the investigative site. 
Subjects with recurrent major rashes, rashes that recur upon re-challenge of IP 
despite (pre-)medication(s), or rashes that do not resolve within 6 weeks will be 
discontinued from further IP administration and will be followed as outlined in 
Section 9.3. 
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Any rate reductions, interruptions or discontinuation of an infusion and, if applicable, any 
medications and/or non-drug therapies used to treat AE(s), must be recorded in the 
appropriate CRF(s). 
10.3.2.3 Pre-Medications 
If the same type of mild-to-moderate, non-serious AE expected to be related to IP 
infusion (eg, headache, chills, fever, flushing, and malaise) or other constitutional 
symptoms recurs for 2 or more infusions, the subject may be pre-medicated for 
subsequent infusion(s) at the discretion of the investigator in accordance with the 
standard of care at the investigative site. The use of any pre-medications must be 
recorded in the appropriate CRF(s). 
10.3.2.4 Post-Infusion Follow-Up 
Following each infusion visit, telephone follow-up will be conducted by the 
investigator/designee at 72 hours (+1 business day) to document AEs, and/or 
administration of concomitant medications or non-drug therapies, which may have 
occurred within 72 hours after the completion of an infusion. 
10.3.3 Clinical Assessment Visits 
Following Week 1 visit, subjects will be asked to return to the study site during Week 13 
and Week 25 for on-treatment clinical and safety laboratory assessments, as well as 
plasma A1PI measurements. Additional blood samples will be drawn for the monitoring 
of plasma A1PI levels during Week 7 and Week 19, which may take place at study site or 
at another suitable location (eg, the subject’s home) by a qualified healthcare 
professional. Following the last infusion (Week 25), subjects will return to the study site 
7±3 days post-infusion for study completion assessments. 
A detailed list of assessments to be performed at each clinical assessment visit is 
provided in Supplement 20.2 and Supplement 20.3. 
10.3.4 BAL Visits 
This section applies to subjects who are to undergo bronchoscopy/BAL procedures. 
Bronchoscopy/BAL procedure will be waived for subjects who are enrolled after 15 to 
18 BAL evaluable subjects have been obtained. An evaluable subject is defined as a 
subject who has successfully completed both the baseline and the on-treatment BAL 
visits, and has acceptable BAL sample (defined as a total recovery of ≥20% of the 
instilled volume of saline, no blood by visual inspection in any individual aliquot, overall 
number of acceptable aliquots no less than 3 per lobe, at least 1 acceptable BAL sample 
obtained from any of the 3 lobes) collected from each visit. 
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Subjects will be asked to undergo the bronchoscopy/BAL procedures on 2 occasions: at 
baseline (prior to randomization) and following initiation of GLASSIA treatment for 
12 to 14 weeks. 
The baseline BAL visit must be conducted after verification of deficient plasma 
(antigenic) A1PI levels (≤11 M) has been obtained. Subjects who have been receiving 
A1PI augmentation therapy prior to study entry must have plasma samples collected 
within 10 days prior to the baseline BAL visit for the measurement of plasma (antigenic) 
A1PI levels to verify the adequacy of the washout from A1PI therapy prior to performing 
BAL. The baseline bronchoscopy/BAL visit must be completed prior to randomization 
and within 48 hours prior to the first IP administration. In order for a subject to be 
randomized and remain in the study, the subject must have acceptable BAL sample (total 
recovery of ≥20% of the total original instilled volume of saline, no blood by visual 
inspection in any individual aliquot, overall number of acceptable aliquots no less than 
3 per lobe). If no acceptable BAL samples can be obtained from any of the 3 lobes 
attempted during the baseline BAL visit, the subject will undergo early termination visit 
and be discontinued from the study. 
During GLASSIA augmentation therapy, the subject will be asked to undergo the on-
treatment BAL visit between Week 12 and Week 14. The on-treatment 
bronchoscopy/BAL procedure will be conducted at 7 (±1) days following the last IP 
infusion, but must be completed prior to the next IP infusion. Whenever possible, it is 
recommended that sufficient time (typically 24 to 48 hours) is allowed for the subject to 
recover from the bronchoscopy/BAL procedures prior to IP administration.  
Subjects who have successfully completed the on-treatment BAL visit and have 
acceptable BAL samples will be considered as an evaluable subject. If acceptable BAL 
samples cannot be obtained from any of the 3 lobes attempted during the on-treatment 
BAL visit, the subject will continue to complete the remaining infusion visits through 
Week 25 and the study completion visit (Week 26). These subjects, however, would not 
be considered as a BAL evaluable subject. New subjects may be enrolled to achieve the 
target of 15 to 18 evaluable subjects, as necessary. 
During the BAL visits, plasma samples will be collected within 2 hours prior to the 
BAL procedure for the measurement of plasma urea, as well as plasma antigenic and 
functional A1PI levels. Vital signs will be measured within 2 hours prior to each BAL 
procedure and within 1 hour after the completion of the BAL procedure. Pre-BAL vital 
signs are to be assessed prior to bronchodilator and local anesthesia administration.  
 
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The subject should be monitored for ECG, blood pressure, respiratory rate, and pulse 
oximetry during the procedure in accordance with standard practice at the local 
institution. The subject will remain in the hospital/clinic until, in the investigator’s 
medical judgment, it is safe to discharge the subject. Subjects will be followed for post-
BAL safety monitoring (ie, AEs and concomitant medications/non-drug therapies) at the 
study site or by telephone within 2 weeks after each BAL procedure. 
In order to assess the effects of GLASSIA maintenance treatment on the ELF A1PI 
levels, it is important for the on-treatment BAL procedure be performed after stable 
dosing of GLASSIA has been maintained for at least 4 half-lives of A1PI (ie, average 
half-life ~4.6 days, see GLASSIA package insert and/or IB). Thus, should a subject miss 
1 or more consecutive GLASSIA infusion(s) within 4 week(s) immediately prior to the 
scheduled on-treatment BAL visit, the BAL procedure will be rescheduled to occur after 
the subject has received at least 4 consecutive weekly GLASSIA administrations. The 
timing of the rescheduled BAL visit will follow the same requirements as described 
above for the on-treatment BAL visit. 
10.4 COPD Exacerbation and Lower Respiratory Tract Infection 
An exacerbation of COPD is defined as an acute event characterized by a worsening of 
the patient’s respiratory symptoms that is beyond normal day-to-day variations and lead 
to a change in medication. The onset of an exacerbation is defined as the first day of an 
increase in or new onset of more than one of the respiratory symptoms (cough, sputum, 
sputum purulence, wheezing, or dyspnea), compared to the subject’s usual clinical state, 
for at least 2 consecutive days and requiring treatment with antibiotics and/or systemic 
(oral, intramuscular or intravenous) corticosteroids. The end of an exacerbation is defined 
as the first day that any signs and symptoms of COPD exacerbation and/or LRTI 
symptoms are no longer clinically evident (ie, the first day that a subject returns to his/her 
usual clinical state) for at least 2 consecutive days. As depicted in Figure 10-1, the total 
length of the episode includes any delay in treatment (time taken for treatment to be 
initiated after the onset of exacerbation) and time to resolution of signs and 
symptoms.21,22  
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10.5 Medications and Non-Drug Therapies 
The following medications are not permitted at any time during the course of the study: 
 
Any A1PI augmentation therapy other than IP in this study; commercially 
available GLASSIA is also not permitted. 
 
Any investigational drug, biologic, or device other than IP in this study. 
A subject who has taken any of the above medications will be discontinued from further 
treatment and/or from the study.  
The following medications are not permitted within a pre-specified time interval prior to 
each BAL procedure: 
 
Immunosuppressive therapies (such as systemic corticosteroids at doses greater 
than 10 mg/day of prednisone or its equivalent, mycophenolate mofetil, 
azathioprine, and cyclophosphamide) within 4 weeks prior to and during the 
BAL procedures 
 Rituximab at any time during the study. 
 
Anticoagulant or anti-platelet therapy (such as warfarin and clopidogrel) within 
7 days prior to and during the BAL procedures, with the exception of low-dose 
aspirin which is allowed. 
The following medications are permitted during the course of the study provided that the 
dosage remains stable throughout the course of the study: 
1. Any respiratory medications including inhaled bronchodilators, inhaled 
anticholinergics, inhaled corticosteroids, or low-dose systemic corticosteroids 
(prednisone ≤10 mg/day or its equivalent) 
2. Theophylline. 
3. Other medications that a subject is taking for a pre-existing medical condition 
except for those listed under prohibited medications above. 
Dosages of permitted concomitant medications are to remain stable throughout the course 
of the study, unless otherwise medically indicated. 
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10.6 Subject Completion/Discontinuation 
A subject is considered to have completed the study when he/she ceases active 
participation in the study because the subject has, or is presumed to have, completed all 
study procedures according with the protocol (with or without protocol deviations). 
Reasons for completion/discontinuation will be reported on the 
Completion/Discontinuation CRF, including: completed, screen failure, (S)AE (eg, 
death), discontinuation by subject (eg, lost to follow-up [defined as 3 documented 
unsuccessful attempts to contact the subject], dropout), physician decision (eg, 
pregnancy, progressive disease, non-compliance with IP/protocol violation(s), recovery), 
study terminated by sponsor, or other (reason to be specified by the investigator, eg, 
technical problems). Regardless of the reason, all data available for the subject up to the 
time of completion/discontinuation should be recorded on the appropriate CRF.  
Every effort will be made to have discontinued subjects complete the study 
completion/termination visit. Subjects who are discontinued early from the study prior to 
receiving any IP administration will not need to undergo early termination procedures, 
except for those subjects who have undergone the baseline BAL procedure in which case 
subjects will be followed for potential post-BAL complications for a period of time in 
accordance with local institutional standard practice but not to exceed 30 days. 
If the completion/termination visit is done as an additional, unscheduled visit, the 
assessment results shall be recorded with the completion/termination visit. If a subject 
terminates participation in the study and does not return for the completion/termination 
visit, their last recorded assessments shall remain recorded with their last visit. The 
reason for discontinuation will be recorded, and the data collected up to the time of 
discontinuation will be used in the analysis and included in the clinical study report. If 
additional assessments are required, the assessments shall be recorded separately. 
Assessments to be performed at the termination visit (including in cases of withdraw or 
discontinuation) can be found in Supplement 20.2 Schedule of Study Procedures and 
Assessments and Supplement 20.3 Schedule of Clinical Laboratory Assessments. 
In the event of subject discontinuation due to an (S)AE, clinical and/or laboratory 
investigations that are beyond the scope of the required study observations/assessments 
may be performed as part of the evaluation of the event. These investigations will take 
place under the direction of the investigator in consultation with the sponsor, and the 
details of the outcome may be reported to the appropriate regulatory authorities by the 
sponsor. 
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10.7 Procedures for Monitoring Subject Compliance 
All study procedures are to be performed under the direct supervision of the 
investigator/a qualified healthcare professional at the study site or at another suitable 
location (eg, the subject’s home or infusion center), and thus, no separate procedures will 
be used to monitor subject compliance. 
Trough antigenic and functional A1PI levels in plasma would be determined as a check 
on subject’s compliance/adherence to treatment. 
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11. ASSESSMENT OF EFFICACY 
11.1 ELF Antigenic and Functional A1PI Levels 
This study will evaluate the effects of GLASSIA weekly augmentation therapy on the 
A1PI levels in the ELF. 
BAL samples will be analyzed for the determination of the following in the BAL fluid 
using validated bioanalytical assays at a qualified laboratory: 
1. Antigenic A1PI level 
2. Functional A1PI (ANEC) level 
3. Urea level 
ELF antigenic and functional A1PI levels will be estimated based on the respective 
values measured in the BAL fluid using the plasma-to-BAL urea correction method. 
This approach is based on the fact that urea is freely diffusible through most body 
compartments, including the alveolar wall. A dilution factor, k, will be determined with 
the following formula: dilution factor k = UP (concentration of urea in plasma)/UBAL 
(concentration of urea in BAL fluid). Using this dilution factor, quantitative 
measurements of ELF A1PI and 
 will be corrected accordingly. 
11.2 
 
 
 
 
 
 
 
 
 
 
 
 
 
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12. ASSESSMENT OF SAFETY 
12.1 Adverse Events 
12.1.1 Definitions 
An AE is defined as any untoward medical occurrence in a subject administered an IP 
that does not necessarily have a causal relationship with the treatment. An AE can 
therefore be any unfavorable and unintended sign (eg, an abnormal laboratory finding), 
symptom (eg, rash, pain, discomfort, fever, dizziness, etc.), disease (eg, peritonitis, 
bacteremia, etc.), or outcome of death temporally associated with the use of the IP, 
whether or not considered causally related to the IP. 
12.1.1.1 Serious Adverse Event  
A serious adverse event (SAE) is defined as an untoward medical occurrence that at any 
dose meets 1 or more of the following criteria: 
 
Outcome is fatal/results in death (including fetal death). 
 
Is life-threatening – defined as an event in which the subject was, in the judgment 
of the investigator, at risk of death at the time of the event; it does not refer to an 
event that hypothetically might have caused death had it been more severe. 
 
Requires inpatient hospitalization or results in prolongation of an existing 
hospitalization – inpatient hospitalization refers to any inpatient admission, 
regardless of length of stay. 
 
Results in persistent or significant disability/incapacity (ie, a substantial 
disruption of a person’s ability to conduct normal life functions). 
 
Is a congenital anomaly/birth defect. 
 
Is a medically important event – a medical event that may not be immediately 
life-threatening or result in death or require hospitalization but may jeopardize the 
subject or may require medical or surgical intervention to prevent one of the other 
outcomes listed in the definitions above. Examples of such events are:  
 Intensive treatment in an emergency room or at home for allergic 
bronchospasm, blood dyscrasias, or convulsions that do not result in 
hospitalization, or development of drug dependence or drug abuse. 
 Reviewed and confirmed seroconversion for human immunodeficiency virus 
(HIV), hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus 
(HCV), hepatitis E virus (HEV), or parvovirus B19 (B19V). 
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12.1.1.1.1 Uncomplicated Pregnancies  
Uncomplicated pregnancies following maternal or paternal exposure to the IP are not 
considered an (S)AE; however, any pregnancy complication or pregnancy termination by 
therapeutic, elective, or spontaneous abortion shall be considered an SAE. 
12.1.1.2 Non-Serious Adverse Event 
A non-serious AE is an AE that does not meet the criteria of an SAE. 
12.1.1.3 Adverse Reactions Plus Suspected Adverse Reactions 
An AR plus suspected AR is any adverse event which met any of the following criteria:  
(a) an adverse event that began during infusion or within 72 hours following the end 
of IP infusion, or 
(b) an adverse event considered by either the investigator and/or the sponsor to be 
possibly or probably related to IP administration, or  
(c) an adverse event for which causality assessment was missing or indeterminate. 
In addition, safety data will also be analyzed for any ARs plus suspected ARs which met 
any of the following criteria: 
(a) an adverse event that began during infusion or within 24 hours following the end 
of IP infusion, or 
(b) an adverse event considered by either the investigator and/or the sponsor to be 
possibly or probably related to IP administration, or  
(c) an adverse event for which causality assessment was missing or indeterminate. 
12.1.1.4 Unexpected Adverse Events 
An unexpected adverse event is an AE whose nature, severity, specificity, or outcome is 
not consistent with the term, representation, or description used in the Reference Safety 
Information (eg, IB, package insert). “Unexpected” also refers to the AEs that are 
mentioned in the Reference Safety Information as occurring with a class of drugs or as 
anticipated from the pharmacological properties of the drug, but are not specifically 
mentioned as occurring with the particular drug under investigation. The expectedness of 
AEs will be determined by the sponsor using the IB and/or prescribing information as the 
RSI. This determination will include considerations such as the number of AEs 
previously observed, but not on the basis of what might be anticipated form the 
pharmacological properties of a product. 
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12.1.1.5 Adverse Events Potentially Associated with Protein Aggregates 
The safety database will be reviewed and assessed for AEs that may potentially be 
associated with protein aggregates in GLASSIA solution. 
12.1.1.6 Preexisting Diseases 
Preexisting diseases that are present before entry into the study are described in the 
medical history, and those that manifest with the same severity, frequency, or duration 
after IP exposure, will not be recorded as AEs. However, when there is an increase in the 
severity, duration, or frequency of a preexisting disease, the event must be described on 
the AE CRF. 
Any occurrences of COPD exacerbation and/or LRTI are to be recorded on the AE CRF 
(see Section 10.4). 
12.1.2 Assessment of Adverse Events 
Each AE from the first IP exposure until study completion/early discontinuation from the 
study will be described on the AE CRF using the medical diagnosis (preferred), or, if no 
diagnosis could be established at the time of reporting the AE, a symptom, or sign, in 
standard medical terminology in order to avoid the use of vague, ambiguous, or 
colloquial expressions (see definition in Section 12.1). Each AE will be evaluated by the 
investigator for: 
 
Seriousness as defined in Section 12.1.1.1. 
 
Severity as defined in Section 12.1.2.1. 
 
Causal relationship to IP exposure or study procedure as defined in 
Section 12.1.2.2. 
For each AE, the outcome (ie, recovering/resolving, recovered/resolved, 
recovered/resolved with sequelae, not recovered/not resolved, fatal, unknown) and if 
applicable action taken (ie, dose increased, dose not changed, dose reduced, drug 
interrupted, drug withdrawn, not applicable, or unknown) will also be recorded on the AE 
CRF. Recovering/resolving AEs will be followed until resolution, medically stabilized, or 
30 days after the study completion/termination visit, whichever comes first. AE and other 
CRF(s), as applicable, will be updated if additional follow-up information is 
collected/reported prior to study completion (no additional reporting on CRF(s) is 
necessary after study completion). 
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If the severity rating for an ongoing AE changes before the event resolves, the original 
AE report will be revised (ie, the event will not be reported as separate AE). During the 
course of any AE, the highest severity rating will be reported. 
Deviations from the protocol-specified dosage (including overdosing [by >50%], 
underdosing [by >50%], abuse, and withdrawal), treatment errors (including incorrect 
route of administration, use of an incorrect product, and deviations from the protocol-
defined dosing schedule), failures of expected pharmacological actions, and unexpected 
therapeutic or clinical benefits will be followed with regard to occurrence of AEs, lack of 
efficacy, and/or other observations because these events may be reportable to regulatory 
authorities. 
Any pregnancy that occurs after administration of IP will be reported on a Pregnancy 
Report Form within 24 hours of awareness and followed-up at estimated date of delivery 
and 1 year post-delivery, if feasible. (S)AEs associated with these events must be 
reported on the appropriate (S)AE forms, and follow the guidance on timing of the report 
provided in Section 12.1.2.3. 
If an investigator becomes aware of an SAE occurring in a subject after study 
completion, the SAE must be reported on the provided SAE Report Form within 24 hours 
after awareness; no additional reporting on CRFs is necessary. 
For the purposes of this study, each AE (expected and unexpected) experienced by a 
subject undergoing bronchoscopy/BAL procedure will be recorded on the AE CRF. 
12.1.2.1 Severity 
The investigator will assess the severity of each AE using his/her clinical expertise and 
judgment based on the most appropriate description below: 
 
Mild 
 The AE is a transient discomfort and does not interfere in a significant 
manner with the subject’s normal functioning level. 
 The AE resolves spontaneously or may require minimal therapeutic 
intervention. 
 
Moderate 
 The AE produces limited impairment of function and may require therapeutic 
intervention. 
 The AE produces no sequela/sequelae. 
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 
Severe 
 The AE results in a marked impairment of function and may lead to 
temporary inability to resume usual life pattern. 
 The AE produces sequela/sequelae, which require (prolonged) therapeutic 
intervention. 
These severity definitions will also be used to assess the severity of an AE with a 
study-related procedure(s), if necessary. 
12.1.2.2 Causality 
Causality is a determination of whether there is a reasonable possibility that the IP is 
etiologically related to/associated with the AE. Causality assessment includes, eg, 
assessment of temporal relationships, dechallenge/rechallenge information, association 
(or lack of association) with underlying disease, presence (or absence) of a more likely 
cause, and physiological plausibility. For each AE, the investigator will assess the causal 
relationship between the IP and the AE using his/her clinical expertise and judgment 
according to the following most appropriate algorithm for the circumstances of the AE: 
 
Not related (both circumstances must be met) 
 Is due to underlying or concurrent illness, complications, concurrent 
treatments, or effects of concurrent drugs. 
 Is not associated with the IP (ie, does not follow a reasonable temporal 
relationship to the administration of IP or has a much more likely alternative 
etiology).  
 
Unlikely related (either 1 or both circumstances are met) 
 Has little or no temporal relationship to the IP. 
 A more likely alternative etiology exists. 
 
Possibly related (both circumstances must be met) 
 Follows a reasonable temporal relationship to the administration of IP. 
 An alternative etiology is equally or less likely compared to the potential 
relationship to the IP. 
 
Probably related (both circumstances must be met) 
 Follows a strong temporal relationship to the administration of IP, which may 
include but is not limited to the following:  
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o Reappearance of a similar reaction upon re-administration (positive 
rechallenge). 
o Positive results in a drug sensitivity test (skin test, etc.). 
o Toxic level of the IP as evidenced by measurement of the IP 
concentrations in the blood or other bodily fluid. 
 Another etiology is unlikely or significantly less likely. 
For events assessed as not related or unlikely related and occurring within 72 hours 
following completion of each IP administration, the investigator shall provide the 
alternative etiology. These causality definitions will also be used to assess the 
relationship of an AE with a study-related procedure(s), if necessary. 
12.1.2.3 Safety Reporting 
Adverse events/SAEs will be assessed at all study visits as outlined in the Schedule of 
Study Procedures and Assessments (see Table 20.2-1) and Section 12.1 above. 
Adverse Events/SAEs are to be recorded on the AE page of the eCRF. Each event should 
be recorded separately. 
Any SAE, including death due to any cause, which occurs during this study, whether or 
not related to the investigational product, must be reported immediately (within 24 hours 
of the study center’s first knowledge of the event). All SAEs must be reported via the 
Electronic Data Capture (EDC) system by completing the relevant electronic Case Report 
Form (eCRF) page(s) in English. Once the SAE has been recorded in the EDC system, 
the sponsor and other designated recipients will be informed of the event automatically. 
For instances in which the EDC may become unavailable, SAEs must be reported using 
the back-up paper SAE Report Form to meet the 24 hour timeline requirement (contacts 
and instructions to be provided in separate documentation). Once the EDC becomes 
available, the site must enter all SAE data as reported on the back-up paper SAE report 
form on the applicable eCRF pages. 
The initial SAE information reported on the applicable eCRF pages (or back-up SAE 
Report Form, if applicable) must at least include the following: 
 
Protocol Number 
 
Subject identification number and demographics (gender, age at onset of event 
and/or date of birth) 
 
Investigational product exposure 
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 
Medical Term for Event (Diagnosis preferably)  
 
Description of the (S)AE, including: 
 Date of onset 
 (S)AE treatment (drug, dose, route of administration) 
 Causal relationship by the investigator 
 Measures taken (ie, action taken regarding investigational product in direct 
relationship to the AE) 
 
Seriousness criteria (ie, death, life-threatening, or other criterion) 
 
Cause of death 
 
Autopsy findings (if available) 
 
Name, address, fax number, email, and telephone number of the reporting 
investigator (for paper SAE Report Forms)  
12.2 Urgent Safety Measures 
An urgent safety measure is an immediate action taken, which is not defined by the 
protocol, in order to protect subjects participating in a clinical trial from immediate harm. 
Urgent safety measures may be taken by the sponsor or clinical investigator, and may 
include any of the following:  
 
Immediate change in study design or study procedures. 
 
Temporary or permanent halt of a given clinical trial or trials. 
 
Any other immediate action taken in order to protect clinical trial participants 
from immediate hazard to their health and safety. 
The investigator may take appropriate urgent safety measures in order to protect subjects 
against any immediate hazard to their health or safety. The measures should be taken 
immediately and may be taken without prior authorization from the sponsor. In the 
event(s) of an apparent immediate hazard to the subject, the investigator will notify the 
sponsor immediately by phone and confirm notification to the sponsor in writing as soon 
as possible, but within 1 calendar day after the change is implemented. The sponsor will 
also ensure the responsible ethics committee and relevant competent authority(s) are 
notified of the urgent safety measures taken in such cases according to local regulations. 
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12.3 Untoward Medical Occurrences 
Untoward medical occurrences occurring before the first exposure to IP are not 
considered AEs (according to the definition of AE, see Section 12.1). However, each 
serious untoward medical occurrence experienced before the first IP exposure (ie, from 
the time of signed informed consent up to but not including the first IP exposure) will be 
described on the AE CRF (and SAE Report Form if eCRF is not available). These events 
will not be considered as SAEs and will not be included in the analysis of SAEs. 
For the purposes of this study, each non-serious untoward medical occurrence 
experienced by a subject undergoing study-related procedure(s) (eg, washout of a 
subject’s pre-study A1PI augmentation therapy, bronchoscopy/BAL procedures) will be 
recorded on the AE CRF. These events, if occurred before the first IP exposure, will not 
be considered as AEs and will not be included in the analysis of AEs. On the other hand, 
these events, if occurred after initiation of IP treatment, will be considered as AEs and 
will be included in the analysis of AEs. 
12.4 Non-Medical Complaints 
A non-medical complaint (NMC) is any alleged product deficiency that relates to 
identity, quality, durability, reliability, safety and performance of the product but did not 
result in an AE. NMCs include but are not limited to the following: 
 
A failure of a product to exhibit its expected pharmacological activity and/or 
design function, eg reconstitution difficulty. 
 
Missing components. 
 
Damage to the product or unit carton. 
 
A mislabeled product (eg, potential counterfeiting/tampering). 
 
A bacteriological, chemical, or physical change or deterioration of the product 
causing it to malfunction or to present a hazard or fail to meet label claims. 
Any NMCs of the product will be documented on an NMC form and reported to the 
sponsor within 1 business day. If requested, defective product(s) will be returned to the 
sponsor for inspection and analysis according to procedures. 
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12.5 Medical, Medication, and Non-Drug Therapy History 
At screening, the subject’s medical history will be described for the following body 
systems including severity (as defined in Section 12.1.2.1) or surgery and start and end 
dates, if known: eyes, ears, nose, and throat; respiratory; cardiovascular; gastrointestinal; 
musculoskeletal; neurological; endocrine; hematopoietic/lymphatic; dermatological; and 
genitourinary. 
All medications taken and non-drug therapies received from enrollment until 
completion/termination will be recorded on the concomitant medications and non-drug 
therapies CRFs. 
12.6 Physical Examinations 
At screening and subsequent study visits (as described in Table 20.2-1), a physical 
examination will be performed on the following body systems: general appearance, head 
and neck, eyes and ears, nose and throat, chest, lungs, heart, abdomen, extremities and 
joints, lymph nodes, skin, and neurological. At screening, if an abnormal condition is 
detected, the condition will be described on the medical history CRF. At study visits, if a 
new abnormal or worsened abnormal pre-existing condition is detected, the condition will 
be described on the AE CRF. If the abnormal value was not deemed an AE because it 
was due to an error, due to a preexisting disease (described in Section 12.1.1.6), not 
clinically significant, a symptom of a new/worsened condition already recorded as an AE, 
or due to another issue that will be specified, the investigator will record the justification 
on the source record. 
12.7 Clinical Laboratory Parameters 
The schedule of sample collection for clinical laboratory assessments is provided in 
Table 20.3-1 Clinical Laboratory Assessments. Detailed requirements for sample 
collection and handling can be found in the Laboratory Manual. 
12.7.1 Hematology and Clinical Chemistry 
The hematology panel will consist of complete blood count: hemoglobin (Hgb), 
hematocrit (Hct), erythrocytes (ie, red blood cell [RBC]) count, leukocytes (ie, white 
blood cell [WBC]) count with differential (ie, basophils, eosinophils, lymphocytes, 
monocytes, and neutrophils), absolute neutrophil count (ANC), absolute lymphocyte 
count, reticulocyte count, and platelet count. 
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The clinical chemistry panel will consist of sodium, potassium, calcium, chloride, 
bicarbonate, total protein, albumin, alanine aminotransferase (ALT), aspartate 
aminotransferase (AST), alkaline phosphatase (ALP), lactic dehydrogenase (LDH), 
gamma-glutamyl-transferase (GGT), bilirubin (direct and total), blood urea nitrogen 
(BUN), uric acid, creatinine, creatine phosphokinase (CPK), and glucose.  
Blood will be collected for the assessment of hematology and clinical chemistry 
parameters during each of the following visits: screening, Week 1 (prior to the first IP 
infusion; this will serve as baseline value), Week 13, Week 25, and at study completion 
(Week 26) visit. Samples to be collected on the day of IP administration (ie, Week 1, 
Week 13, and Week 25) must be collected prior to the start of IP infusion. Subjects who 
are discontinued early from the study will be asked to undergo hematology and clinical 
chemistry assessments at the Early Termination visit, only if these subjects have been 
exposed to IP. 
Hematology and clinical chemistry assessments will be performed on 
ethylenediaminetetraacetic acid (EDTA)-anticoagulated whole blood and serum samples, 
respectively, at a central laboratory. 
12.7.2 Complement Activation and Immune Complex Panel 
Complement activation and immune complex panel will consist of serum complement 
component 3 (C3), complement component 4 (C4), total complement (50% hemolytic 
complement activity of serum; CH50), C1q binding assay for circulating immune 
complexes. 
Blood will be collected to obtain serum samples for the assessment of complement 
activation and circulating immune complexes during each of the following visits: Week 1 
(prior to the first IP infusion; this will serve as baseline value), Week 13, Week 25, and at 
study completion (Week 26) visit. Samples to be collected on the day of IP 
administration (ie, Week 1, Week 13, and Week 25) must be collected prior to the start of 
IP infusion. Subjects who are discontinued early from the study will be asked to undergo 
complement activation and immune complex evaluation at the Early Termination visit, 
only if these subjects have been exposed to IP. 
Complement activation and immune complex assessments will be performed at a central 
laboratory. 
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12.7.3 Viral Serology and Nucleic Acid Tests 
At screening, subjects would be tested for HAV, Hep B, HCV and HIV1/HIV2 by 
serology for antigenemia or antibodies or by PCR based NAT, towards eligibility 
determination. 
Viral testing for B19V will consist of B19V antibody serology test and NAT, based on 
real-time polymerase chain reaction (PCR) detection of B19V DNA. Serum samples will 
be collected prior to the first IP infusion during Week 1 (which serves as the baseline 
value) and at the last infusion visit (Week 25). If a subject’s Week 1 pre-dose sample is 
tested positive, then no further testing (eg, Week 25) is required. Any evidence of 
seroconversion (eg, change from a negative test result at baseline [Week 1 prior to the 
first IP infusion] to a positive result at a post-baseline assessment) for B19V should be  
re-tested. Subjects who are discontinued early from the study will be asked to undergo 
viral serology and NAT testing at the Early Termination visit, only if these subjects have 
been exposed to IP. 
Serology testing and NAT will be performed at a central laboratory. 
12.7.4 Urine Tests 
Urinalysis will consist of color, specific gravity, pH, protein, glucose, ketones, bilirubin, 
urobilinogen, blood, nitrite, leukocyte esterase, and microscopic examination (RBC, 
WBC, bacteria, casts). Urinalysis will be performed during each of the following visits: 
screening, Week 1 (prior to the first IP infusion; this will serve as baseline value), 
Week 13, Week 25, and at study completion (Week 26) visit. Samples to be collected on 
the day of IP administration (ie, Week 1, Week 13, and Week 25) must be collected prior 
to the start of IP infusion. Urinalysis will be performed at a central laboratory. 
Pregnancy test will be performed for females of childbearing potential at screening and at 
study completion (Week 26) visit. Subjects who are discontinued early from the study 
will be asked to undergo urinalysis and urine/serum pregnancy test (for females of 
childbearing potential only) at the Early Termination visit, only if these subjects have 
been exposed to IP. Urine pregnancy test will be performed, unless serum pregnancy test 
is mandatory as specified by local regulatory/institutional requirements. 
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12.7.5 Assessment of Clinical Laboratory Values 
12.7.5.1 Assessment of Abnormal Laboratory Values 
The investigator’s assessment of each safety-related laboratory value will be recorded on 
the laboratory form. For each abnormal laboratory value, the investigator will determine 
whether the value is considered clinically significant or not. For clinically significant 
values, the investigator will indicate if the value constitutes an new AE (see definition in 
Section 12.1, and record the sign, symptom, or medical diagnosis on the AE CRF), is a 
symptom or related to a previously recorded AE, is due to a pre-existing disease 
(described in Section 12.1.1.6), or is due to another issue that will be specified. If the 
abnormal value was not clinically significant, the investigator will indicate the reason, ie 
because it is due to a preexisting disease, due to a lab error, or due to another issue that 
will be specified. Additional tests and other evaluations required to establish the 
significance or etiology of an abnormal value, or to monitor the course of an AE should 
be obtained when clinically indicated. Any seroconversion result for B19V should be re-
tested. Any abnormal value that persists should be followed at the discretion of the 
investigator. 
In addition to investigator’s assessment of the clinical significance of laboratory 
abnormalities, clinical laboratory abnormalities with values that meet the criteria listed in 
Section 20.4 will be separately analyzed and reported. 
12.7.6 Biobanking 
Backup samples should be taken and stored appropriately for additional analysis, if 
necessary. These samples may be used for re-testing, further evaluation of an AE, or 
follow-up of other test results. The following samples are planned: 
 
Plasma samples collected for the determination of the following analytes will each 
be split into duplicate aliquots of approximately equal volume (1 of the 2 aliquots 
will serve as the backup sample): 
 Plasma antigenic A1PI 
 Plasma functional A1PI (ie, ANEC) 
 Plasma urea 
 
Serum samples collected for the determination of the following analytes will each 
be split into duplicate aliquots of approximately equal volume (1 of the 2 aliquots 
will serve as backup sample): 
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 Anti-A1PI antibodies for binding antibody (screening and confirmatory) 
assays 
 Anti-A1PI antibodies for neutralizing antibody assay 
 
BAL samples collected for the determination of the following analytes will each 
be split into 2 or more aliquots of approximately equal volume (at least 1 of the 
aliquots will serve as backup sample; see laboratory manual for further details): 
 BAL antigenic A1PI 
 BAL functional A1PI (ie, ANEC) 
 BAL urea 
Backup samples that remain after study testing is done may be stored and used for 
additional testing (eg, further evaluation of an abnormal test or an AE. Samples will be 
stored in a coded form for up to 2 years after the final study report has been completed, 
unless otherwise notified by the sponsor, and then the samples will subsequently be 
destroyed. 
12.8 Plasma Antigenic and Functional A1PI Levels 
Throughout the treatment period, plasma trough A1PI levels will be assessed to monitor 
the increase in and maintenance of plasma A1PI levels at target of 11 µM or greater. 
Plasma samples for the determination of trough antigenic A1PI and functional A1PI (also 
known as ANEC) levels will be collected prior to the first IP infusion during Week 1, on 
the day of IP administration (must be collected prior to the start of IP infusion) during 
Week 7, Week 13, Week 19, and Week 25, and at the study completion (Week 26) visit.  
For subjects who are to undergo BAL assessments, plasma samples for baseline antigenic 
A1PI level will be collected within 10 days prior to the baseline BAL visit to verify the 
adequacy of the washout from A1PI therapy prior to performing the baseline BAL visit. 
Then, on the day of the baseline BAL visit, plasma samples for the measurement of 
antigenic and functional A1PI levels will be collected simultaneously with plasma 
samples for urea measurements within 2 hours prior to the BAL procedure. These values 
will be used for the calculation of the corresponding A1PI levels in ELF using plasma-to-
BAL urea correction method. Sample collection for plasma antigenic and functional A1PI 
and urea will be repeated on the day of the on-treatment BAL visit within 2 hours prior to 
the BAL procedure (see Section 10.3.4). 
Subjects who are discontinued early from the study after having been exposed to IP 
administration will be asked to have a plasma sample collected for A1PI determination. 
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The early termination plasma sample will be analyzed to support analysis/interpretation 
of the early termination anti-A1PI antibody assessment. 
Sample analysis for the determination of plasma antigenic and functional A1PI levels will 
be performed using validated bioanalytical assays at a qualified laboratory. 
12.9 Immunogenicity 
Blood will be collected to obtain serum samples for monitoring the appearance/presence 
of anti-A1PI antibodies prior to the first IP infusion during Week 1, on the day of IP 
administration (must be collected prior to the start of IP infusion) during Week 13 and 
Week 25, and at study completion (Week 26) visit. Subjects who are discontinued early 
from the study after having been exposed to IP administration will be asked to have a 
serum sample collected for immunogenicity assessment at the Early Termination visit. 
Unscheduled samples for the detection of circulating anti-A1PI antibodies may be 
collected as necessary and upon consultation with or notification by the sponsor, to 
support investigation of suspected immune-related adverse events. At any scheduled or 
unscheduled time points, plasma samples for the determination of circulating A1PI levels 
will be collected concurrently to assess potential interference with the assay.  
Each sample is to be stored as duplicate aliquots each with sufficient volume needed for 
sample analysis. Detailed sample handling and storage instructions will be provided in 
the laboratory manual. 
Anti-A1PI antibodies will be detected using validated binding and neutralizing anti-A1PI 
antibody assays at a qualified immunoassay laboratory. The presence of anti-A1PI 
antibodies in a sample will be detected using a screening assay and confirmed using a 
confirmatory assay. Only those samples with confirmed positive results will be further 
analyzed for the examination for the presence of neutralizing antibodies. 
12.10 Vital Signs 
Body height (in or cm) will be collected at screening only. Body weight (lb or kg) will be 
measured at screening and at study visits during Weeks 1, 7, 13, 19, and 25. 
Vital signs will include body temperature (°C or °F), respiratory rate (breaths/min), pulse 
rate (beats/min), and systolic and diastolic blood pressure (mmHg). Blood pressure 
measurements will be taken when subjects are in either the sitting or supine position; the 
same position should preferably be maintained each time a blood pressure is measured.  
 
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These vital signs will be measured at screening, during treatment period (Weeks 1, 7, 13, 
19, and 25), and at study completion (Week 26)/early termination visit (see also 
Section 10.3.2.1 and Table 20.3-1). 
For each of the IP infusion visits where vital signs are to be taken, vital signs will be 
recorded at any time prior to the start of an infusion, at each rate reduction due to AE(s) 
and/or infusion interruption/discontinuation due to AE(s), and at 30 (±15) minutes after 
the completion of an infusion. The investigator should be contacted to determine 
appropriate action to be taken, as necessary, if vital signs meet any of the following 
criteria: 
 
Systolic blood pressure ≤80 mm Hg or ≥180 mm Hg and/or diastolic blood 
pressure: ≤50 mm Hg or ≥110 mm Hg. 
 
Pulse rate ≤48 beats/min or ≥110 beats/min. 
 
Respiratory rate ≤8 breaths/min or ≥24 breaths/min. 
 
Body temperature ≥38.2ºC (101ºF). 
For subjects undergoing BAL procedures, vital signs will be measured within 2 hours 
prior to each BAL procedure and within 1 hour after the completion of the BAL 
procedure. Pre-BAL vital signs are to be performed prior to the administration of 
bronchodilator and local anesthesia. 
Vital sign values are to be recorded on the CRF. For each abnormal vital sign value, the 
investigator will determine whether or not to report an AE (see definition in Section 12.1 
and record the medical diagnosis (preferably), symptom, or sign on the AE CRF). 
Additional tests and other evaluations required to establish the significance or etiology of 
an abnormal vital sign value or to monitor the course of an AE should be obtained when 
clinically indicated. Any abnormal value that persists should be followed at the discretion 
of the investigator. 
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13. STATISTICS 
13.1 Sample Size and Power Calculations 
The sample size calculation for the BAL component of the study was based on the natural 
log transformed primary endpoint data, ELF antigenic A1PI level (nM), generated during 
a previous clinical study (Clinical Protocol 460502; Baxter Healthcare Corporation) for 
the evaluation of the effects of A1PI augmentation therapy with ARALAST NP on the 
levels of A1PI and other analytes in the ELF. In Clinical Study 460502, a mean 
difference from pre- to post-treatment in ELF antigenic A1PI of 1.32 with standard 
deviation of 0.96 on natural log scale was observed. Using this variance estimate, a 
sample size of 15 evaluable subjects should be sufficient to detect a mean difference in 
the natural log transformed ELF antigenic A1PI of approximately 0.87 with 90% power, 
using a paired t-test and a 1-sided significance level of 0.025. 
A sample size of 15 evaluable subjects will also be sufficient to detect a mean difference 
in the natural log transformed ELF functional A1PI (ANEC) of approximately 1.04, with 
90% power, assuming a standard deviation in the differences between pre- and post-
treatment ANEC values to be 20% higher than that for antigenic A1PI. 
Based on the experience from Clinical Study 460502, it is estimated that approximately 
26 to 32 subjects will be needed in order to achieve 15 to 18 BAL evaluable subjects, 
respectively. Thus, an overall study enrollment target of 36 subjects should be adequate 
to meet the target sample size for the BAL component of the study. 
13.2 Datasets and Analysis Cohorts 
13.2.1 Full Analysis Set 
The full analysis set (FAS) will include all subjects who received at least 1 IP infusion 
and have at least 1 available A1PI measurement during the treatment period. 
13.2.2 Per-Protocol Analysis Set 
The per-protocol (PP) analysis set will include a subset of the full analysis set, 
comprising subjects with no major protocol deviations. For the purpose of statistical 
analysis, major deviations include, but are not limited to, the following: failure to comply 
with the washout period for pre-study A1PI augmentation therapy, missing 2 or more 
consecutive weekly infusions and/or >15% of planned infusions, and use of an A1PI 
product (including commercially available GLASSIA) other than IP during the study 
treatment period. 
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13.2.3 BAL Analysis Set 
The BAL analysis set will include a subset of the FAS analysis set, comprising subjects 
who meet all of the following criteria: 
 
Subjects who have met all study inclusion and exclusion criteria, including 
additional BAL-related eligibility criteria. 
 
Subjects have successfully completed both the baseline and the on-treatment BAL 
visits and have a minimum of 1 evaluable sample per BAL visit with no missing 
infusion(s) within 4 weeks immediately preceding the on-treatment BAL 
procedure. 
 
Subjects must have available ELF data for both the baseline and the on-treatment 
BAL visits in order to be included in the efficacy analyses for the assessment of 
ELF analyte levels following GLASSIA augmentation therapy. 
13.2.4 Safety Analysis Set 
The safety analysis set will include all subjects enrolled in the study who received at least 
1 IP infusion. 
13.3 Handling of Missing, Unused, and Spurious Data 
No missing data imputation will be performed. 
13.4 Methods of Analysis 
13.4.1 Efficacy Outcome Measures 
Antigenic and functional A1PI levels in the ELF will be estimated based on the 
corresponding BAL measurements at each time point using plasma-to-BAL urea 
correction method. ELF antigenic and functional A1PI levels, as well as changes from 
baseline, will be summarized descriptively and displayed graphically (data permitting) 
based on data pooled across both treatment arms. 
Since an increase from baseline in the mean ELF levels of antigenic A1PI is expected, 
a 1-sided paired t-test will be conducted at an α-level of 0.025 with the following null and 
alternative hypotheses where the mean change in antigenic A1PI from baseline to the on-
treatment BAL measurement is μd:  
H0: Mean change in antigenic A1PI in the ELF from baseline to the on-treatment 
measurement will be less than or equal to zero. 
H0: μd ≤0 
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H1: Mean change in antigenic A1PI in the ELF from baseline to the on-treatment 
measurement will be greater than zero. 
H1: μd >0 
The mean change in functional A1PI (ANEC) from baseline to on-treatment 
measurement will be analyzed in a similar fashion, if data permit. The natural logarithm 
transformation may be applied to the ELF antigenic or functional A1PI values prior to 
analysis if the distributions are highly skewed. This analysis will be conducted with the 
BAL analysis set. 
 
 
 
Changes from baseline in ELF and plasma antigenic and functional A1PI levels, as well 
as 
, will be summarized in the following subgroups: by 
sex, age  (≤65; >65)race, and ethnicity. 
 
 
13.4.2 Exposure 
Plasma trough antigenic and functional A1PI levels, as well as changes from baseline, 
will be summarized descriptively and displayed graphically (data permitting) based on 
data pooled across both treatment arms. Plasma antigenic and functional A1PI levels 
obtained at the baseline and on-treatment BAL visits will be summarized separately and, 
data permitting, to be correlated with the corresponding values in the ELF. Plasma A1PI 
levels obtained at the study completion (Week 26) or early termination visit will not be 
part of this analysis. These analyses will be conducted with both the FAS and the PP 
analysis sets. 
In the event of anti-A1PI antibody formation is detected, the individual antigenic and 
functional A1PI levels may be evaluated in conjunction with binding and neutralizing 
anti-A1PI antibody titers, as applicable. 
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13.4.3 Safety Outcome Measures 
The safety analysis set will be used for the following analyses, unless otherwise stated: 
AEs that are considered potentially related to the presence of protein aggregates or 
immune-mediated will be summarized descriptively with 95% confidence intervals (CIs) 
as appropriate for each AE of interest by each treatment arm and, if appropriate, pooled 
across both treatment arms. In the event of any clinically significant trends in treatment-
emergent AE(s) of interest, further analysis including potential correlation with the 
presence of particulates in the GLASSIA solution will be performed. 
ARs plus suspected ARs, using a time frame for AE onset of (a) during and within 
24 hours and (b) during and within 72 hours of completion of an infusion, will be 
tabulated separately and presented according to seriousness, severity, and causality, as 
well as by MedDRA preferred term. Similar tabulation of data will be conducted for AEs 
and SAEs. 
The number (proportion) of subjects experiencing SAEs, AEs, related AEs, and/or ARs 
plus suspected ARs will be summarized by each treatment arm and, if appropriate, pooled 
across both treatment arms with their point estimates and exact 95% CIs. 
The number (proportion) of infusions (defined as percentage of the total number of 
infusions administered) temporally associated with AEs or SAEs (defined as during or 
within (a) 24 hours and (b) 72 hours of completion of infusion) will be computed for each 
subject. The median (95% CI), minimum, and maximum of these numbers (or 
percentages, respectively) will be tabulated. 
The number (proportion) of infusions (defined as percentage of the total number of 
infusions administered) causally associated with AEs or SAEs will be computed for each 
subject. The median (95% CI), minimum, and maximum of these numbers (or 
percentages, respectively) will be tabulated. 
The number (proportion) of infusions (defined as percentage of the total number of 
infusions administered) associated with ARs will be computed for each subject. The 
median (95% CI), minimum, and maximum of these numbers (or percentages, 
respectively) will be tabulated. 
The number (proportion) of infusions that are discontinued, slowed, or interrupted due to 
an AE will be summarized. The rates of AEs and ARs expressed as the number of events 
that occurred in total number of infusions administered will be provided by MedDRA 
term. 
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The proportion of subjects who develop binding and/or neutralizing anti-A1PI antibodies 
will be summarized with their point estimates and exact 95% CIs. Treatment-emergent 
anti-A1PI antibody data will be listed along with the corresponding plasma antigenic and 
functional A1PI levels in the individual subject. Additionally, temporal relationship of 
anti-A1PI antibody formation with potentially immune-related AEs, if any, will be 
examined. 
The number (proportion) of subjects who experienced a shift from normal or clinically 
non-significant abnormal laboratory values at baseline to clinically significant abnormal 
laboratory values will be summarized with their point estimates and exact 95% CIs. Any 
clinically significant laboratory values that are considered as clinically significant by the 
investigator (ie, reported as AEs), as well as in accordance with the thresholds provided 
in Section 20.4, will be analyzed and reported, including shift tables. 
Changes in vital signs obtained pre- and post-infusions, as well as pre- and post-BAL 
procedures as applicable, will be provided in a listing. 
The proportion of subjects with confirmed treatment-emergent seroconversion by viral 
serology or nucleic acid test for B19V during or following treatment with GLASSIA will 
be summarized with exact 95% CIs. 
Safety parameters will be summarized descriptively by sex, age  (≤65; >65), race, and 
ethnicity. No hypothesis tests are planned; however, 
 
 
AEs that occur before treatment will be listed separately. 
13.5 Planned Interim Analysis of the Study 
Not applicable; no interim analyses are planned for this study. 
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14. DIRECT ACCESS TO SOURCE DATA/DOCUMENTS 
The investigator/study site will cooperate and provide direct access to study documents 
and data, including source documentation for monitoring by the study monitor, audits by 
the sponsor or sponsor’s representatives, review by the EC, and inspections by applicable 
regulatory authorities, as described in the Clinical Study Agreement. If contacted by an 
applicable regulatory authority, the investigator will notify the sponsor of contact, 
cooperate with the authority, provide the sponsor with copies of all documents received 
from the authority, and allow the sponsor to comment on any responses, as described in 
the Clinical Study Agreement. 
15. QUALITY CONTROL AND QUALITY ASSURANCE 
15.1 Investigator’s Responsibility 
The investigator will comply with the protocol (which has been approved/given favorable 
opinion by the EC), ICH GCP, and applicable regulatory requirements as described in the 
Clinical Study Agreement. The investigator is ultimately responsible for the conduct of 
all aspects of the study at the study site and verifies by signature the integrity of all data 
transmitted to the sponsor. The term “investigator” as used in this protocol as well as in 
other study documents, refers to the investigator or authorized study personnel that the 
investigator has designated to perform certain duties. Sub-investigators or other 
authorized study personnel are eligible to sign for the investigator, except where the 
investigator’s signature is specifically required. 
15.1.1 Final Clinical Study Report  
The investigator, or coordinating investigator(s) for multicenter studies, will sign the 
clinical study report. The coordinating investigator will be selected before study start. 
15.2 Training 
The study monitor will ensure that the investigator and study site personnel understand 
all requirements of the protocol, the investigational status of the IP, and his/her regulatory 
responsibilities as an investigator. Training may be provided at an investigator’s meeting, 
at the study site, and/or by instruction manuals. In addition, the study monitor will be 
available for consultation with the investigator and will serve as the liaison between the 
study site and the sponsor. 
15.3 Monitoring 
The study monitor is responsible for ensuring and verifying that each study site conducts 
the study according to the protocol, standard operating procedures, other written 
instructions/agreements, ICH GCP, and applicable regulatory guidelines/requirements. 
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The investigator will permit the study monitor to visit the study site at appropriate 
intervals, as described in the Clinical Study Agreement. Monitoring processes specific to 
the study will be described in the clinical monitoring plan.  
15.3.1 Safety Monitoring 
The safety of the subjects in this study shall be monitored by an internal safety review 
board (ISRB). The ISRB is a group of individuals with pertinent expertise within the 
sponsor that reviews on a regular basis accumulating data from an ongoing clinical study. 
For this study, the ISRB will be composed of appropriate sponsor representatives from 
the relevant functions (eg. Global Drug Safety, Clinical Research, Medical Affairs, 
Clinical Development) with expertise/specialization in pulmonology clinical care and 
research. The ISRB will recommend whether to continue or stop the trial or to continue 
the study after proper amendment to the protocol. 
15.4 Auditing 
The sponsor and/or sponsor’s representatives may conduct audits to evaluate study 
conduct and compliance with the protocol, standard operating procedures, other written 
instructions/agreements, ICH GCP, and applicable regulatory guidelines/requirements. 
The investigator will permit auditors to visit the study site, as described in the Clinical 
Study Agreement. Auditing processes specific to the study will be described in the 
auditing plan. 
15.5 Non-Compliance with the Protocol 
The investigator may deviate from the protocol only to eliminate an apparent immediate 
hazard to the subject. In the event(s) of an apparent immediate hazard to the subject, the 
investigator will notify the sponsor immediately by phone and confirm notification to the 
sponsor in writing as soon as possible, but within 1 calendar day after the change is 
implemented. The sponsor (Baxalta) will also ensure the responsible ethics committee is 
notified of the urgent measures taken in such cases according to local regulations. 
If monitoring and/or auditing identify serious and/or persistent non-compliance with the 
protocol, the sponsor may terminate the investigator’s participation. The sponsor will 
notify the EC and applicable regulatory authorities of any investigator termination. 
15.6 Laboratory and Reader Standardization 
Not applicable; each type of assay is planned to be conducted at a single laboratory 
facility for consistency and standardization. 
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16. ETHICS 
16.1 Subject Privacy 
The investigator will comply with applicable subject privacy regulations/guidance as 
described in the Clinical Study Agreement. 
16.2 Ethics Committee and Regulatory Authorities 
Before enrollment of patients into this study, the protocol, ICF, any promotional 
material/advertisements, and any other written information to be provided will be 
reviewed and approved/given favorable opinion by the EC and applicable regulatory 
authorities. The EC’s composition or a statement that the EC’s composition meets 
applicable regulatory criteria will be documented. The study will commence only upon 
the sponsor’s receipt of approval/favorable opinion from the EC and, if required, upon 
the sponsor’s notification of applicable regulatory authority(ies) approval, as described in 
the Clinical Study Agreement.  
If the protocol or any other information given to the subject is amended, the revised 
documents will be reviewed and approved/given favorable opinion by the EC and 
applicable regulatory authorities, where applicable. The protocol amendment will only be 
implemented upon the sponsor’s receipt of approval and, if required, upon the sponsor’s 
notification of applicable regulatory authority(ies) approval. 
16.3 Informed Consent 
Investigators will choose patients for enrollment considering the study eligibility criteria. 
The investigator will exercise no selectivity so that no bias is introduced from this source.  
All patients and/or their legally authorized representative must sign an ICF before 
entering into the study according to applicable regulatory requirements and ICH GCP. 
Before use, the ICF will be reviewed by the sponsor and approved by the EC and 
regulatory authority(ies), where applicable, (see Section 16.2). The ICF will include a 
comprehensive explanation of the proposed treatment without any exculpatory 
statements, in accordance with the elements required by ICH GCP and applicable 
regulatory requirements. Patients or their legally authorized representative(s) will be 
allowed sufficient time to consider participation in the study. By signing the ICF, patients 
or their legally authorized representative(s) agree that they will complete all evaluations 
required by the study, unless they withdraw voluntarily or are terminated from the study 
for any reason. 
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The sponsor will provide to the investigator in written form any new information that 
significantly bears on the subjects’ risks associated with IP exposure. The informed 
consent will be updated, if necessary. This new information and/or revised ICF that have 
been approved by the applicable EC and regulatory authorities, where applicable, will be 
provided by the investigator to the subjects who consented to participate in the study (see 
Section 16.3). 
16.4 Data Monitoring Committee 
A Data Monitoring Committee (DMC) will not be used for this study, since the IP is 
already a licensed product and the dosing regimen being evaluated is already approved 
for chronic treatment in the patient population to be enrolled in this study. 
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17. DATA HANDLING AND RECORD KEEPING 
17.1 Confidentiality Policy 
The investigator will comply with the confidentiality policy as described in the Clinical 
Study Agreement. 
17.2 Study Documents and Case Report Forms 
The investigator will maintain complete and accurate paper format study documentation 
in a separate file. Study documentation may include information defined as “source data” 
(see Section 8.8), records detailing the progress of the study for each subject, signed 
ICFs, correspondence with the EC and the study monitor/sponsor, enrollment and 
screening information, CRFs, SAE reports (SAERs), laboratory reports (if applicable), 
and data clarifications requested by the sponsor. 
The investigator will comply with the procedures for data recording and reporting. Any 
corrections to paper study documentation must be performed as follows: 1) the first entry 
will be crossed out entirely, remaining legible; and 2) each correction must be dated and 
initialed by the person correcting the entry; the use of correction fluid and erasing are 
prohibited. 
The investigator is responsible for the procurement of data and for the quality of data 
recorded on the CRFs. CRFs will be provided in electronic form. 
If electronic format CRFs are provided by the sponsor, only authorized study site 
personnel will record or change data on the CRFs. If data is not entered on the CRFs 
during the study visit, the data will be recorded on paper, and this documentation will be 
considered source documentation. Changes to a CRF will require documentation of the 
reason for each change. An identical (electronic/paper) version of the complete set of 
CRFs for each subject will remain in the investigator file at the study site in accordance 
with the data retention policy (see Section 17.3). 
The handling of data by the sponsor, including data quality assurance, will comply with 
regulatory guidelines (eg, ICH GCP) and the standard operating procedures of the 
sponsor. Data management and control processes specific to the study will be described 
in the data management plan. 
17.3 Document and Data Retention  
The investigator will retain study documentation and data (paper and electronic forms) in 
accordance with applicable regulatory requirements and the document and data retention 
policy, as described in the Clinical Study Agreement. 
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18. FINANCING AND INSURANCE 
The investigator will comply with investigator financing, investigator/sponsor insurance, 
and subject compensation policies, if applicable, as described in the Clinical Study 
Agreement. 
19. PUBLICATION POLICY 
The investigator will comply with the publication policy as described in the Clinical 
Study Agreement.  
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20.2 Schedule of Study Procedures and Assessments 
Table 20.2-1 
Schedule of Study Procedures and Assessments 
Procedures/ 
Assessments 
Screening 
(Max 6 
Weeks) 
Baseline 
BALa (Max 
2 Weeks) 
Week 1 
Week 7 
(±2 Days) 
On-Treatment BAL 
(Week 12-14)b 
Week 13 
(±2 Days) 
Week 19 
(±2 Days) 
Week 25 
(±2 Days) 
Study Completion 
(Week 26±3 Days)/ 
Early Terminationc 
Informed Consentd 
X 
 
 
 
 
 
 
 
 
Eligibility Criteria 
X 
 
 
 
 
 
 
 
 
Randomization 
 
Xe 
 
 
 
 
 
 
 
Demographics 
X 
 
 
 
 
 
 
 
 
Medical and 
Medication History 
X 
 
 
 
 
 
 
 
 
Height 
X 
 
 
 
 
 
 
 
 
Body Weightf 
X 
 
X 
X 
 
X 
X 
X 
 
Physical Exam 
X 
 
Xg 
 
 
Xg 
 
X 
 
Vital Signs 
X 
 
Xh 
Xh 
 
Xh 
Xh 
Xh 
 
ECGi 
X 
 
 
 
 
 
 
 
 
Chest X-ray/CTj 
X 
 
 
 
 
 
 
 
 
Pulmonary Function 
Testsk 
X 
 
 
 
 
 
 
 
 
Screening/Safety 
Laboratory Testsl 
X 
 
Xg 
 
 
Xg 
 
Xg 
X 
Screening/On-
Treatment Trough 
A1PIm 
X 
 
Xg 
Xg 
 
Xg 
Xg 
Xg 
X 
 
 
Xg 
Xg 
 
Xg 
Xg 
Xg 
 
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Table 20.2-1 
Schedule of Study Procedures and Assessments 
Procedures/ 
Assessments 
Screening 
(Max 6 
Weeks) 
Baseline 
BALa (Max 
2 Weeks) 
Week 1 
Week 7 
(±2 Days) 
On-Treatment BAL 
(Week 12-14)b 
Week 13 
(±2 Days) 
Week 19 
(±2 Days) 
Week 25 
(±2 Days) 
Study Completion 
(Week 26±3 Days)/ 
Early Terminationc 
Anti-A1PI 
Antibodiesm,n 
 
 
Xg 
 
 
Xg 
 
Xg 
X 
Weekly GLASSIA 
Infusionso 
 
 
X
 
 
Adverse Event 
X 
X 
X
 
X 
Concomitant 
Medications and Non-
drug Therapies 
X 
X 
X
 
X 
Telephone Follow-upp 
 
 
X
 
 
Additional Procedures for Subjects Undergoing BAL Procedures 
BAL Procedure 
 
X 
 
 
X 
 
 
 
 
Vital Signs 
 
Xq 
 
 
Xq 
 
 
 
 
BAL and Plasma 
Urea and A1PIm 
 
X 
 
 
X 
 
 
 
 
Abbreviations: BAL = Bronchoalveolar lavage; ECG = Electrocardiogram; A1PI = Alpha1-Proteinase Inhibitor. 
a. For subjects who undergo bronchoscopy/BAL procedures (see Section 10.3.4 for more details). The baseline bronchoscopy/BAL visit will be 
postponed once if a subject experiences a moderate or severe COPD exacerbation and/or LRTI during the screening period (see Section 10.4 for 
more details). 
b. The on-treatment BAL procedure will be performed between Week 12 and Week 14 (see Section 10.3.4 for more details). The on-treatment 
bronchoscopy/BAL visit will be postponed once if a subject experiences a moderate or severe COPD exacerbation and/or LRTI (see Section 10.4 
for more details). 
c. Subjects who are being discontinued from the study early and having been exposed to IP will be asked to return to the study site 7±3 days after the 
last infusion for early termination assessments. Subjects who are discontinued early from the study prior to receiving any IP administration will not 
need to undergo early termination procedures, except for those subjects who have undergone the baseline BAL procedure in which case subjects 
will be followed for potential post-BAL complications for a period of time in accordance with local institutional standard practice but not to exceed 
30 days. 
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Continued 
d. Written informed consent must be obtained prior to performance of any study procedures including screening/re-screening procedures. 
e. Randomization is to take place after verification of subject’s meeting all the main eligibility criteria, as well as additional 
bronchoscopy/BAL-related eligibility criteria (as applicable).. Bronchoscopy/BAL visit with evaluable BAL samples collected must be completed 
prior to randomization and within 48 hours prior to the first IP administration. 
f. 
Body weight will be taken at screening (for the calculation of the initial IP infusion dose [in mg]/volume [in mL]). Body weight will be monitored 
at 6-week intervals (ie, during Weeks 1, 7, 13, 19, and 25) throughout the study. All body weight measurements must be taken using standardized 
procedures. Dose adjustment based on body weight changes during the course of the study may be made if the changes are clinically significant 
(eg, >5%). 
g. To be performed prior to dosing on the day of the IP administration. Measurements taken prior to the first IP infusion (Week 1) will serve as the 
baseline values. 
h. During treatment period, vital signs (body temperature, respiratory rate, pulse rate, and systolic and diastolic blood pressure) are to be taken on the 
day of IP infusion during Weeks 1, 7, 13, 19, and 25 infusion visits at any time prior to the infusion, at each rate reduction due to AE(s) and/or 
infusion interruption/discontinuation due to AE(s), and at 30 (±15) minutes after the completion of an infusion. 
i. ECG obtained within 26 weeks prior to screening may be used, if available. 
j. Chest X-ray or CT scan obtained within 52 weeks prior to screening may be used, if available. 
k. Pulmonary function tests include spirometry (forced expiratory volume in 1 second [FEV1] and forced vital capacity [FVC]), which is to be taken 
30±15 minutes after administration of a short-acting inhaled β2 agonist bronchodilator (eg, 400 μg of salbutamol, or its equivalent). 
l. For laboratory assessments, see Table 20.3-1. 
m. Samples will each be split into duplicate aliquots of approximate equal volume. One of the 2 aliquots will serve as the backup sample and stored 
appropriately until notified by the sponsor. 
n. In the event of suspected immune-related adverse events, unscheduled anti-A1PI antibody samples may be collected as necessary and upon 
consultation with or notification by the sponsor to support AE investigation. The unscheduled anti-A1PI antibody samples must be accompanied by 
plasma sample collection for the determination of antigenic and functional A1PI levels. 
o. The first infusion (Week 1), as well as infusions at Week 13 and Week 25, must be administered at the study site. Other weekly infusions may be 
administered at the study site or at another suitable location (eg, the subject’s home) by a qualified healthcare professional, as acceptable per local 
regulations and standard practices of the study site. 
p. Following each infusion visit, telephone follow-up will be conducted by the investigator/designee at 72 hours (+1 business day) to document AEs, 
and/or administration of concomitant medications or non-drug therapies, which may have occurred within 72 hours after the completion of an 
infusion. Any adverse events that occur and/or concomitant medications/non-drug therapies that the subject takes after the post-infusion telephone 
follow-up will be collected during the subsequent weekly infusion visit. 
q. Vital signs will be measured within 2 hours prior to each BAL procedure and within 1 hour after the completion of the BAL procedure. Pre-BAL 
vital signs are to be performed prior to the administration of bronchodilator and local anesthesia. 
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20.3 Schedule of Clinical Laboratory Assessments 
Table 20.3-1 
Clinical Laboratory Assessments 
Assessments 
Screening 
(Max 6 
Weeks) 
Baseline BALa 
(Max 2 Weeks) Week 1 
Week 7 
(±2 Days) 
On-Treatment 
BAL 
(Week 12-14)b 
Week 13 
(±2 Days) 
Week 19 
(±2 Days) 
Week 25 
(±2 Days) 
Study Completion 
(Week 26±3 Days)/ 
Early Terminationc 
Hematologyd 
W 
 
We 
 
 
We 
 
We 
W 
Clinical Chemistryf 
S 
 
Se 
 
 
Se 
 
Se 
S 
Complement Activation 
and Immune Complex 
Panelg 
 
 
Se 
 
 
Se 
 
Se 
S 
HAV, Hep B, HCV, 
and HIV1/HIV2 by 
serology for 
antigenemia or 
antibodies or by PCR 
based NAT 
S 
 
 
 
 
 
 
 
 
B19V Serology and 
NATh 
 
 
Se 
 
 
 
 
Se 
S 
Urinalysisi 
U 
 
Ue 
 
 
Ue 
 
Ue 
U 
Pregnancy Testj 
S/U 
 
 
 
 
 
 
 
S/U 
Serum IgA 
S 
 
 
 
 
 
 
 
 
Serum Cotinine 
S 
 
Se 
 
 
S 
 
S 
 
Screening (Antigenic) 
A1PIk,l 
P 
 
 
 
 
 
 
 
 
On-Treatment Trough 
Plasma Antigenic 
A1PIl 
 
 
Pe 
Pe 
 
Pe 
Pe 
Pe 
P 
On-Treatment Trough 
Plasma Functional 
A1PIl 
 
 
Pe 
Pe 
 
Pe 
Pe 
Pe 
P 
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Table 20.3-1 
Clinical Laboratory Assessments 
Assessments 
Screening 
(Max 6 
Weeks) 
Baseline BALa 
(Max 2 Weeks) Week 1 
Week 7 
(±2 Days) 
On-Treatment 
BAL 
(Week 12-14)b 
Week 13 
(±2 Days) 
Week 19 
(±2 Days) 
Week 25 
(±2 Days) 
Study Completion 
(Week 26±3 Days)/ 
Early Terminationc 
 
 
Pe 
Pe 
 
Pe 
Pe 
Pe 
 
Serum Anti-A1PI 
Antibodiesl 
 
 
Se 
 
 
Se 
 
Se 
S 
Additional Procedures for Subjects Undergoing BAL Procedures 
Plasma Ureal 
 
Pm 
 
 
Pm 
 
 
 
 
Plasma Antigenic 
A1PIl 
 
Pm,n 
 
 
Pm 
 
 
 
 
Plasma Functional 
A1PIl 
 
Pm 
 
 
Pm 
 
 
 
 
 
Pm 
 
 
Pm 
 
 
 
 
BAL Ureal 
 
L 
 
 
L 
 
 
 
 
BAL Antigenic A1PIl 
 
L 
 
 
L 
 
 
 
 
BAL Functional A1PI 
(ANEC)l 
 
L 
 
 
L 
 
 
 
 
 
 
L 
 
 
L 
 
 
 
 
 
 
L 
 
 
L 
 
 
 
 
 
L 
 
 
L 
 
 
 
 
Abbreviations: BAL = Bronchoalveolar lavage; W = Whole blood; S = Serum; HAV = Hepatitis A Virus; Hep B = Hepatitis B virus;  
HCV = Hepatitis C virus; HIV = Human immunodeficiency virus; NAT = Nucleic acid test; B19V = Parvovirus B19; U = Urine;  
IgA = Immunoglobulin A; A1PI = Alpha1-Proteinase Inhibitor; P = Plasma; L = Bronchoalveolar lavage fluid;  
ANEC = Anti-neutrophil elastase capacity; 
. 
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Continued 
a. For subjects undergoing bronchoscopy/BAL procedures (see Section 10.3.4 for more details). The baseline bronchoscopy/BAL visit will be 
postponed once if a subject experiences a moderate or severe COPD exacerbation and/or LRTI during the screening period (see Section 10.4 for 
more details). 
b. The on-treatment BAL procedure will be performed between Week 12 and Week 14 (see Section 10.3.4 for more details). The on-treatment 
bronchoscopy/BAL visit will be postponed once if a subject experiences a moderate or severe COPD exacerbation and/or LRTI (see Section 10.4 
for more details). 
c. Subjects who are being discontinued from the study early and having been exposed to IP will be asked to return to the study site 7±3 days after the 
last infusion for early termination assessments. Subjects who are discontinued early from the study prior to receiving any IP administration will not 
need to undergo early termination procedures, except for those subjects who have undergone the baseline BAL procedure in which case subjects 
will be followed for potential post-BAL complications for a period of time in accordance with local institutional standard practice but not to exceed 
30 days. 
d. Hematology panel will consist of complete blood count: hemoglobin (Hgb), hematocrit (Hct), erythrocytes (ie, red blood cell [RBC]) count, 
leukocytes (ie, white blood cell [WBC]) count with differential (ie, basophils, eosinophils, lymphocytes, monocytes, and neutrophils), absolute 
neutrophil count (ANC), absolute lymphocyte count, reticulocyte count, and platelet count. 
e. Samples must be collected prior to GLASSIA administration. 
f. 
Clinical chemistry panel will consist of sodium, potassium, calcium, chloride, bicarbonate, total protein, albumin, alanine aminotransferase (ALT), 
aspartate aminotransferase (AST), alkaline phosphatase (ALP), lactic dehydrogenase (LDH), gamma-glutamyl-transferase (GGT), bilirubin (direct 
and total), blood urea nitrogen (BUN), uric acid, creatine, creatine phosphokinase (CPK), and glucose. 
g. Complement activation and immune complex panel will consist of serum C3, C4, total complement (CH50), C1q binding assay (circulating 
immune complexes). 
h. Viral testing will consist of viral serology for parvovirus B19 (PVB19) antibody and NAT (PVB19 PCR). If a subject’s Week 1 pre-dose sample is 
tested positive, then no further testing (eg, Week 25) is required. 
i. 
Urinalysis will consist of color, specific gravity, pH, protein, glucose, ketones, bilirubin, urobilinogen, blood, nitrite, leukocyte esterase, and 
microscopic examination (RBC, WBC, bacteria, casts). 
j. 
For females of childbearing potential only. Urine pregnancy test will be performed, unless serum pregnancy test is mandatory as specified by local 
regulatory/institutional requirements. 
k. For those subjects who are receiving or have recently been exposed to A1PI therapy at the time of study enrollment, pre-study A1PI therapy must 
be discontinued and sample for the determination of endogenous circulating A1PI level is to be taken after completion of an adequate washout 
period (approximately 4 half-lives; average half-life ~4.6 days). The screening A1PI measurement may be repeated if an exclusionary level 
(≥11 µM) is obtained that is suspected to be due to inadequate washout of the prior A1PI therapy. 
l. 
Samples will each be split into duplicate aliquots of approximate equal volume. One of the 2 aliquots will serve as the backup sample and stored 
appropriately until notified by the sponsor.  
m. Samples must be collected within 2 hours prior to BAL procedure. 
n. For subjects who have received A1PI augmentation therapy prior to study entry, plasma sample for baseline antigenic A1PI level will be collected 
within 10 days prior to the baseline BAL visit to verify the adequacy of the washout from A1PI therapy prior to performing BAL. 
 
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20.4 Thresholds for Clinically Significant Laboratory Abnormalities 
Each abnormal laboratory test result will be assessed for clinical significance by the 
investigator based on the medical judgment of the investigator. Independently, abnormal 
clinical laboratory values that meet the following criteria will be analyzed and reported. 
Laboratory Test 
Lowest Alert 
Limit 
Highest Alert 
Limit 
Comment 
Hematology 
Hemoglobin (Hgb) 
(M) 10.0 g/dL 
(F) 9.0 g/dL 
---- 
---- 
Serial Hgb values allow assessment 
of the rate of decline over time 
Leukocytes 
2800/mm3 
16,000/mm3 
To be interpreted in the context of 
clinical symptoms 
Absolute neutrophil count 
<1000/mm3 
--- 
 
Reticulocyte count 
<0.5% 
>10% 
To be interpreted in relation to 
changes in Hgb and other evidence 
of bone marrow suppression or 
hemolysis  
Platelet count 
<50,000/mm3 
>750,000/mm3 
 
Clinical Chemistry 
Sodium  
<125 mmol/L 
>160 mmol/L 
Serial values allow assessment of 
rate of change 
Potassium 
<3 mmol/L 
>6 mmol/L 
To be interpreted in conjunction with 
possible changes in ECG  
ALT 
--- 
>3x ULN 
 
AST 
--- 
>3x ULN 
 
ALP 
--- 
>3x ULN 
 
LDH 
--- 
>3x ULN 
 
GGT 
--- 
>3x ULN 
 
Bilirubin (total and indirect) 
--- 
>3x ULN 
 
Serum creatinine 
--- 
(M) >2.0 mg/dL 
(F) >1.6 mg/dL 
 
CPK 
--- 
>5x ULN 
 
Glucose 
<30 mg/dL 
>200 mg/dL 
Hyperglycemia should be interpreted 
in the context of known diabetes as a 
comorbidity 
Serum albumin 
<3.0 g/dL 
---- 
May indicate protein loss, 
inflammation or malnutrition 
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Laboratory Test 
Lowest Alert 
Limit 
Highest Alert 
Limit 
Comment 
Complement Activation and Immune Complex 
Serum C3 
<70 mg/dL 
--- 
 
Serum C4 
<14 mg/dL 
--- 
 
Total complement (CH50) 
<30 U/ml 
--- 
 
C1q binding/CICs 
<12 mg/dL 
 
 
Urinalysis 
Protein 
--- 
>3+ 
Must be interpreted in relation to 
urinary concentration. Only valid 
when urine specific gravity is ≥1.010 
RBC 
--- 
>15/hpf or gross 
hematuria 
 
Abbreviations: M = Male; F = Female; Hgb = Hemoglobin; ALT = Alanine aminotransferase;  
ULN = Upper limit of normal; AST = Aspartate aminotransferase; ALP = Alkaline phosphatase;  
LDH = Lactic dehydrogenase; GGT = Gamma-glutamyl-transferase; CPK = creatine phosphokinase;  
C3 = Complement component 3; C4 = Complement component 4; CH50 = 50% hemolytic complement 
activity of serum; RBC = Red blood cell; hpf = High power field. 
 
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21. REFERENCE LIST 
1. 
a1-antitrypsin deficiency: memorandum from a WHO meeting. Bull World Health 
Organ,. 1997;75(5):397-415. 
2. 
de Serres FJ, Blanco I. Prevalence of a1-antitrypsin deficiency alleles PI*S and 
PI*Z worldwide and effective screening for each of the five phenotypic classes 
PI*MS, PI*MZ, PI*SS, PI*SZ, and PI*ZZ: A comprehensive review. Ther Adv 
Respir Dis. 2012;6(5):277-295. 
3. 
de Serres FJ, Blanco I, Fernández-Bustillo E. Ethnic differences in alpha-1 
antitrypsin deficiency in the United States of America. Ther Adv Respir Dis. 
2010;4(2):63-70. 
4. 
Brantly M, Nukiwa T, Crystal RG. Molecular basis of alpha-1-antitrypsin 
deficiency. Am J Med. 1988;84(6A):13-31. 
5. 
Hutchison DC. Natural history of alpha-1-protease inhibitor deficiency. Am J Med. 
1988;84(6A):3-12. 
6. 
Hubbard RC, Crystal RG. Alpha-1-antitrypsin augmentation therapy for alpha-1-
antitrypsin deficiency. Am J Med. 1988;84(6A):52-62. 
7. 
Ogushi F, Fells GA, Hubbard RC, Straus SD, Crystal RG. Z-type a1-antitrypsin is 
less competent than M1-type a1- antitrypsin as an inhibitor of neutrophil elastase. J 
Clin Invest. 1987;80(5):1366-1374. 
8. 
Buist AS, Burrows B, Cohen A, et al. Guidelines for the approach to the patient 
with severe hereditary alpha- 1-antitrypsin deficiency. American Thoracic Society. 
Am Rev Respir Dis. 1989;140(5):1494-1497. 
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9. 
Stoller JK. Clinical features and natural history of severe a1- antitrypsin deficiency. 
Roger S. Mitchell Lecture. Chest. 1997;111(6 Suppl):123S-128S. 
10. 
Crystal RG, Brantly ML, Hubbard RC, Curiel DT, States DJ, Holmes MD. The 
alpha 1-antitrypsin gene and its mutations. Clinical consequences and strategies for 
therapy. Chest. 1989;95(1):196-208. 
11. 
Wewers MD, Casolaro MA, Sellers SE, et al. Replacement therapy for alpha 1-
antitrypsin deficiency associated with emphysema. N Engl J Med. 
1987;316(17):1055-1062. 
12. 
Casolaro MA, Fells G, Wewers M, et al. Augmentation of lung antineutrophil 
elastase capacity with recombinant human a-1-antitrypsin. J Appl Physiol. 
1987;63(5):2015-2023. 
13. 
Crystal RG. a1-antitrypsin deficiency: pathogenesis and treatment. Hosp Pract (Off 
Ed). 1991;26(2):81-89, 93-94. 
14. 
Crystal RG. a 1-antitrypsin deficiency, emphysema, and liver disease. Genetic basis 
and strategies for therapy. J Clin Invest. 1990;85(5):1343-1352. 
15. 
Hubbard RC, Sellers S, Czerski D, Stephens L, Crystal RG. Biochemical efficacy 
and safety of monthly augmentation therapy for a-1-antitrypsin deficiency. JAMA. 
1988;260(9):1259-1264. 
16. 
Hubbard RC, Crystal RG. Augmentation therapy of a 1-antitrypsin deficiency. Eur 
Respir J Suppl. 1990;9:44s-52s. 
17. 
Stoller JK. a 1-antitrypsin deficiency and augmentation therapy in emphysema. 
Cleve Clin J Med. 1989;56(7):683-689. 
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18. 
Wewers MD, Casolaro MA, Crystal RG. Comparison of alpha-1-antitrypsin levels 
and antineutrophil elastase capacity of blood and lung in a patient with the alpha-1-
antitrypsin phenotype null-null before and during alpha-1-antitrypsin augmentation 
therapy. Am Rev Respir Dis. 1987;135(3):539-543. 
19. 
Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur 
Respir J. 2005;26(2):319-338. 
20. 
Miller MR, Crapo R, Hankinson J, et al. General considerations for lung function 
testing. Eur Respir J. 2005;26(1):153-161. 
21. 
Tashkin DP, Celli B, Senn S, et al. A 4-year trial of tiotropium in chronic 
obstructive pulmonary disease. N Engl J Med. 2008;359(15):1543-1554. 
22. 
Vijayasaratha K, Stockley RA. Relationship between frequency, length, and 
treatment outcome of exacerbations to baseline lung function and lung density in 
alpha-1 antitrypsin-deficient COPD. Int J Chron Obstruct Pulmon Dis. 2012;7:789-
796. Link to Publisher's Site: 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3514009/pdf/copd-7-789.pdf 
 
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22. SUMMARY OF CHANGES 
Protocol Amendment 5: 2017 NOV 21 
Replaces: Protocol Amendment 4: 2016 JAN 15 
In this section, changes from the previous version of the Protocol Amendment 4, dated 
2016 JAN 15, are described and their rationale is given. 
1. Throughout the document 
Description of Change: Editorial/grammatical and/or administrative changes that do 
not substantively affect the study conduct or patient safety have been made. 
Rearrangement/modifications of text have been made to align with the current 
version of the sponsor’s protocol template. Changes in the numbering of 
sections/lists without substantial/major changes in the content will not be listed 
individually in the list of changes below. 
Purpose for Change: To comply with current protocol standards and regulatory 
requirements, to improve the readability and/or clarity of the protocol, to minimize 
redundancy, to correct typos and inconsistencies, and to reflect minor 
administrative/operational changes. 
2. Synopsis (Study Design), Section 8.2 
Description of Change: The text on target enrollment, evaluable subjects and 
remaining enrolled subjects is updated, to read as ‘Once the target of 15 to 18 
evaluable subjects has been reached, the remaining subjects to be enrolled will not 
be required to undergo baseline and on-treatment bronchoscopy/BAL procedures. 
Subjects with confirmed medical history (IC #1a, #9a, EC #20, #21, #22, #23, and 
#24) known not to meet eligibility criteria to undergo bronchoscopy/BAL 
procedures, may be screened with sponsor approval before the target enrollment of 
BAL evaluable subjects is reached’. 
Purpose for Change: There have been subjects keen to participate in the BAL 
portion of the study and have been unable to do so owing to a confirmed medical 
history known not to meet eligibility criteria to undergo bronchoscopy/BAL 
procedures. This change would allow such individuals to participate in the 
immunogenicity portion of the study with sponsor approval, wherein these medical 
exclusionary criteria for an invasive procedure like bronchoscopy would not apply. 
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3. Synopsis (Inclusion Criteria #1), Section 9.1 
Description of Change: The age criteria for the subjects eligible for inclusion in the 
study is updated in the criteria point #1 (a), with upper age limit revised to 75 years 
instead of 65 years at the time of screening. 
Purpose for Change: From interaction with clinicians with expertise in this area, it 
was gathered that there is an increasing comfort in performing BAL/bronchoscopy 
procedures in older individuals owing to advancements in the procedure in 
conjunction with those in supportive care. Hence, the upper age limit has been 
relaxed and revised. 
4. Synopsis (Inclusion Criteria #1)  
Description of Change: The parenthesis text ‘(after adequate number of BAL 
evaluable subjects has been reached)’ is deleted from the criteria point #1 (b) for 
the subjects who will be waived from undergoing bronchoscopy/BAL procedures,. 
Purpose for Change: Please refer to point 2. 
5. Synopsis (Inclusion Criteria #2), Section 9.1, Section 10.3.1.1 
Description of Change: The text regarding other “at-risk” allelic combinations is 
modified to read as ‘other “at-risk” allelic combinations such as SZ (excluding MS 
and MZ)’, instead of ‘other “at-risk” allelic combinations (excluding MS, MZ, and 
SZ)’. 
Purpose for Change: This change was incorporated to include individuals with 
allelic combinations like SZ, since a portion of these would have endogenous 
plasma A1PI levels of ≤11 µM. 
6. Synopsis (Inclusion Criteria #2, #3), Section 10.3.1.1, Section 10.3.1.3, 
Section 10.3.4, Section 12.8, Section 20.3 Table 20.3-1 Footnote #k 
Description of Change: Plasma A1PI levels have been revised to require 
endogenous levels of ≤11 µM instead of ≤8 µM at screening. 
Purpose for Change: Individuals with a severe deficiency are defined as those with 
serum A1PI levels less than 35% of the average normal level, or less than 11 μM. 
Additionally, GLASSIA is indicated for chronic augmentation therapy for the 
management of emphysema in individuals with A1PI deficiency and plasma A1PI 
levels less than 11 μM. Hence, plasma A1PI levels have been revised to require 
endogenous A1PI levels of ≤11 µM instead of ≤8 µM at screening; to facilitate 
subject participation without impacting the scientific hypothesis of the study. 
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7. Synopsis (Inclusion Criteria #4)  
Description of Change: Text has been added to specify the criteria regarding 
subjects who must have at least one of the following: clinical diagnosis of 
emphysema, evidence of emphysema on chest X-ray or computerized tomography 
(CT) scan of the chest, and/or evidence of airway obstruction which is not 
completely reversed with bronchodilator treatment at the time of screening. 
Purpose for Change: The text was added, as was mistakenly omitted in the 
synopsis. 
8. Synopsis (Inclusion Criteria #6) 
Description of Change: Text has been added regarding eligibility pertaining to 
positive cotinine test prior to screening, as ‘Subjects with a positive cotinine test 
due to nicotine replacement therapy (eg, patches, chewing gum), vapor cigarettes, 
or snuff are eligible’. 
Purpose for Change: Clearly, smoking has been causatively related to deleterious 
pulmonary damage and to the pathognomosis of several forms of COPD. With 
COPD/emphysema developing secondary to genetic deficiency of A1PI, smoking 
has also been demonstrated to cause accelerated progression of disease. Thus, 
smoking cessation, including that with nicotine replacement therapy is a 
cornerstone of preventative care directed to decrease the progression of COPD. 
While clearly including participation of non-smokers, this change facilitates study 
participation by subjects on nicotine replacement therapy, which has not been 
shown to have a deleterious effect on pulmonary function. 
9. Synopsis (Note point after Inclusion Criteria), Section 9.1 
Description of Change: The note point about the inclusion criteria #9 is modified to 
read as ‘Inclusion criterion #9 is not applicable to subjects who are not required to 
undergo the bronchoscopy/BAL procedures’, and the specific text ‘who are 
enrolled after the target of 15 to 18 evaluable subjects has been reached and’ was 
deleted. 
Purpose for Change: Please refer to point 2. 
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10. Synopsis (Exclusion Criteria #2), Section 9.2 
Description of Change: The text regarding history of cor pulmonale is modified to 
read as ‘The subject is experiencing or has a history of chronic severe cor 
pulmonale (resting mean pulmonary artery pressure ≥40 mm Hg)’, instead of ‘The 
subject is experiencing or has a history of cor pulmonale’. 
Purpose for Change: The definition of pulmonary heart disease or cor pulmonale 
varies in the medical literature and there is presently no consensual definition. 
Clearly, pulmonary hypertension is often the common link between lung 
dysfunction and the heart in cor pulmonale and most patients with COPD have 
some degree of cor pulmonale and indeed Right Heart Failure. This change in the 
protocol seeks to accomplish a clearly defined eligibility criteria that would exclude 
subjects with chronic severe cor pulmonale (resting mean pulmonary artery 
pressure ≥40 mm Hg) which is associated with a particularly poor prognosis, from 
participating in the study. 
11. Synopsis (Note point after Exclusion Criteria), Section 9.2 
Description of Change: The note point about the exclusion criteria is modified to 
read as ‘Exclusion criterion #20, #21, #22, #23, and #24 are not applicable to 
subjects who are not required to undergo the bronchoscopy/BAL procedures’, and 
the specific text ‘who are enrolled after the target of 15 to 18 evaluable subjects has 
been reached and’ was deleted. 
Purpose for Change: Please refer to point 2. 
12. Section 6 
Description of Change: The text for GLASSIA lots that were chosen to represent 
the high and low ends of the range of particle counts normal observed for 
GLASSIA manufactured in recent in vitro study was updated, to specify the 
GLASSIA lots with at least a factor of 2 fold differential were chosen. 
Purpose for Change: To provide more clarity and further explanation. 
13. Section 6.6 
Description of Change: The expansion of ICH is updated in the document to 
‘International Council for Harmonisation Guideline for Good Clinical Practice’. 
Purpose for Change: To comply with use of standard abbreviation in the document. 
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14. Section 9.3 
Description of Change: A new point #5 added to the withdrawal and 
discontinuation criteria. Subjects will be withdrawn from treatment or discontinued 
from further study participation if ‘If a subject experiences >1 moderate or severe 
COPD exacerbation and/or lower respiratory tract infection (LRTI) during the 
screening period (Rescreening may be permitted as defined in Section 10.3.1.3)’. 
Purpose of Change: To provide more clarity and further explanation. 
15. Section 10.3.1 
Description of Change: Study site responsibility text is modified and re-screening 
related text is updated, which reads as ‘If a subject is re-screened, the End of Study 
CRF should be completed, and a new ICF, new SIC and new CRF are required for 
that subject.’ 
Purpose of Change: To comply with the standard template text and for more clarity. 
16. Section 10.3.1.3 
Description of Change: The text regarding rescreening was updated, to mention 
about the subjects who were discontinued early from the study due to failure to 
yield adequate baseline BAL samples or failure to meet the eligibility criteria 
required to undergo the bronchoscopy/BAL procedure will be allowed to be 
rescreened before the target enrollment of BAL evaluable subjects is completed. 
Purpose of Change: Please refer to point 2. 
17. Section 10.3.4 
Description of Change: The definition of the acceptable BAL sample in evaluable 
subject was updated as BAL sample having a total recovery of ≥20% of the 
instilled volume of saline, no blood by visual inspection in any individual aliquot, 
overall number of acceptable aliquots no less than 3 per lobe, at least 1 acceptable 
BAL sample obtained from any of the 3 lobes. 
Purpose of Change: To provide more clarity and further explanation. 
18. Section 11.2 
Description of Change: 
 
 
Purpose of Change: To provide more clarity. 
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19. Section 12.7.3, Section 20 Table 20.3-1 
Description of Change: Viral serology and nucleic acid tests information towards 
eligibility determination is updated to read as ‘At screening, subjects would be 
tested for HAV, HBV, HCV, and HIV-1/HIV-2 by serology for antigenemia or 
antibodies or by PCR based NAT, towards eligibility determination’, instead of 
‘Viral serology tests for HAV antibody, hepatitis B virus surface antigen (HBsAg), 
HCV antibody, and HIV-1/HIV-2 antibody will be performed at screening for 
subject eligibility determination’.  
Purpose of Change: To provide more clarity and further explanation. 
20. Section 20.1, Figure 20-1 
Description of Change: The text for on-treatment BAL visit (between Week 12 and 
Week 14) is updated to read as ‘BAL visit may not be applicable for subjects who 
are not required to undergo the bronchoscopy/BAL procedures’, instead of ‘BAL 
visit may not be applicable for subjects enrolled after the target of at least 15 BAL 
evaluable subjects have been reached’. 
Purpose of Change: Please refer to point 2. 
21. Section 20.2, Table 20.2-1 Footnote #e 
Description of Change: The footnote for randomization is updated to include 
‘Bronchoscopy/BAL visit with evaluable BAL samples collected must be 
completed prior to randomization and within 48 hours prior to the first IP 
administration.’ and this text was deleted ‘For those undergoing 
bronchoscopy/BAL procedures, randomization is to take place only after the 
subject has successfully completed the baseline BAL visit with evaluable BAL 
samples collected’. 
Purpose of Change: Please refer to point 2. 
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INVESTIGATOR ACKNOWLEDGEMENT 
PRODUCT: GLASSIA 
STUDY TITLE: A PHASE 3/4 STUDY TO EVALUATE THE SAFETY, 
IMMUNOGENICITY, AND EFFECTS ON THE ALPHA1-PROTEINASE 
INHIBITOR (A1PI) LEVELS IN EPITHELIAL LINING FLUID FOLLOWING 
GLASSIA THERAPY IN A1PI-DEFICIENT SUBJECTS 
PROTOCOL IDENTIFIER: 471101 
CLINICAL TRIAL PHASE 3/4 
AMENDMENT 5: 2017 NOV 21 
Replaces: AMENDMENT 4: 2016 JAN 15 
ALL VERSIONS:  
Amendment 5: 2017 NOV 21 
Amendment 4: 2016 JAN 15 
Amendment 3: 2015 AUG 26 
Amendment 2: 2015 MAY 07 
Amendment 1: 2015 JAN 19 
Original: 2011 JUL 05 
OTHER ID(s) 
NCT Number: NCT02525861 
IND NUMBER: 14774 
By signing below, the investigator acknowledges that he/she has read and understands 
this protocol, and will comply with the requirements for obtaining informed consent from 
all study subjects prior to initiating any protocol-specific procedures, obtaining written 
initial and ongoing EC(s) protocol review and approval, understands and abides by the 
requirements for maintenance of source documentation, and provides assurance that this 
study will be conducted according to all requirements as defined in this protocol, clinical 
study agreement, ICH GCP guidelines, and all applicable regulatory requirements. 
 
Signature of Principal Investigator  
 
 
 
 
Date 
 
Print Name of Principal Investigator 
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