A Phase 2/3 Open-label Single Arm Multicentre Study to Assess Safety Tolerability Pharmacokinetics and Efficacy of i.v. Administrations of NI-0501 an Anti-IFNγ mAb in Paediatric Patients With Primary Haemophagocytic Lymphohistiocytosis
Phase: PHASE2
Conditions: Primary Haemophagocytic Lymphohistiocytosis
Sponsor: Swedish Orphan Biovitrum

NI-0501-04 
NI-0501 in 
HLH 
10f99 
Clinical Study Protocol 
A Phase 2/3 , Open-label, Single Arm, Multicentre Study to Assess Safety, 
Tolerability, Pharmacokinetics and Efficacy of Intravenous Multiple AdministratiQns 
ofNI-OS01, an Anti-interferon Gamma (Anti-IFNy) Monoclonal Antibody, in 
Paediatric Patients with Primary Haemophagocytic Lymphohistiocytosis (HLH) 
Study number: 
NI-0501-04 
Protocol number: 
NI-050 1-04-EU-EudraCT#20 12-003632-23 
Version: 
6.0 
Date: 
Febmary 26,2016 
Amendment number: 
07 - Febmary 26,2016 
EudraCT Number: 
2012-003632-23 
This document is a confidential communicatioll ofNovImmune S.A. Acceptance ofthis document cOllstitutes the agl'eement by the l'ecipient 
that no unpublished informatioll cOlltained within will be published or disclosed without prior written approvai, except as required to pemlit 
review by responsible Ethics Committees and Health AuUlOrities or to obtaio infOlmed consent from potentia1 patients. 
Protocol NI-0501-04-EU-EudraCT#2012-003632-23 .... Version 6.0 - February 26,2016 
CONFIDENTIAL 
NI-0501-04 NCT number:
NCT01818492 

Study NI-0501-04 
NI-0501 in Primary HLH 
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Protocol NI-0501-04-EU-EudraCT#2012-003632-23  – Version 6.0 – February 26, 2016 
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INVESTIGATOR AGREEMENT 
 
Protocol Number: NI-0501-04-EU-EudraCT#2012-003632-23  
 
Protocol date and version: February 26, 2016 – Version 6.0  
 
Study drug:  NI-0501   
 
Study title: A Phase 2/3, Open-label, Single Arm, Multicentre Study to Assess Safety, 
Tolerability, Pharmacokinetics and Efficacy of Intravenous Multiple Administrations of 
NI-0501, an Anti-interferon Gamma (Anti-IFNγ) Monoclonal Antibody, in Paediatric Patients 
with Primary Haemophagocytic Lymphohistiocytosis (HLH).  
 
Investigator endorsement: 
I, the undersigned, am responsible for the conduct of this study at this site and agree to conduct 
the study according to the protocol and any approved protocol amendments, ICH GCP and all 
applicable regulatory authority requirements. 
I will not deviate from the protocol without prior permission from the Sponsor and prior review 
and written approval from the Institutional Review Board or Independent Ethics Committee, 
and where applicable, from the Competent Authorities, except where necessary to prevent any 
immediate danger to a patient. 
I have read and understand fully the Investigator Brochure for NI-0501 and I am familiar with 
the investigational product and its use according to this protocol. 
 
 
 
 
 
 
 
_______________________________________ 
 
 
 
____________________ 
Site Investigator’ Signature  
 
 
 
 
Date 
 
 
 
_______________________________________ 
Site Investigator’s Name 

Study NI-0501-04 
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CONFIDENTIAL 
CONTACT LIST 
 
Study Location: 
Multicentre 

Study NI-0501-04 
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CONFIDENTIAL 
NI-0501-04 SYNOPSIS 
Title: 
A Phase 2/3, open-label, single arm, multicentre study to assess safety, 
tolerability, pharmacokinetics and efficacy of intravenous multiple 
administrations of NI-0501, an anti-interferon gamma (anti-IFNγ) 
monoclonal 
antibody, 
in 
paediatric 
patients 
with 
primary 
Haemophagocytic Lymphohistiocytosis (HLH)  
Sponsor: 
NovImmune SA, Switzerland 
Study Type, Phase and 
Design: 
 
Interventional Phase 2/3 study 
 
Open-label, single arm, international multicentre study  
 
NI-0501-04 study is performed both in the US and in Europe 
according to twin protocols called NI-0501-04 (P-IND#111015) and 
NI-0501-04 (EudraCT#2012-003632-23), respectively 
Study Objectives: 
 
To determine the safety and tolerability profile of multiple 
intravenous (IV) administrations of NI-0501. 
 
To determine NI-0501 efficacy and benefit/risk profile in HLH 
patients. 
 
To describe the PK profile of NI-0501 in HLH patients.  
 
To define an appropriate NI-0501 therapeutic dose regimen for HLH. 
 
To assess the immunogenicity of NI-0501. 
Study Population: 
 
Primary HLH patients  
 
Patients can be naïve to HLH treatment (first line patients), or may 
have already received conventional HLH therapy (second line 
patients) without having obtained a satisfactory response according 
to the treating physician or having shown signs of intolerance to it. 
 
Patients who receive NI-0501 as second line treatment for HLH will 
represent the pivotal cohort of the study. 
Main Inclusion Criteria: 
 
Gender: male and female. 
 
Age: up to and including 18 years at diagnosis of HLH  
 
Patient (if ≥ 18 years old), or patient’s legally authorized 
representative(s) must have signed informed consent 
 
Having accepted contraceptive measures whenever relevant 
Exclusion Criteria: 
 
 
Diagnosis of secondary HLH consequent to a proven rheumatic or 
neoplastic disease. 
 
Body weight < 3 kg. 
 
Patients treated with: 
- 
any T-cell depleting agents (such as anti-thymocyte globulin 
[ATG], anti-CD52) during the previous 2 weeks prior to 

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CONFIDENTIAL 
screening 
- 
any other biologic drug within 5 times their defined half-life 
period (except for rituximab in case of documented B-cell EBV 
infection). 
 
Active 
mycobacteria, 
Histoplasma 
Capsulatum, 
Shigella, 
Campylobacter, Leishmania or Salmonella infections.  
 
Evidence of past history of tuberculosis or latent tuberculosis. 
 
Positive serology for HIV antibodies, hepatitis B surface antigen or 
hepatitis C antibodies. 
 
Presence of malignancy. 
 
Patients who have another concomitant disease or malformation 
severely affecting the cardiovascular, pulmonary, liver or renal 
function. 
 
History of hypersensitivity or allergy to any component of the study 
regimen. 
 
Receipt of a live or attenuated live (including BCG) vaccine within 
the previous 12 weeks from screening. 
 
Pregnant or lactating female patients. 
Study Drug: 
 
Dosing Regimen & Frequency 
of Administration: 
 
 
NI-0501 is a fully human IgG1 monoclonal antibody (mAb) directed 
against human IFNγ. 
 
NI-0501 will be administered by IV infusion over a period of one 
hour at an initial dose of 1 mg/kg.  
 
Infusions will be performed every 3 days until Study Day 15 (SD15) 
(infusion #6), and twice per week thereafter. 
 
NI-0501 dose increase to 3 mg/kg will be possible according to pre-
defined criteria guided by clinical and laboratory response in each 
patient (see Table 4, protocol section 5.2.2) at any time during the 
study. 
 
After a minimum of two infusions at 3 mg/kg if, upon re-assessment, 
the same clinical and laboratory criteria qualifying the patient to 
receive 3 mg/kg of NI-0501 are found to still apply, the dose of NI-
0501 may be increased to 6 mg/kg for up to four infusions, with a 
regular monitoring of the clinical and laboratory HLH parameters.  
 
Based on the evolution of these parameters, the dose of NI-0501 may 
either i) be decreased back to 3 mg/kg, or ii) remain at 6 mg/kg for 
additional infusions (or be increased above 6 mg/kg), if PK and PD 
evidence indicates excessively high IFN production and, 
consequently, fast NI-0501 elimination (see Appendix B). 
 
Dose increase may occur any time during the study, if the clinical 
and laboratory criteria in Table 4 are met.   
Treatment Duration: 
 
NI-0501 administration is foreseen for 8 weeks. After this time 
period, pre-transplantation conditioning regimen can be initiated in 
preparation for Hematopoeitic Stem Cell Transplantation (HSCT). 
 
The anticipated duration of treatment can be shortened, although not 

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to less than 4 weeks, if the patient’s condition and the donor 
availability allow earlier HSCT. 
 
In the event that an appropriate donor has not been identified by 
Week 8 or in case of the need to delay the schedule of HSCT for 
reasons unrelated to the administration of NI-0501, NI-0501 
treatment can be continued beyond this time, upon the request of the 
Investigator, in the context of an extension long-term follow-up 
study (NI-0501-05) to this proposed study, provided that a 
favourable benefit/risk has been established for the patient. 
Background Therapy & 
Concomitant Medication: 
 
NI-0501 will be administered on a background of dexamethasone, 
which can be tapered depending on patient condition. 
 
Patients will receive prophylactic treatment for Pneumocystis 
jiroveci, fungal and Herpes Zoster virus infection from the day 
before initiation of NI-0501 treatment until the end of the study. 
 
Cyclosporine A can be continued if already being administered to the 
patient prior to screening. Cyclosporine can be withdrawn at any 
time, upon the judgement of the Investigator. Cyclosporine is not to 
be introduced de novo during the course of the study once NI-0501 
administration has started. 
 
If 
the 
patient 
is 
receiving 
intrathecal 
methotrexate 
and 
glucocorticoids at the time of NI-0501 treatment initiation, this 
treatment will be continued as required.  
 
IV immunoglobulin (IVIG) use is allowed only as substitutive 
treatment in case of a documented immunoglobulin deficiency 
outside of screening and the 2 first weeks of NI-0501 administration. 
 
Analgesic treatment, transfusion of blood products, electrolyte and 
glucose infusions, antibiotics, antifungal and anti-viral treatment and 
general supportive care (e.g. gastro-protective agents) are allowed. 
 
Vaccination with a live or attenuated (including BCG) vaccine will 
be avoided during the whole study including the 4 weeks follow-up 
period. 
 
Additional HLH treatments may be allowed in case of unsustained or 
limited HLH improvement once the maximum NI-0501 dose level is 
achieved. 
- Unsustained HLH Improvement: Patients who are unable to 
maintain at least 50% improvement from baseline for 3 HLH 
parameters (see Table 1). At least two consecutive measurements 
must document the loss of HLH improvement. 
- Limited HLH Improvement: Less than 50% change from baseline in 
a minimum of 3 HLH clinical and laboratory criteria. 
Etoposide should be administered as additional HLH treatment, 
unless clear evidence of lack of response or intolerance to the drug is 
derived from previous medical history.  
In this circumstance, the Investigator may propose an alternative 
agent which requires to be approved by the Data Monitoring 
Committee. 

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Sample Size: 
 
Sample size is estimated for the pivotal cohort of the study, i.e. 
patients receiving NI-0501 in second line. 
 A minimum of 28 evaluable second line patients will be enrolled in 
the study. Sample size calculation is based on the primary efficacy 
endpoint of “Overall Response Rate”. Assuming an Overall Response 
Rate of 70%, the study will have 90% power to show a significant 
improvement above 40% using an exact binomial test at a one-sided 
significance level of 2.5%. 
Number of Sites and 
Recruitment Duration: 
 
It is estimated that in EU approximately 14 sites will participate in 
this study. The time needed to complete enrolment of the required 
number of second line patients, in this rare population, is estimated 
to be approximately 1 year. 
 
A twin protocol is actively recruiting in the US. The recruitment will 
be competitive across all US and European sites. 
Study Duration and Study 
End Definition:   
 After the treatment period, or, in any case, at treatment 
discontinuation, patients will enter a follow-up period of 4 weeks 
(short term follow-up). 
 End of the study is defined as last patient last visit.  
 After study end, a separate long term follow-up study (NI-0501-05) 
will allow: 
- long term safety surveillance, investigation of the impact of NI-
0501 treatment on survival and post-HSCT outcome measures for 
all patients who have received at least one dose of NI-0501  
- continuation of NI-0501 treatment for patients for whom an 
appropriate donor has not been identified by week 8 or in case of 
the need to delay HSCT for reasons unrelated to the 
administration of NI-0501. 
Study Safety Monitoring   
and Stopping Rules: 
 An independent Data Monitoring Committee (DMC) composed of 
relevant Experts (pediatric onco-hematologists, pediatric immune 
deficiency/infectious disease specialists, a bio-statistician and 
specialist in ethics) will oversee the study conduct, reviewing data 
generated both in the US and in Europe.  
 The main DMC responsibility is to review all safety and relevant 
efficacy data as they are generated on an on-going basis for the 
determination of the benefit/risk profile and to ensure that no patient 
is exposed to unnecessary risks. 
 The DMC can recommend treatment discontinuation for individual 
patients as well as to halt temporarily or permanently the entire study. 
Predefined stopping rules will guide the DMC review process.  
 Patients withdrawn from the study will receive rescue therapy, 
according to the standard of care at the site. 
 
A patient’s withdrawal can be decided at any time by the patient or 
his/her representative as well as by the Investigator. In any case this 
decision will have no impact on the patient’s care.  

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Efficacy Endpoints: 
Evolution of clinical signs (fever, splenomegaly, CNS symptoms) and 
laboratory parameters (CBC, fibrinogen, ferritin, sCD25 levels), which 
characterize the disease, will be used to assess the achievement of 
response and time to response. 
Primary efficacy endpoint: 
 
Overall Response Rate, i.e. achievement of either Complete or 
Partial Response or HLH Improvement, at End of Treatment (EoT), 
as defined in Table 1. 
Secondary efficacy endpoints: 
 
Time to Response any time during the study  
 
Durability of Response, i.e. maintenance of response achieved any 
time during the study until EoT and beyond (including data collected 
in the long-term follow-up study NI-0501-05). 
 
Number of patients able to reduce glucocorticoids by 50% or more of 
baseline dose.  
 
Number of patients able to proceed to HSCT, when deemed 
indicated. 
 
Survival at Week 8 (or EoT) and at the end of the study Long-term 
survival (in particular D+30 and D+100 post-HSCT survival) will be 
assessed in the context of long-term study NI-0501-05. 
 
Serum 
concentration 
of 
NI-0501 
to 
determine 
NI-0501 
pharmacokinetic (PK) profile. 
 
Determination of pharmacodynamic (PD) effects (levels of 
circulating total IFNγ and markers of its neutralization, namely 
CXCL9 and CXCL10). 
 Determination of other biomarkers, e.g. sCD25, IL-10. 
Safety Endpoints: 
 Safety parameters to be collected and assessed: 
- Incidence, severity, causality and outcomes of Adverse Events 
(serious and non-serious), with particular attention being paid to 
infections 
- Evolution of laboratory parameters such as complete blood cell 
count (CBC), with a focus on red cells (haemoglobin), neutrophils 
and platelets, liver tests, renal function tests and coagulation 
- Number of patients withdrawn for safety issues 
 Other parameters: 
- Level (if any) of circulating antibodies against NI-0501 to 
determine immunogenicity (ADA) 
 
Statistical Analysis: 
 
The primary endpoint Overall Response Rate will be evaluated using 
the exact binomial test at the one-sided 0.025 level.  
 
Time to Response, durability of Response and Survival time will be 
presented using Kaplan-Meier curves with medians calculated if 
available. 95% confidence intervals will be calculated for the median 
for each of these endpoints.  

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CONFIDENTIAL 
 
Additional endpoints based on binary outcomes including number of 
patients who reduce glucocorticoids by 50% or more, and number of 
patients able to proceed to HSCT will be converted to proportions 
and associated 95% confidence intervals calculated.  
 Statistical significance in terms of p-values will only be obtained for 
the primary endpoint. All other endpoints will be viewed as 
supportive for the primary endpoint and as a consequence no formal 
hierarchy of endpoints will be declared. 

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CONFIDENTIAL 
CONTENTS 
INVESTIGATOR AGREEMENT ............................................................................................................................... 2 
CONTACT LIST ..................................................................................................................................................... 3 
NI-0501-04 SYNOPSIS .......................................................................................................................................... 4 
PART I ............................................................................................................................................................. 20 
1 
BACKGROUND INFORMATION ................................................................................................................. 20 
1.1 
NI-0501 ...................................................................................................................................................... 20 
1.1.1 
Description and mode of action ....................................................................................................... 20 
1.1.2 
Preclinical Data ................................................................................................................................ 20 
1.1.3 
Clinical Data ..................................................................................................................................... 21 
1.2 
HAEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS (HLH) .............................................................................................. 22 
1.3 
STUDY RATIONALE .......................................................................................................................................... 23 
2 
OBJECTIVES .............................................................................................................................................. 25 
3 
STUDY DESIGN ......................................................................................................................................... 25 
3.1 
OVERALL DESIGN ............................................................................................................................................ 25 
3.2 
SCREENING PERIOD.......................................................................................................................................... 26 
3.3 
TREATMENT PERIOD ........................................................................................................................................ 26 
3.4 
FOLLOW-UP PERIOD ....................................................................................................................................... 27 
3.5 
STUDY END .................................................................................................................................................... 27 
3.6 
LONG-TERM FOLLOW-UP STUDY (NI-0501-05) ................................................................................................... 27 
4 
TARGET POPULATION .............................................................................................................................. 28 
4.1 
ELIGIBILITY CRITERIA ....................................................................................................................................... 28 
4.1.1 
Inclusion Criteria .............................................................................................................................. 28 
4.1.2 
Exclusion Criteria .............................................................................................................................. 29 
5 
INVESTIGATIONAL MEDICINAL PRODUCT (IMP) ....................................................................................... 29 
5.1 
DESCRIPTION OF IMP ...................................................................................................................................... 29 
5.2 
RATIONALE FOR DOSE SELECTION ....................................................................................................................... 30 
5.2.1 
Initial dose (see Appendix A) ............................................................................................................ 30 
5.2.2 
Subsequent doses (see Appendices A and B) .................................................................................... 30 
5.3 
DOSING REGIMEN ........................................................................................................................................... 33 
5.4 
IMP HANDLING ............................................................................................................................................. 33 
5.4.1 
Packaging and Labelling .................................................................................................................. 33 
5.4.2 
IMP Supply ....................................................................................................................................... 33 
5.4.3 
IMP Receipt and Storage .................................................................................................................. 33 
5.4.4 
IMP Preparation, Administration, Accountability and Destruction .................................................. 33 
6 
PATIENT BACKGROUND TREATMENT AND CARE ..................................................................................... 35 
6.1 
BACKGROUND THERAPY WITH DEXAMETHASONE .................................................................................................. 35 
6.2 
PROPHYLACTIC TREATMENT .............................................................................................................................. 35 
6.3 
CONCOMITANT THERAPY ................................................................................................................................. 36 
6.3.1 
Cyclosporin A .................................................................................................................................... 36 
6.3.2 
Intrathecal Methotrexate and Glucocorticoids ................................................................................ 36 

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6.3.3 
Other possible concomitant therapies ............................................................................................. 36 
6.3.4 
Not allowed concomitant therapies ................................................................................................. 36 
6.4 
EMERGENCY TREATMENT ................................................................................................................................. 37 
6.5 
RESCUE THERAPY............................................................................................................................................ 37 
7 
ENDPOINTS .............................................................................................................................................. 37 
7.1 
SAFETY ENDPOINTS ......................................................................................................................................... 37 
7.2 
EFFICACY ENDPOINTS ...................................................................................................................................... 37 
7.3 
PHARMACOKINETIC ENDPOINTS ......................................................................................................................... 38 
7.4 
PHARMACODYNAMIC ENDPOINTS ...................................................................................................................... 38 
8 
OUTLINE OF STUDY PROCEDURES ............................................................................................................ 38 
8.1 
SCREENING .................................................................................................................................................... 40 
8.2 
STUDY DAY-1 (SD-1) ...................................................................................................................................... 41 
8.3 
STUDY DAY 0 (SD0, DAY OF FIRST INFUSION OF NI-0501) ................................................................................... 42 
8.3.1 
Pre-NI-0501 infusion ........................................................................................................................ 42 
8.3.2 
During NI-0501 infusion ................................................................................................................... 42 
8.3.3 
At the end of NI-0501 infusion ......................................................................................................... 42 
8.3.4 
During the 24 hours following NI-0501 infusion .............................................................................. 42 
8.4 
STUDY DAY 1 (SD1) ...................................................................................................................................... 43 
8.5 
STUDY DAY 2 (SD2) ..................................................................................................................................... 43 
8.6 
FROM SD3 TO SD15 (REMAINDER OF TREATMENT PERIOD 1) ................................................................................ 43 
8.6.1 
Assessments to be performed pre-NI-0501 infusion on SD3, SD6, SD9, SD12 and SD15.................. 43 
8.6.2 
During and immediately after NI-0501 infusion  .............................................................................. 44 
8.6.3 
During the 24 hours following NI-0501 infusion  ............................................................................. 45 
8.6.4 
Assessments to be performed on the day before the infusion ......................................................... 45 
8.7 
TREATMENT PERIOD 2 (WEEKS 3 TO 8) .............................................................................................................. 45 
8.7.1 
Assessments to be performed on all Infusion Days .......................................................................... 46 
8.7.2 
Efficacy and safety assessments  ..................................................................................................... 47 
8.7.3 
End of Treatment visit: three days after the last NI-0501 infusion .................................................. 48 
8.8 
FOLLOW-UP VISITS (WEEKLY POST LAST NI-0501 INFUSION)................................................................................... 48 
8.9 
STUDY COMPLETION VISIT (4TH WEEK AFTER THE LAST NI-0501 INFUSION) OR WITHDRAWAL VISIT ............................. 49 
8.10 
ASSESSMENTS IN CASE OF UNPLANNED (UNSCHEDULED) VISITS .......................................................................... 50 
8.11 
UNPLANNED ASSESSMENTS .......................................................................................................................... 50 
9 
SAFETY MONITORING .............................................................................................................................. 50 
9.1 
STUDY SCIENTIFIC OVERSIGHT ........................................................................................................................... 50 
9.2 
DESCRIPTION OF SAFETY PARAMETERS ................................................................................................................ 51 
9.3 
RECORDING AND REPORTING SAFETY PARAMETERS............................................................................................ 51 
9.3.1 
Adverse events ................................................................................................................................. 51 
9.3.2 
Serious Adverse Events ..................................................................................................................... 52 
9.3.3 
SUSAR reporting ............................................................................................................................... 53 
9.3.4 
Managing Abnormal Laboratory Test Values .................................................................................. 53 
9.4 
FOLLOW-UP OF SAFETY PARAMETERS ................................................................................................................. 54 
9.4.1 
Treatment and Follow-up of Adverse Events ................................................................................... 54 
9.4.2 
Follow-up of Abnormal Laboratory Test Values ............................................................................... 54 
9.4.3 
Pregnancy ........................................................................................................................................ 54 
9.5 
BENEFIT/RISK MANAGEMENT ........................................................................................................................... 54 
9.5.1 
Safety Surveillance Management .................................................................................................... 54 

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9.5.2 
General Benefit/Risk Considerations ................................................................................................ 54 
10 
STOPPING RULES ..................................................................................................................................... 57 
10.1 
AT PATIENT LEVEL ...................................................................................................................................... 57 
10.1.1 
Decision to slow down or stop NI-0501 infusion due to systemic reaction ................................. 57 
10.1.2 
Local reaction to NI-0501 infusion ............................................................................................... 58 
10.1.3 
Decision to Discontinue Treatment ............................................................................................. 58 
10.2 
AT STUDY LEVEL ........................................................................................................................................ 59 
10.2.1 
Recruitment Suspension .............................................................................................................. 59 
10.2.2 
Study Termination ....................................................................................................................... 59 
10.3 
MANAGEMENT OF TREATMENT DISCONTINUATION .......................................................................................... 59 
11 
STATISTICAL CONSIDERATIONS AND ANALYTICAL PLAN .......................................................................... 59 
11.1 
SAMPLE SIZE ............................................................................................................................................. 59 
11.2 
ANALYSIS SETS .......................................................................................................................................... 60 
11.2.1 
Safety Analysis Set ....................................................................................................................... 60 
11.2.2 
Intent-to-Treat Analysis Set ......................................................................................................... 60 
11.2.3 
Per-Protocol Analysis Set ............................................................................................................. 60 
11.3 
STATISTICAL AND ANALYTICAL METHODS ........................................................................................................ 60 
11.3.1 
Efficacy Data ............................................................................................................................... 60 
11.3.2 
Safety Data .................................................................................................................................. 61 
11.3.3 
Pharmacodynamic Data .............................................................................................................. 61 
11.3.4 
Immunogenicity Data .................................................................................................................. 61 
11.3.5 
Missing Data ............................................................................................................................... 61 
11.4 
REPLACEMENT POLICY ................................................................................................................................ 61 
11.4.1 
For Patients ................................................................................................................................. 61 
11.4.2 
For Centres .................................................................................................................................. 62 
PART II ........................................................................................................................................................... 63 
12 
ETHICAL AND LEGAL ASPECTS .................................................................................................................. 63 
12.1 
GOOD CLINICAL PRACTICE ........................................................................................................................... 63 
12.2 
RESPONSIBILITIES ....................................................................................................................................... 63 
12.3 
CONSENT ................................................................................................................................................. 63 
12.4 
CONFIDENTIALITY AND DATA PRIVACY............................................................................................................ 64 
12.5 
PROTOCOL AMENDMENTS ........................................................................................................................... 64 
12.6 
APPROVAL OF THE CLINICAL STUDY PROTOCOL AND AMENDMENTS ..................................................................... 64 
12.7 
ONGOING INFORMATION FOR INDEPENDENT ETHICS COMMITTEE ....................................................................... 65 
12.8 
CLOSURE OF THE STUDY .............................................................................................................................. 65 
12.9 
RECORD RETENTION ................................................................................................................................... 65 
12.10 
LIABILITY AND INSURANCE ........................................................................................................................... 66 
12.11 
FINANCIAL DISCLOSURE ............................................................................................................................... 66 
12.12 
DISCLOSURE OF PROTOCOL AND STUDY RESULTS AND PUBLICATION POLICY .......................................................... 66 
13 
MONITORING AND AUDITING.................................................................................................................. 67 
13.1 
STUDY MONITORING AND SOURCE DATA VERIFICATION .................................................................................... 67 
13.2 
ON-SITE AUDITS ........................................................................................................................................ 67 
13.3 
SERIOUS GCP BREACHES ............................................................................................................................. 67 
 

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14 
DOCUMENTATION AND USE OF STUDY FINDINGS ................................................................................... 67 
14.1 
DOCUMENTATION OF STUDY RESULTS............................................................................................................ 67 
14.2 
USE OF COMPUTERISED SYSTEMS AT THE CLINICAL TRIAL CENTRE ....................................................................... 67 
15 
REFERENCES ............................................................................................................................................. 69 
APPENDICES ...................................................................................................................................................... 71 
APPENDIX A: NI-0501 DOSE JUSTIFICATION IN HLH PATIENTS .......................................................................................... 72 
APPENDIX B: DECISION MAKING PROCESS ON DOSE INCREASE ........................................................................................ 86 
APPENDIX C: DETAIL OF ESTIMATED BLOOD VOLUMES TO BE DRAWN DURING THE STUDY ....................................................... 90 
APPENDIX D: MEMBERSHIP OF THE STUDY SCIENTIFIC COMMITTEE (SSC) .......................................................................... 91 
APPENDIX E: NOVIMMUNE SAE REPORTING FORM ........................................................................................................ 92 
 
 
 

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CONFIDENTIAL 
LIST OF ABBREVIATIONS 
Abbreviation 
Term 
ADA 
Anti-drug-antibodies 
ADCC 
Antibody-dependent cell-mediated cytotoxicity 
AE 
Adverse event 
ALP 
Alkaline Phosphatase 
ALT 
Alanine aminotransferase 
aPTT 
Activated Prothrombin Time 
AST 
Aspartate aminotransferase 
ATG 
Anti-thymocyte globulin 
AUC 
Area Under the Curve 
BCG 
Bacillus Calmette-Guérin 
BSA 
Body Surface Area 
CBC 
Complete blood cell count 
CDC 
Complement Dependent Cytotoxicity 
CL 
Systemic drug clearance 
Cmax 
Peak drug plasma concentration  
CMV 
Cytomegalovirus 
CNS 
Central nervous system 
CRF 
Case report form 
CRP 
C-reactive protein 
CsA 
Cyclosporin A 
CSF 
Cerebrospinal fluid 
Ctrough 
Plasma drug concentration immediately prior next dosing 
DMC 
Data Monitoring Committee 
eCRF 
Electronic case report form 
EBV 
Epstein-Barr virus 
EoT 
End of treatment 
γGT 
Gamma Glutamyl Transferase 
GM-CSF 
Granulocyte-macrophage colony-stimulating factor 
HBV 
Hepatitis B virus 
HCV 
Hepatitis C virus 
HIV 
Human immunodeficiency virus 
HLH 
Haemophagocytic lymphohistiocytosis 
HSCT 
Haematopoietic stem cell transplantation 
HSV 
Herpes simplex virus 
HZ 
Herpes Zoster 

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CONFIDENTIAL 
HZV 
Herpes zoster virus 
ICMJE 
International Committee of Medical Journal Editors  
IFNγ 
Interferon gamma 
IFNγ-R1 
Interferon gamma receptor chain 1 
IFPMA 
International Federation of Pharmaceutical Manufacturers & Associations 
IgG1 
Immunoglobulin G1 
IL 
Interleukin 
IMP 
Investigational medicinal product 
IT 
Intrathecal 
ITT 
Intention-to-treat 
IVIG 
IV immunoglobulin 
KD 
Dissociation constant 
KO 
Knock Out  
LCMV 
Lymphocytic choriomeningitis virus 
LDH 
Lactate dehydrogenase 
mAb 
Monoclonal antibody 
MCSF 
Macrophage colony stimulating factor 
MRI 
Magnetic resonance imaging 
NK 
Natural killer 
NaCl 
Sodium Chloride 
PCR 
Polymerase chain reaction 
PD 
Pharmacodynamic 
PPD 
Purified protein derivative 
PK 
Pharmacokinetic 
PR 
Partial Response 
PT 
Prothrombin Time 
PVC 
Polyvinyl chloride 
SAE 
Serious adverse event 
SAP 
Statistical analysis plan 
SAD 
Single ascending dose 
sCD25 
soluble CD25 (i.e. soluble IL-2 receptor) 
SD(n) 
Study Day number (e.g. Study day 1 = SD1) 
SSC 
Scientific steering committee 
SUSAR 
Suspected Unexpected Serious Adverse Reaction 
TB 
Tuberculosis 
t1/2  
Elimination half-life 
Tmax 
Time when plasma concentration is at peak 
TMDD 
Target mediated drug disposition 

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TMF 
Trial Master File 
TNFα 
Tumour necrosis factor alpha 
US 
Ultrasonography 
Vss 
Volume of distribution at steady state 
WD 
Withdrawal 
 

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CONFIDENTIAL 
Table 1: Definition of response  
Overall Response Rate 
Complete Response 
Complete Response is adjudicated if: 
- 
No fever = body temperature < 37.5C 
- 
Normal spleen size as measured by 3D abdominal ultrasound 
- 
No cytopenia = Absolute Neutrophil Counts  1.0x109/L and platelet count  
100x109/L absence of G-CSF and transfusion support must be documented for at 
least 4 days to report no cytopenia 
- 
No hyperferritinemia = serum level is  < 2000 g/L   
- 
No evidence of coagulopathy, i.e. normal D-Dimer and/or normal (> 150 mg/dL) 
fibrinogen levels  
- 
No neurological and CSF abnormalities attributed to HLH 
- 
No sustained worsening of sCD25 (as indicated by at least two consecutive 
measurements that are > 2-fold higher than baseline)  
Partial Response 
Partial Response is adjudicated if: 
- 
At least 3 of the HLH clinical and laboratory abnormalities (including CNS 
abnormalities) meet the above mentioned criteria for “Complete Response”. In 
the case of “reactivated patients” who enter the study with 3 abnormal HLH 
features, at least 2 criteria should meet the definition given 
- 
There is no progression of other aspects of HLH disease pathology (e.g., 
jaundice, liver size, oedema, CNS clinical alterations) 
HLH improvement 
- 
Improvement (>50% change from baseline) of at least 3 HLH clinical and 
laboratory abnormalities (including CNS involvement).  In the case of “reactivated 
patients” who enter the study with 2 abnormal HLH features, a change from 
baseline greater than 50% for both will define HLH as improved. 
Limited Improvement/Lack of Improvement/No Response 
- Less than 50% change from baseline of 3 or more of the above mentioned HLH clinical and laboratory 
abnormalities in the case of “reactivated patients” who enter the study with 2 abnormal HLH features, less 
than 50% change from baseline in both will be sufficient to define limited improvement 
and 
- No apparent improvement in other aspects of disease pathology 
Reactivation 
- 
Deterioration of two or more HLH d clinical and laboratory criteria with the following specifications: 
1. numerical laboratory values* must become abnormal and worsen by more than 30% compared to the 
previous evaluation, on two sequential assessments performed with an interval of minimum 1 day and 
maximum 1 week 
2. deterioration of clinical criteria must be confirmed by consistent observations of worsening over three 
consecutive days 
- 
The development of new or recurrent CNS symptoms counts as a single criterion for reactivation.  
* The following laboratory parameters are specifically considered for determination of reactivation: 
- platelets  
- neutrophils 
- fibrinogen 
- ferritin  
- soluble CD25 (sCD25; i.e. soluble IL-2 receptor). 
The assessment of NK function, red blood cells/hemoglobin and triglyceride levels cannot be considered for the 
determination of reactivation. 
 

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CONFIDENTIAL 
Table 2: Schedule of Assessments – Screening & Treatment Period 1 –SD0 to SD15 (Weeks 1 and 2) 
Inf. 1
Inf. 2
Inf. 3
Inf. 4
Inf. 5
Inf. 6
SD0
SD1
SD2
SD3
SD5
SD6
SD8
SD9
SD11
SD12
SD14
SD15
Starting from SD-1 
After this time-
point patients 
may be 
discharged 
Starting from SD-1 
Starting from SD-1 
X 
X
X 
X 
X 
X 
X
X
X (Pre, during, 
post)
X
X
X (Pre, during, 
post)
X
X (Pre, during, 
post)
X
X (Pre, during, 
post)
X
X (Pre, 
during, post)
X
X (Pre, during, 
post)
X (Pre, during, 
post)
X (Pre, during, 
post)
X (Pre, during, 
post)
X (Pre, during, 
post)
X (Pre, 
during, post)
X (Pre, during, 
post)
X
X
X (Pre)
X
X 
X (Pre)
X
X (Pre)
X
X (Pre)
X
X (Pre)
X
X (Pre)
Procedure 
X
X (Post)
X
X 
X (Pre)
X
X
X (Pre)
X
X
X
X (Pre)
X (morning)
X (morning)
X (Pre)
X
X (Pre)
X
X
X
X
X (Pre)
X (Pre)
X
X (Pre)
X
X
X (Pre)
X
X (Pre)
X
X
X
X
X (Pre)
X
X
X (Pre)
X
X (Pre)
X
X
X
X
X
X
X (Pre)5
X
X
X (Pre)
X
X (Pre)
X
X
X
X
X
X
Histopathology
X 
X (Pre)
X
X
X (Pre)
X
X (Pre)
X
X (Pre)
X (Pre)
X (Pre)
X (Pre - post 
infusion)
X
X
X (Pre - post 
infusion)
X
X (Pre - post 
infusion)
X
X (Pre - post 
infusion)
X (Pre - post 
infusion)
X (Pre - post 
infusion)
X
5: Urinalysis= glucose, blood, protoein, leukocytes, ketone, pH, gravity. On SD0 urinalysis needs to be performed if not done at screening
6: Chest X-ray: every 4 weeks, except if required more frequently in case of clinical suspicion of a pulmonary infection
Hospitalisation
Assessments
 Screening 
Treatment Period 1 - SD0 to SD15 (wk 1 and  2)
Up to one 
week prior to 
first infusion
SD-1
Dexamethasone
Prophilactic treatment, as described in Section 6.2
Infusion 
Patient Information
Clinical 
Assessment 
Vital signs 1
Continuous cardiac monitoring / pulse oxymetry
Physical Examination 2
ECG
only if clinically indicated
Search for 
Infections
TB 3
Adenoviruses, EBV, CMV  (viral load)
HSV, HZV, HIV, HBV, HCV
Atypical mycobacteria, Histoplasma 
Capsulatum , Shigella , Salmonella 
Campylobacter , Leishmania 
In case of suspicion of infection
2: Physical examination: : includes as a minimum: weight (at screening, at SD-1, and prior to each infusion), height (at screening only), and in particular at each visit, occurrence of skin rashes, jaundice, purpura, 
bleeding, edema, ascites, search for tonsillitis, lymphadenopathies,  dyspnea, cough, spleen and liver size, and neurological examination
3: TB: search for tuberculosis mycobacteria: At screening: IGRA/PPD and PCR; after screening by PCR
Imaging
3D abdominal US (spleen and liver size)
Chest X-ray6
Brain MRI
In case of CNS symptoms occurrence
Cerebrospinal Fluid (CSF) analysis if coagulation 
allows
Only if clinically indicated (to monitor evolution or to confirm occurrence of new  CNS symptoms)
4: Biochemistry= glucose, electrolytes, ferritin, CRP, AST, ALT, ALP, gGT, LDH, bilirubin, albumin, creatinin, urea
In case of suspicion of infection
PD/Exploratory  (sCD25, IL-10. CXCL9, CXCL10, CXCL11), IFNγ (free  IFNγ at SD0 
predose, total IFNγ for all other timepoints)
PK (NI-0501 circulating concentration) 
Immunogenicity (ADA)
1: Vital signs: Temperature, heart rate, blood pressure, respiratory rate. Oxygen saturation is also recorded at SD-1 and pre-, during and after infusion on infusion days
Laboratory
CBC
Lymphocyte subsets
Coagulation (aPTT, PT, D.-dimers), fibrinogen
Biochemistry4, triglycerides
IgG level
Pregnancy test (if applicable) 
Urinalysis5 
 

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CONFIDENTIAL 
Table 3: Schedule of Assessments - Treatment Period 2 – SD 16 to EoT(3 days after last infusion) (Weeks 3 to 8) & Follow-up Period 
Infusion visit
Efficacy/Safety visit6
End of treatment visit 
Infusion X 
Efficacy/Safety visit X
3 days post last infusion 
( 1 day) 
Week 
2
Week 
3
Pre-
conditioning 
visit8
X
X (Pre, during, post)
X
X 
X
X
X
X
X
X (Pre, during, post)
X (Pre)
X
X 
X
X
X
X
X
Procedure
X
X
X (every 2 weeks)
X
X
X
X (every 2 weeks)
X
X
X
X 
X
X
X
X
X
X 
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X (every 2 weeks)
X
X
X (every 4 weeks)
X
X
Histopathology
X  (pre)
X 
X
X
X
X
X  ( pre and post)
X 
X 
X
X 
X
X
X
6: Efficacy/Safety visits: should occur every 6 days, with a time-window of  48 hours in order to combine, whenever possible,  with NI-0501 infusion visits. 
7: Pre-HSCT visit: if applicable, i.e. if transplant takes place during the 4-week follow-up period, appropriate schedule will be applied to combine a weekly follow-up visit with the pre-HSCT visit at the site. 
Infusion 
8: Pre-conditioning visit: if applicable, i.e. if the patient starts conditioning during the 4-week follow-up period, the closer weekly follow-up visit will be combined, in order to allow collection of clinical and laboratory HLH 
parameters before administration of the conditioning drugs. 
Assessments
Treatment Period 2 - Week 3-8                                        
SD16 until EoT (3 days after last NI-0501 infusion) 
Follow-Up Period7
Wk 4/
Study 
completion visit 
or Withdrawal 
(WD) visit
Unscheduled 
Visit (UV)9
Clinical 
Assessment 
Vital signs 1
Continuous cardiac monitoring/ pulse 
oxymetry
Physical Examination 2
ECG
only if clinically indicated
Infections
TB 3
Adenoviruses, EBV, CMV (viral load)
5: Chest X-ray: every 4 weeks, except if required more frequently in case of clinical suspicion of a pulmonary infection.  At EoT and follow-up visits, chest X-ray will not be performed unnecessarily if a recent exam is available
Atypical mycobacteria, Histoplasma 
Capsulatum , Shigella, Salmonella 
Campylobacter, Leishmania
In case of suspicion of infection
only if clinically indicated
Laboratory
CBC
Coagulation, fibrinogen
Biochemistry4, triglycerides
Urinalysis (glucose, blood, protein, 
leukocytes, ketone, pH, gravity)
10: PK/PD: Additional PK/PD samples may be required to better characterize the PK/PD profile and/or for further safety assessments. Number of additional samples taken will be based on body weight, patient characteristics 
and clinical status of the patient. 
9: Unscheduled Visit: These assessments should be performed at minimum, but additional assessments may be added according to the clinical judgment of the Investigator.
In case of CNS symptoms 
CSF analysis
only if clinically indicated
PD/Exploratory10
PK (NI-0501 circulating concentration)10
Immunogenicity  (ADA)
Imaging
3D abdominal ultrasound (spleen and 
liver size)
Chest X-ray5
Brain MRI
1: Vital signs: Temperature, heart rate, blood pressure, respiratory rate. Oxygen saturation is also recorded pre-, during and after infusion on infusion days
2: Physical examination: :  includes: as a minimum weight prior to each infusion, at each follow-up visit and each unscheduled visit; weight and height at the end of treatment visit and at Week 4/Study completion visit or 
Withdrawal (WD) visit and in particular at each visit, occurrence of skin rashes, jaundice, purpura, bleeding, edema, ascites, search for tonsillitis, lymphadenopathies, dyspnea, cough, spleen and liver size, and neurological 
examination
3: TB: search for tuberculosis mycobacteria by PCR
4: Biochemistry= glucose, electrolytes, ferritin, CRP, AST, ALT, ALP, gGT, LDH, bilirubin, albumin, creatinin, urea
 

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PART I 
1 
BACKGROUND INFORMATION 
1.1 
NI-0501 
1.1.1 
Description and mode of action 
NI-0501 is a fully human IgG1anti-interferon gamma (IFNγ) monoclonal antibody (mAb) which binds 
and neutralizes IFNγ. IFNγ is one of the most potent and pleiotropic cytokines of the immune system. It 
is critical for innate and adaptive immunity against viral and intracellular bacterial infections.  
After binding to its receptor, IFNγ acts to produce a variety of physiological and cellular responses. 
Numerous studies over the last 20 years have associated IFN with the pathogenesis and the maintenance 
of inflammatory diseases1-3. 
IFNγ is produced predominantly by natural killer (NK) and natural killer T (NKT) cells, as part of the 
innate immune response, and by CD4 Th1 and CD8 cytotoxic T lymphocyte (CTL) effector T cells, once 
antigen-specific immunity develops. 
1.1.2 
 Preclinical Data  
1.1.2.1 Non-clinical Pharmacology 
NI-0501 has shown similar binding affinity and blocking activity for IFNγ from non-human species, 
including Rhesus and Cynomolgus monkeys, but not from dogs, cats, pigs, rabbits, rats or mice.  
NI-0501 binds to soluble and receptor (IFNγR1)-bound forms of IFNγ.  
Since NI-0501 is a human IgG1, it retains the characteristics of this immunoglobulin isotype, including 
the capacity to engage Fcγ receptors and bind complement.  
Due to NI-0501 capacity to bind free and IFNγR1-bound IFNγ, studies were performed to investigate the 
potential of NI-0501 to mediate ADCC and CDC activities, in the presence of target. A lack of ADCC 
activity was demonstrated and no induction of CDC activity was observed.  
1.1.2.2 Toxicology 
Binding and functional data demonstrated Rhesus or Cynomolgus monkeys to be relevant species to 
evaluate the safety of NI-0501. No off-target toxicity was attributed to the drug when administered to 
Cynomolgus monkeys in 13 weekly doses of up to 200 mg/kg. An enhanced susceptibility to infections 
due to an exaggerated pharmacological effect of the drug has been observed at all dose levels in animals 
originally harbouring gastrointestinal pathogens (Shigella, Salmonella, Campylobacter) prior to NI-0501 
administration. In a second study, where Cynomolgus monkeys were not initially found to be harbouring 
gastrointestinal pathogens, weekly administrations of NI-0501 for 8 consecutive weeks at doses up to 30 
mg/kg were well tolerated, without the need for antibiotic prophylaxis.  
Results from a human tissue cross-reactivity study, involving a panel of 35 different human tissues, 
demonstrated that NI-0501 did not cross-react with any of the human samples tested. 
1.1.2.3 Safety pharmacology 
There were no abnormal findings in ECGs taken periodically during treatment and recovery periods in 
the 8 week and 13 week repeated dose toxicology studies in Cynomologus monkeys, where animals were 
exposed to doses up to 200 mg/kg of NI-0501 weekly. No abnormal findings were observed in the 

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histopathological investigations of the hearts and lungs in these animals compared to untreated animals. 
Histopathological analysis of kidneys from these animals revealed no abnormal findings and the periodic 
urinalysis readings were also normal, indicating no abnormal effects on renal function. There were no 
histopathological findings in brains in both studies. Furthermore, no abnormal behaviour of the animals 
was observed throughout the study periods, suggesting no effects on CNS.  
1.1.3 
 Clinical Data 
A Phase 1 randomized double-blinded placebo-controlled single ascending dose study in 20 healthy adult 
volunteers investigating the safety, tolerability and pharmacokinetic profiles of single intravenous (IV) 
administrations of NI-0501 took place between September 2011 and April 2012. During this study 6 
subjects received placebo, while 3, 3, 4, and 4 subjects (in total 14 subjects) received NI-0501 doses of 
0.01, 0.1, 1, and 3 mg/kg, respectively. 
The pharmacokinetics (PK) analysis of NI-0501 revealed the expected profile for an IgG1 with a long 
half-life (around 22 days), a slow clearance (≤ 0.1 mL/kg/hr) and a low volume of distribution (< 65 
mL/kg on average). The serum concentrations and the AUC measured at 1 and 3 mg/kg were in line with 
the prediction that NI-0501 induces at these doses a significant neutralization of IFNγ. 
A total of 41 adverse events (AEs) were observed after start of drug infusion in 14 out of 20 subjects 
(70%), 10 of which were reported by 4 subjects having received placebo. Thirty-six (87.8%) AEs were of 
mild intensity and 5 (12.2%) were of moderate intensity. No severe or life-threatening AEs were 
reported. Twenty-three AEs (56.1%) in 10 of the 14 subjects who experienced an AE were reported as 
drug-related (at least with a reasonable possibility). Most AEs were singular occurrences and no trend in 
relation to increasing NI-0501dosage was observed. 
All NI-0501 infusions were uneventful. 
Among the AEs reported during the 24 hours post infusion, chills (1 in the 1 mg/kg cohort), myalgia (1 in 
the 3 mg/kg cohort) and pyrexia (3 in the 1 mg/kg cohort) were reported. These symptoms were assessed 
as mild, except one assessed as moderate (temperature increase up to 38.4°C, treated by paracetamol 
administration) and were concomitant to transient laboratory changes (CRP and neutrophil elevation) and 
some slight cytokine variations. These observations at the higher doses of NI-0501 administration suggest 
an attempt by the immune system to adjust to a new homeostasis upon IFNγ abrogation. They appear to 
be consistent with the mild flu-like symptoms reported with another IFNγ neutralizing antibody 
(Fontolizumab), after its first administration in Crohn’s disease patients4;5. 
Regarding the occurrence of infections, only common infections such as upper respiratory tract infections 
were observed after administration of NI-0501, with a similar incidence reported in placebo subjects.  
Herpes zoster (HZ) was also reported in one subject (male, aged 26) 14 days after the infusion of 3 mg/kg 
of NI-0501. This event was assessed as related to the NI-0501 infusion and considered as serious 
(medically significant) in the context of a Phase I study in healthy volunteers (HVs). Its intensity was 
moderate and its course normal under antiviral therapy and the subject recovered with no sequelae. 
The occurrence of an HZ infection in a subject who has received a dose of NI-0501 intended to fully 
neutralize IFNγ can be attributed to the expected pharmacological effect of the drug. An increased 
susceptibility to HZ infections in patients having developed auto-antibodies against IFNγ6 or having 
received ustekinumab (a mAb which decreases IFNγ production by inhibiting the p40 subunit of IL-12) 
has been described in the literature. HZ infection is reported in the ustekinumab USPI with a frequency 
rate less than 1% in controlled clinical studies. However, the subject who suffered from the HZ infection 
also exhibited unexplained elevated serum IgE levels prior to inclusion in, and during, the study. A non-
detectable subtle defect in the immune system linked to the elevated IgE levels may have increased the 
susceptibility of this subject to the pharmacological effect of NI-0501. 

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A blood sample was taken pre-infusion and at Week 8 for anti-drug antibody (ADA) detection. All 
samples were reported as negative for the presence of anti-NI-0501 antibodies. As in a few subjects NI-
0501 levels were still detectable at Week 8, additional samples at follow-up monthly visits were taken. 
The presence of ADA was found in one subject (having received 1 mg/kg) at Week 28, not affecting PK.  
In conclusion, the infusion of NI-0501 was well tolerated and the effects observed during the 8 week 
monitoring after drug infusion did not reveal any serious or unexpected off-target safety or 
immunogenicity concerns. Therefore, neither the clinical features and laboratory results, nor the PK 
profile and pharmacodynamic (PD) effects observed after administration of NI-0501 in HVs prevent 
moving NI-0501 into the next development phase. 
At the cut-off date of January 31st 2016, seventeen patients with confirmed or suspected primary HLH 
have been enrolled in the present NI-0501-04 study (8 in US, 9 in EU). Two patients received NI-0501 as 
a first-line treatment and 15 patients received NI-0501 as a second-line treatment because of an 
inadequate response to previous HLH treatments. For interim outcome data please refer to the latest 
Investigator’s Brochure (presently version 5.0, dated 20 January 2016). A favourable benefit risk profile 
of NI-0501 in primary HLH patients has been assessed based on data so far obtained in the study.  
Please refer to section 9.5.2 – General Benefit/Risk Considerations, for the current benefit/risk 
assessment on the use of NI-0501 in HLH patients. 
1.2 
HAEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS (HLH) 
HLH is a syndrome characterized by a severe impairment or absence of cytotoxic function by NK and 
CD8+ T cells with striking activation of the immune system. 
HLH comprises primary (genetic/familial) HLH and secondary HLH, both clinically described by a 
dysregulation of the immune system leading to a profound hypercytokinaemia with deleterious 
consequences on various tissues and organs7. 
Primary HLH is a heterogeneous autosomal recessive disorder found to be more prevalent with parental 
consanguinity. Primary HLH is mostly seen in infancy and early childhood with an estimated prevalence 
in Europe of 1/50,000 live births8. The disease is invariably fatal with a median survival of less than 2 
months after diagnosis, if untreated9;10.  
The impaired cytotoxic function present in HLH leads to hypercytokinemia and heamophagocytosis. 
These in turn cause all the typical symptoms of HLH11-13: 
 
Prolonged fever 
 
Splenomegaly 
 
Cytopenia 
 
Hyperferritinemia 
 
Hypertriglyceridemia 
 
Hypofibrinogenemia 
 
Lymphohistiocytic infiltrate, bone marrow hypoplasia, meningeal infiltrate. 
Among the cytokines dramatically elevated in HLH patients are: IFNγ, interleukin (IL)-6, IL-10, tumour 
necrosis factor (TNF) α, IL-8, macrophage colony stimulating factor (MCSF) and granulocyte-
macrophage colony-stimulating factor (GM-CSF).  
HLH can also occur during the course of an infection, a rheumatic or a neoplastic disease and in this case 
it is referred to as secondary HLH. Secondary HLH presents with the same signs and symptoms of 
primary forms and can be equally severe. The current treatment of secondary HLH is aimed at addressing 
the cause of the underlying disease. This is certainly the case for HLH caused by infections such as 
Leishmaniasis. Of note, the presence of certain infections, in particular viral infections such as those due 

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to CMV or EBV, is very often the trigger for the manifestation of primary forms of HLH. This 
observation is also supported by the evidence that in animal models of primary HLH14-17, infection with 
lymphocytic choriomeningitis virus (LCMV) is required for the development of the disease.  
When HLH manifests during a neoplastic disease, in particular an hematological malignancy, often the 
severity of the patient condition requires the immediate treatment of HLH, prior to specifically addressing 
the underlying disease.   
The presence of signs and symptoms of HLH in patients suffering from a rheumatic disease, such as 
systemic Juvenile Idiopathic Arthritis (sJIA) and Systemic Lupus Erythematosus (SLE), is often referred 
to by rheumatologists as Macrophage Activation Syndrome (MAS) and can precede the appearance of the 
rheumatic disease itself. The majority of patients with MAS have impaired NK and perforin functional 
tests and a significant number of patients show polymorphisms or heterozygous mutations in PRF1 and 
UNC13D. Although it is an extremely severe and life threatening condition, usually it resolves when an 
adequate treatment is initiated, consisting in most cases of corticosteroids and cyclosporine. However, in 
approximately 15%18 of patients developing MAS, the disease can be difficult to control and the use of 
etoposide may be considered.   
While primary HLH is recognized as predominantly a childhood disease, HLH is a condition that can be 
found in adults, and increased awareness indicates this may happen more often than recognized in the 
past. In the majority of adult patients the disease develops during malignancies (mainly non-Hodgkin 
lymphomas), infections, auto-inflammatory or autoimmune diseases and iatrogenic immune deficiencies. 
There are currently no approved drugs for the treatment of HLH. However, experts in the field have 
established guidelines for the management of HLH patients19-21.  
The management of primary HLH patients currently comprises of the following steps19:  
 
Induction therapy of 8 weeks with a combination of corticosteroids and immunosuppressive 
drugs (e.g. VP-16, cyclosporin, alemtuzumab, ATG); 
 
Maintenance therapy up to haematopoietic stem cell transplantation (HSCT); 
 
HSCT for all patients with an identified genetic deficiency and eventually in very severe HLH 
cases with no disease-associated mutations. 
The main goal of induction therapy is to suppress the life-threatening inflammatory process that 
characterizes HLH, enabling HSCT in those patients who require it22. HSCT is the only curative 
treatment for HLH associated with high penetrance genetic mutations20. 
Despite the adoption of such guidelines the overall mortality rate for primary HLH remains around 40 to 
50%20;23. 
The need to use, during the induction period, drugs associated with severe short and long term-safety 
issues further contributes to the already high mortality. This constitutes a strong argument for the 
development of a targeted treatment ensuring efficacy with less toxicity. 
1.3 
STUDY RATIONALE 
During the last years, growing evidence of the pivotal role of IFNγ in the development of HLH has been 
demonstrated7;14;15;24-26. 
The mutations of genes which characterize primary forms of HLH all affect proteins involved in the same 
process, ultimately impairing cytotoxic activity. Perforin mutations were the first identified in HLH 
patients.  

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Perforin knocked out (KO) mice are considered a relevant model for the human disease. In fact, these 
mice, once infected with LCMV, develop all the diagnostic and many of the clinical and laboratory 
characteristic features of the human disease, and they die if untreated. For these reasons, perforin KO 
mice have been used to study the pathophysiology of HLH. The HLH-like pathology that they develop is 
dependent on CD8+ T cells and IFNγ produced in response to antigen stimulation. 
It was demonstrated that when the high circulating levels of IFNγ are neutralized, with the administration 
of an anti-IFN antibody, not only are the clinical and laboratory abnormalities reverted, but also survival 
rate is dramatically improved. On the contrary, the ablation of any other cytokine had no impact on 
survival14;15. 
Two models of secondary HLH have been investigated in the context of the NI-0501 development 
program. In one model, repeated administration of CpG (causing TLR9 stimulation) has been used to 
mimic a chronic severe hyperstimulation in healthy mice (i.e. with normal genetics of the cytotoxic 
pathway) as a model of HLH secondary to infection. Although these mice do not necessarily die, they 
develop typical clinical and laboratory features of HLH. When IFNγ is neutralized, with the 
administration of an anti-IFNγ antibody, clinical and laboratory features of the disease are reverted. 
Interestingly, in this model it has been demonstrated that administration of the anti-IFNγ antibody leads 
to full neutralization of IFNγ effects also in relevant target tissues, such as liver and spleen (manuscript in 
preparation). 
To study the physiopathology of secondary HLH occurring in the context of rheumatic diseases, an 
animal model has been generated using IL-6 transgenic mice expressing high levels of IL-6, similarly to 
what occurs in patients with sJIA, the rheumatic disease most frequently associated with secondary forms 
of HLH. When triggered with Toll Like Receptor (TLR) ligands, these mice die with many of the features 
of the human disease27. In these mice, when IFNγ is neutralized with the administration of an anti-IFNγ 
antibody, survival is markedly improved and laboratory parameters reverted (Prencipe G et al, manuscript 
in preparation). 
Further strengthening the importance of IFNγ in HLH are the high concentrations of circulating IFNγ 
levels in primary HLH patients7;25. In a series of 71 patients monitored from HLH diagnosis to treatment 
and follow-up (including 2 with leukaemia and 3 with lymphoma), IFNγ levels were above upper limit of 
normal (17.3 pg/mL) in all patients, and in particular 53.5 % had levels above 1000 pg/mL. It was also 
reported that IFNγ levels rise early and quickly, and can fall from > 5000 pg/mL to normal in 48 hours 
upon effective treatment of HLH. 
More recently, in an observational study in patients with secondary forms of HLH, high levels of IFNγ 
were demonstrated both in patients with HLH secondary to infections and in patients with HLH occurring 
in the context of sJIA. The levels of CXCL9, CXCL10 and CXCL11, three chemokines that are known to 
be induced by IFNγ, were also significantly elevated. Noteworthy, levels of IFN, and of the three IFN 
chemokines, were found to be significantly correlated with laboratory parameters of disease severity, 
such as ferritin, platelet count and transaminases (Bracaglia et al., manuscript submitted). 
As hypercytokinemia and organ infiltration by activated lymphocytes and hystiocytes are responsible for 
all symptoms present in HLH patients and are dependent on CD8+ T cells hyperactivity and high IFNγ 
levels, the neutralization of IFNγ represents a rational approach, as no agents specifically targeting CD8+ 
T cells are available at the moment, and targeting individual cytokines downstream of IFNγ would not 
necessarily be feasible.  
Therefore, based on the data from animal models of primary and secondary HLH and from the 
observation made in patients with both primary and secondary HLH, confirming the critical role played 
by IFNγ in the pathogenesis of this disease, the neutralization of IFNγ offers a robust rationale to develop 
a targeted therapy for HLH, which must be effective with no or limited toxicity.  

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2 
OBJECTIVES 
 
To determine the safety and tolerability profile of multiple IV administrations of NI-0501  
 
To determine the efficacy and benefit/risk profile of NI-0501 in HLH patients 
 
To describe the PK profile of NI-0501 in HLH patients  
 
To define an appropriate NI-0501 therapeutic dose regimen for HLH  
 
To determine the PD effects (levels of circulating Total IFNγ and biomarkers of its 
neutralization, namely CXCL9 and CXCL10) 
 
To determine other biomarkers, e.g. sCD25, IL-10 
 
To assess the immunogenicity of NI-0501 
3 
STUDY DESIGN 
3.1 
OVERALL DESIGN 
This is an open-label, single arm, international multicentre Phase 2/3 study.  
The study, initially designed as a pilot Phase 2 study, with the target of enrolling 10 evaluable patients 
with primary HLH, based on the positive benefit risk profile observed in the patients enrolled in the study 
so far and in consideration of:  
i) the rare nature of the disease;  
ii) the lack of valuable therapeutic options especially for patients having failed previous HLH 
therapies or being unable to continue due to toxicity;  
iii) the significant number of requests for compassionate use of NI-0501 for HLH patients;  
has been amended to become a Phase 2/3 continuing enrolment of both first and second line patients. 
Patients who receive NI-0501 after having failed conventional HLH therapy or having shown intolerance 
to it represent the pivotal cohort of the study, to demonstrate the efficacy of NI-0501 as second line 
treatment of primary HLH. 
Treatment-naïve patients will be enrolled for collection of efficacy and safety data in the first line setting. 
The study foresees a screening, a treatment and a follow-up period. The study design is summarised 
below (Figure 1). 
If not already hospitalised, patients will be admitted to the unit the day before the first administration of 
the study drug (study day minus one, SD-1).  Discharge from the hospital cannot occur before SD15. 
After SD15, in case the patient condition allows, the Investigator at the site can discharge a patient from 
the hospital provided the following condition has been met: 
- 
no active infections requiring IV antimicrobial therapy are present.  

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Figure 1: NI-0501-04 Study Design 
 
 
3.2 
SCREENING PERIOD 
Screening will be carried out within 1 week prior to first administration of NI-0501 (SD0) to enable 
confirmation of patient eligibility and following the signature of the Informed Consent Form. 
In the event that a patient’s medical condition warrants rapid treatment initiation, and to avoid 
unnecessary repetition of recent interventions, results of tests which have been performed as part of the 
normal patient’s care at the site not more than 12 days prior to first NI-0501 infusion, can be considered 
for screening purposes (inclusion/exclusion criteria checks), with the agreement of both the Sponsor and 
the Investigator. 
Samples for infection screening need to be collected for analysis according to the protocol requirements; 
however availability of the results is not required prior to initiation of NI-0501 treatment provided that 
there are no clinical findings suggestive for the presence of any of the infections which represent 
exclusion criteria. 
3.3 
TREATMENT PERIOD 
NI-0501 will be administered for 8 weeks as induction treatment of HLH. 
The treatment period will be divided in 2 separate periods: Treatment Period 1 and 2 (please refer to 
Figure 1).  
NI-0501 treatment can be shortened, although not less than 4 weeks, if patient’s condition and donor 
availability allow an earlier HSCT.  
Based on the current knowledge, no wash-out period is required between the last administration of NI-
0501 and the start of conditioning. 
In the event that an appropriate donor has not been identified by Week 8 or in case of the need to delay 
the schedule of HSCT for reasons unrelated to the administration of NI-0501, NI-0501 treatment can be 
continued beyond this time upon the request of the Investigator, provided a favourable benefit/risk has 
been established for that patient. 

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3.4 
FOLLOW-UP PERIOD 
All patients who have received at least one dose of NI-0501 will be monitored for 4 weeks after the last 
administration of NI-0501 within the context of the NI-0501-04 protocol, independently of the duration 
of treatment with NI-0501.  
In the event that the NI-0501 concentration is still measurable after the 4 week follow-up period (i.e. 
short-term follow-up), NI-0501 monitoring will continue until a measurable concentration of NI-0501 is 
no longer detectable. This monitoring should occur, whenever possible, in the context of the long-term 
follow-up study, NI-0501-05.  
Patients for whom an Investigator has requested a prolongation of NI-0501 treatment beyond Week 8 will 
directly enter the long-term follow-up study NI-0501-05, without having to complete the 4 week short-
term follow-up. 
All patients having completed the follow-up period will also be asked to enter the open label safety 
extension study (NI-0501-05). 
3.5 
STUDY END 
The end of the study is defined as the last visit of the last patient. 
The last visit of a patient should occur, at the latest, 4 weeks after the last administration of NI-0501, 
except for patients continuing NI-0501 treatment beyond Week 8 (see paragraph below). 
In case of an ongoing serious adverse event (SAE), the patient will continue to be monitored until 
resolution or until the outcome of the event is known and stable, beyond the defined study end as 
necessary. In the event that additional NI-0501 concentration monitoring is not performed in the context 
of the NI-0501-05 study, this monitoring will continue beyond the 4 week follow-up period, until a 
measurable concentration of NI-0501 is no longer detectable. This measurement should occur not less 
than every two weeks. 
In this study, no further treatment beyond Week 8 is planned. However, in the event that an appropriate 
donor has not been identified by Week 8 or in case of the need to delay the schedule of HSCT for reasons 
unrelated to the administration of NI-0501, NI-0501 treatment can be continued beyond this time upon 
the request of the Investigator, in the context of an open label safety extension long term follow-up study, 
providing a favourable benefit/risk has been established. For these patients, end of study NI-0501-04 is 
defined as their last visit (i.e. three days after the last infusion administered in the context of NI-0501-04 
study). 
3.6 
LONG-TERM FOLLOW-UP STUDY (NI-0501-05) 
All patients having received at least one dose of NI-0501 in the pilot study will be asked to be part of the 
long-term follow-up study (NI-0501-05), to allow long-term safety surveillance, and, when relevant, 
investigation of the impact of NI-0501 treatment on survival and post-HSCT outcome measures. 
This study will allow monitoring of patients who have been considered for a treatment extension. 

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4 
TARGET POPULATION 
The study population comprises patients of both genders, up to and including 18 yearsi at diagnosis, 
suffering from confirmed or suspected primary HLH. 
Patients can be naïve to HLH treatment (first line patients), or may have already received conventional 
HLH therapyii (second line patients), without obtaining a satisfactory response according to the treating 
physician or having shown signs of intolerance to it. 
4.1 
ELIGIBILITY CRITERIA 
Patients included in the study must be compliant with the following inclusion/exclusion criteria: 
4.1.1 
 Inclusion Criteria 
1. Primary HLH patients of both genders, up to and including 18 yearsi at diagnosis of HLH. The 
diagnosis of HLH must be made on the basis of the following criteria (as per HLH-2004 protocol): 
a. A molecular diagnosis or familial history consistent with primary HLH  
OR 
b. Five out of the eight criteria below are fulfilled: 
- Fever 
- Splenomegaly  
- Cytopenias affecting 2 of 3 lineages in the peripheral blood (hemoglobin < 90 g/L; platelets < 
100 x 109/L; neutrophils  < 1 x 109/L) 
- Hypertriglyceridemia (fasting triglycerides ≥ 3 mmol/L or ≥ 265 mg/dL) and/or 
hypofibrinogenemia (≤ 1.5 g/L) 
- Hemophagocytosis in bone marrow, spleen or lymph nodes, with no evidence of malignancy 
- Low or absent natural killer (NK)-cell activity  
- Ferritin ≥ 500 µg/L 
- Soluble CD25 (sCD25; i.e. soluble IL-2 receptor) ≥ 2400 U/mL. 
2. Presence of active disease in patients as assessed by the treating physician. 
3. Patients having already received HLH conventional therapy must  fulfill one of the following criteria 
as assessed by the treating physician:  
- 
Having not responded 
- 
Having not achieved a satisfactory response 
- 
Having not maintained a satisfactory response 
- 
Showing intolerance to conventional treatment of HLH 
At the time of enrollment, eligible patients might still be receiving treatment (induction or 
maintenance) or might have already discontinued it. 
                                                 
 
i Or an age appropriate to be treated in the Investigator’s practice 
ii Conventional HLH therapy as per site standard of care, e.g. any of the following alone or in combination 
(Etoposide, ATG, Alemtuzumab and Cyclosporine A) or glucocorticoids, namely Dexamethasone at 10 mg/m2 for 
at least 7 days or methylprednisolone pulses for 3 consecutive days 
 

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4. Informed consent signed by the patient (if ≥ 18 years old), or by the patient’s legally authorized 
representative(s) with the assent of patients who are legally capable of providing it.    
5. Having received guidance on contraception for both male and female patients sexually active and 
having reached puberty: 
Females of child-bearing potential, having a negative pregnancy test at screening, and unless true 
abstinence is in line with the preferred and usual lifestyle of the patient, must agree to use adequate 
method(s) of birth control from screening until 6 months after receiving last dose of the study drug. 
Males with partners(s) of child-bearing potential must agree to take appropriate precautions to avoid 
fathering a child from screening until 6 months after receiving last dose of the study drug. 
4.1.2 
Exclusion Criteria 
1. 
Diagnosis of secondary HLH consequent to a proven rheumatic or neoplastic disease. 
2. 
Body weight < 3 kg. 
3. 
Patients treated with: 
 any T-cell depleting agents (such as anti-thymocyte globulin [ATG], anti-CD52) during the  
previous 2 weeks prior to screening 
 any other biologic drug within 5 times their defined half-life period, except for rituximab in case 
of documented B-cell EBV infection (a list of some of the most commonly used biologic half-
lives is included in the Study Specific Risk Management Plan) 
4. 
Active mycobacteria, Histoplasma Capsulatum, Shigella, Campylobacter, Leishmania or Salmonella 
infections.  
5. 
Evidence of past history of tuberculosis or of latent tuberculosis. 
6. 
Positive serology for HIV antibodies, hepatitis B surface antigen or hepatitis C antibodies. 
7. 
Presence of malignancy. 
8. 
Patients who have another concomitant disease or malformation severely affecting cardiovascular, 
pulmonary, liver or renal function. 
9. 
History of hypersensitivity or allergy to any component of the study regimen. 
10. Vaccination with a live or attenuated live (including BCG) vaccine within the previous 12 weeks 
prior to screening. 
11. Pregnant or lactating female patients. 
5 
INVESTIGATIONAL MEDICINAL PRODUCT (IMP) 
5.1 
DESCRIPTION OF IMP 
NI-0501 is a fully human anti-IFNγ monoclonal antibody which binds and neutralises IFNγ. 
NI-0501 is manufactured by a third party manufacturing facility duly qualified by Novimmune and is 
supplied to study sites in either 2 mL and/or 10 mL filled single-use glass vials at a concentration of 5 
mg/mL, for dilution prior to administration. 

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The nominal composition of the NI-0501 sterile concentrate for infusion (per mL) is as follows: 
Ingredient 
Quantity (per mL) 
NI-0501 
5 mg 
L-Histidine 
1.55 mg 
L-Histidine monohydrochloride, monohydrate 
3.14 mg 
Sodium chloride (NaCl) 
7.31 mg 
Polysorbate 80  
0.05 mg 
pH 
6.0 ± 0.2 
 
The solution contains no antimicrobial preservative, and therefore each vial must be used only once. 
5.2 
RATIONALE FOR DOSE SELECTION 
5.2.1 
 Initial dose (see Appendix A) 
Data from in vitro experiments investigating the binding kinetics of NI-0501 to human IFNγ and the 
functional inhibition of human IFNγ by NI-0501 have been used for predicting the concentrations of NI-
0501 expected to inhibit (e.g. 99%) the effect of circulating IFNγ concentrations.  
Based on: 
 
the calculated neutralizing concentrations of NI-0501  
 
the PK parameters of NI-0501 in healthy volunteers  
 
the PK information from recombinant IFNγ in humans,  
simulations were performed regarding the dose that would inhibit the effect of circulating and newly 
formed IFNγ by up to 99% over a period of 3 days in HLH patients.  
Based on these simulations, the starting dose in HLH patients is 1 mg/kg. This dose is predicted to inhibit 
for 3 days at least 99% of IFNγ effect in patients with baseline IFNγ concentrations lower or equal to 
3400 pg/mL. This dose is mainly driven by the estimated production of IFNγ which is expected to impact 
the clearance of NI-0501 (due to target-mediated drug disposition) and varies considerably between 
patients as already indicated by the wide range of baseline IFNγ concentrations observed in these 
patients. 
5.2.2 
 Subsequent doses (see Appendices A and B) 
Due to the expected target-mediated drug disposition (TMDD) effect and to the high inter-individual 
variability of IFNγ concentrations in HLH patients, doses subsequent to the initial one can be increased to 
3 mg/kg, if required, based on clinical and laboratory criteria (see Table 4).  
After a minimum of two infusions at 3 mg/kg, if upon re-assessmen, the same clinical and laboratory 
criteria are found to still apply, the dose of NI-0501 may be increased to 6 mg/kg for up to four infusions, 
with a regular monitoring of the clinical and laboratory HLH parameters.  
If clinical and laboratory response criteria are no longer applicable, the dose of NI-0501 will be decreased 
back to 3 mg/kg, 

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On the other hand, if criteria still apply, based on careful benefit/risk assessment, the Investigator may 
propose either 
i) to continue treatment at 6 mg/kg for additional infusions  
        or  
ii) to increase NI-0501 dose above 6 mg/kg if PK and PD evidence indicates extremely high IFN levels 
and, consequently, fast NI-0501 elimination. 
However, the Investigator’s proposal of either continuing 6 mg/kg infusions or increasing the dose above 
6 mg/kg has to be discussed and approved by the DMC, after thorough assessment of all available data, 
including PK and PD. 
Appendix A “NI-0501 dose justification in HLH patients” provides a detailed descriptions of the 
rationale supporting the initial and subsequent NI-0501 doses in HLH patients. 
Appendix B “Decision making process on dose selection” includes a detailed description of the clinical 
criteria and the process to guide decision on dosing increase by the Investigator.  
 

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Table 4 : Clinical and laboratory criteria to guide dose increase 
 
Study day (SD) 
NI-0501 dose 
 
On SD0 
Starting dose of 1 mg/kg 
 
On SD3 
Increase to 3 mg/kg 
Criteria to be met: 
- 
if fever persists or reoccurs (when present at baseline) 
or 
- 
if significant worsening of clinical conditions 
From SD6 
onwardsa 
Increase to 3 mg/kgb 
 
Criteria to be met: 
- 
if no satisfactory improvement in clinical conditions (as 
assessed by the Investigators) 
and 
- 
at least 1 of the followings: 
 
 
Platelet counts (x103/mcl) 
 
 
If  
   bsl. counts < 50            
   bsl. counts 50-100  
   bsl. counts > 100          
          
 no improvement to > 50 
 less than 30% improvement 
 any decrease to < 100 
 
 
ANC (count/mcl) 
 
 
If  
   bsl. counts < 500 
   bsl. counts 500-1000   
   bsl. counts > 1000         
          
 no improvement to > 500 
 any decrease to < 500 
 any decrease to < 1000 
 
 
Ferritin (ng/ml) 
 
 
 
If  
   bsl. levels  3000 
    
   bsl. levels < 3000        
          
 no improvement (<20%    
     decrease) 
 any increase to > 3000 
 
 
Splenomegaly 
  worsening (at clinical or US 
     examination) 
 
 
Coagulopathy (both D-Dimer and Fibrinogen have to apply) 
 
 
 D-Dimer  
 If   abnormal at bsl. 
 
 no improvement 
 
 
 Fibrinogen (mg/dL) 
 
 
 If 
       bsl. levels  100 
       bsl. levels > 100 
 
 no improvement 
 any decrease to < 100 
From SD9 or 
SD12 
onwardsc 
Increase to 6 mg/kgd 
Criteria to be met: 
- 
In case, after a minimum of two infusions at 3 mg/kg, the 
criteria above reported have been reassessed and found to 
be still met 
a NI-0501 dose has to be increased from 1 to 3 mg/kg if these criteria apply after SD6. 
b If NI-0501 dose has been already increased on SD3, at least two infusions at the dose of 3 mg/kg have to be 
  performed before criteria re-assessment.  
c Depending on whether dose increase to 3 mg/kg has occurred on SD3 or SD6. 
d For a maximum of four infusions.  
Abbreviations: bsl. = baseline; ANC = absolute neutrophil count; US = ultrasound 
 

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5.3 
DOSING REGIMEN  
NI-0501 will be administered by IV infusion over a period of one hour, at a starting dose of 1 mg/kg.   
Infusions will be performed every 3 days for the first NI-0501 six infusions (until SD15). Dose increases 
are possible at any time during the study  (see 5.2.2 above). 
From SD15 during Treatment Period 2, the administration of NI-0501 will occur on a twice-a-week 
schedule. Elongation of the dosing interval to 1 week can occur after 4 weeks of treatment, if the patient 
has achieved Complete Response and maintained it for at least one week.  
5.4 
IMP HANDLING 
5.4.1 
 Packaging and Labelling 
NI-0501 will be supplied to study sites in glass vials containing a either 2 and/or 10 ml solution at a 
concentration of 5mg/ml. Labelling and packaging will be prepared to meet local regulatory 
requirements. 
5.4.2 
 IMP Supply 
NI-0501 will be supplied to the study sites as open-label supplies. 
5.4.3 
 IMP Receipt and Storage 
The NI-0501 vials will be transported with temperature deviation alarms (TempTale 4 or equivalent 
device), in order to ensure consistent temperatures during transit. When the study drug is received at the 
site, the Investigator or Pharmacist will check for accurate delivery and absence of temperature deviation 
alarms. 
The study drug should be stored between 2-8°C (36 - 46°F). All vials must be stored in a secure locked 
location in a temperature-controlled refrigerator or cold room. Any deviations from the recommended 
storage conditions should be immediately reported to the Sponsor and responsible study monitor or 
contract research organisation (CRO). Affected vials should not be used and should be quarantined until 
the Sponsor has authorised their use, return or destruction. 
Documentation of the storage conditions of the study drug must be maintained for the duration of the 
time the study drug is stored at the site, until such time as it is used, disposed of, or returned to 
NovImmune or designee. 
Regular inspections of the NI-0501 vials are required, as detailed in the IMP manual’s directions for the 
Preparation and Administration of Individual Doses of Study Drug NI-0501. 
5.4.4 
 IMP Preparation, Administration, Accountability and Destruction 
5.4.4.1 Preparation  
The study drug must be prepared only by a Pharmacist or other appropriately qualified staff member, 
specifically authorised by the Investigator/Pharmacist. 
The specific dose to be administered for an individual infusion is determined as detailed in Section 5.3. 
As NI-0501 is dosed in mg/kg, the weight of the patient must be taken within 24 hours of the preparation 
of the study drug for administration.  

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Full instructions for the preparation, including dilution steps, and method for administration of NI-0501 
are available in the IMP manual’s directions for the Preparation and Administration of Individual Doses 
of Study Drug NI-0501. 
5.4.4.2 Administration 
The patient should receive the designated volume through an infusion pump over 1 hour (or more 
depending on the volume to infuse). A 0.2 μm filter has to be added to all infusion lines.  
It is recommended that an intravenous central line remains in place to ensure venous access during the 
treatment period. Since no data is available on the compatibility of NI-0501 with other intravenous 
substances or additives, other medications/substances should not be added to the infusion material or 
infused simultaneously through the same intravenous line. If the same intravenous line is used for 
subsequent infusions of other drugs, the line should be flushed with saline before and after infusion of 
NI-0501. 
The infusion of NI-0501 will be administered under the direct supervision of the Investigator (or 
delegate). It must be performed in the morning, preferably always at the same time, with a maximal 
tolerated difference in onset of infusion of not more than 3 hours compared to the initial infusion. Details 
of the infusion administered must be recorded in the patient’s Medical Notes (source documents) and 
CRF with: 
 
The date of administration 
 
The time (start and finish) of administration 
 
The volume administered 
 
Any incidence of adverse effects or general illness experienced by the patient. 
 
Any other event(s) judged relevant by the site personnel. 
5.4.4.3 Accountability 
When the study drug is received at the site, the Investigator or Pharmacist (or appropriate designee) 
should acknowledge its receipt by signing (or initialling) and dating the documentation. Documentation 
should be returned to NovImmune (or its designee) and a copy retained in the Investigator’s file. 
The dispensing of the study drug shall be carefully recorded on Drug Accountability Forms and an 
accurate accounting must be available for verification by the Monitor at each monitoring visit. 
The used (or unused) infusion material should be sent back to the Pharmacist at the end of the infusion, if 
possible, for later inventory. If this is not possible, accountability should be made at the bed-side before 
discarding the material. 
Drug accountability records shall include: 
 
Confirmation of the study drug’s delivery to the study site 
 
The inventory at the study site 
 
The use of study drug by each patient  
 
The return to the Sponsor or alternative disposition of unused products. 
The records should include dates, quantities, expiration dates, if applicable, and batch number and patient 
number.  
Unused study drug must not be discarded or used for any purpose other than the present study. Study 
drug that has been dispensed to a patient and returned unused must not be re-dispensed to a different 
patient. 

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5.4.4.4 Destruction, Return and Disposal  
Periodically during the study and at the conclusion of participation of the study by the site, the clinical 
research associate (CRA) will monitor and collect the Drug Accountability Forms, before making 
arrangements for study drug return or authorisation of destruction by the study site. 
6 
PATIENT BACKGROUND TREATMENT AND CARE 
6.1 
BACKGROUND THERAPY WITH DEXAMETHASONE 
In treatment-naïve patients, NI-0501 will be administered on a background of 10 mg/m2 of 
dexamethasone. In patient receiving NI-0501 as second line HLH treatment, dexamethasone has to be 
administered at the dose of at least 5mg/m2, or at the same dose administered prior to screening if higher. 
Patients are required to have received dexamethasone from at least SD-1. 
Dexamethasone can be tapered depending on patient condition, according to the judgment of the treating 
physician. The tapering scheme can be selected by the treating physician, provided that the 
dexamethasone dose, at each step, is not more than halved and frequency of change is not more than 
weekly.  
In the event of disease worsening after tapering of dexamethasone, the dose of dexamethasone can be 
increased and maintained until a satisfactory response is achieved according to the treating physician.  
6.2 
PROPHYLACTIC TREATMENT  
As recommended in HLH treatment guidelines, patients will receive prophylactic treatment for 
Pneumocystis jiroveci and fungal infections. In addition, prophylaxis for HZ virus infection will be 
performed to mitigate the potential risk associated to NI-0501 administration (see Benefit/Risk 
Management, Section 9.5). In the unlikely event that a patient, previously vaccinated for TB, shows a 
Purified Protein Derivative (PPD) test result ≥ 5mm and a negative IFNγ-release assay, the patients will 
receive prophylaxis. 
Patients will therefore receive prophylactic treatments starting from the day prior to initiation of NI-0501 
treatment (i.e. SD-1) until the end of the study: 
 
For Pneumocystis jiroveci prevention, according to Institution Guidelines/ Recommendations 
(e.g. 750 mg/m2/day sulfamethoxazole with 150 mg/m2/day trimethoprim given orally in 
equally divided doses twice a day, on 3 consecutive days per week). 
 
For fungal infection prevention, according to Institution Guidelines/Recommendations (e.g. 
Fluconazole 12 mg/kg daily with a maximum of 400 mg daily dose). 
 
For Varicella Zoster virus prevention, according to Institution Guidelines/Recommendations 
(e.g. Acyclovir 200 mg four times daily for children over two years, for children under two 
years 100 mg four times daily). 
 
For TB, if required (see above), according to Institution Guidelines/Recommendations (e.g. 
Isoniazid). 
These treatments will be given orally, whenever possible, otherwise intravenously. 
In the event that NI-0501 concentrations remain at therapeutic levels after the end of the study, it is 
strongly recommended that the above mentioned prophylaxis be maintained, regardless of the 
participation of the patient in the NI-0501-05 study.  

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6.3 
CONCOMITANT THERAPY 
6.3.1 
 Cyclosporin A 
CsA can be continued, if already administered prior to screening. CsA can be withdrawn at any time, 
upon the judgement of the Investigator. CsA is not to be introduced de novo during the course of the 
study, once NI-0501 administration has started. As it is recommended in other HLH protocols, CsA 
concentrations should be monitored at least weekly to maintain trough levels of 150-200 ng/ml. 
6.3.2 
 Intrathecal Methotrexate and Glucocorticoids  
For patients receiving intrathecal methotrexate and glucocorticoids at the time of NI-0501 treatment 
initiation, this treatment should be continued as required. If the appearance of CNS symptoms occurs 
before the initiation of NI-0501 treatment, therapy with intrathecal methotrexate and glucocorticoids must 
be initiated prior to the first administration of NI-0501.  
6.3.3 
 Other possible concomitant therapies 
Intravenous immunoglobulin (IVIG) will not be administered at the dose expected to produce an 
immunomodulator effect (e.g. 2 g/kg). However, if deemed justified by the treating physician, in case of a 
documented immunoglobulin deficiency justifying replacement, IVIG can be given at a dose of 0.5 g/kg, 
every 4 weeks or more frequently in order to maintain adequate IgG levels. Any infusion within the 
previous 4 weeks prior to screening, as well as any infusion during NI-0501 treatment, should be 
documented in the CRF (dose, date of administration). 
Analgesic treatment, transfusion of blood products, electrolyte and glucose infusions, antibiotics, anti-
fungal and anti-viral treatment and general supportive care (e.g. gastro-protective agents) are permitted 
within the study.  
Use of any additional prescription drugs or over-the-counter medication (including herbal and 
homeopathic preparations), with the exception of multi-vitamins, requires approval from the Investigator. 
Contraception guidance: See Inclusion Criteria Section 4.1.1, point 6. 
6.3.4 
 Not allowed concomitant therapies 
During treatment with NI-0501, concomitant use of etoposide, T-cell depleting agents, or any other 
biologic drug is generally not allowed except for the followings: 
- 
G-CSF, in case of prolonged neutropenia  
- 
Rituximab, in case of documented B-cell EBV infection 
- 
additional HLH treatments, in case of unsustained or limited HLH improvement (as defined 
below) at the maximum NI-0501 dose level. Etoposide should be administered, unless a clear 
evidence of lack of response or intolerance to the drug is derived from previous medical history.  
In this circumstance, the Investigator may propose an alternative agent which requires to be 
approved by the Data Monitoring Committee. 
The definitions below apply: 
- Unsustained HLH Improvement:  
Patients who are unable to maintain at least 50% improvement from baseline in 3 HLH 
parameters (see Table 1). At least two consecutive measurements must document the loss of 
HLH improvement. 
- Limited HLH Improvement:  

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Less than 50% change from baseline in a minimum of 3 HLH clinical and laboratory 
criteria. 
 
Vaccination with a live or attenuated-live (including BCG) vaccine will be avoided during the whole 
study including the 4-week follow-up period. In the event that NI-0501 concentrations remain at 
therapeutic levels after the end of the study, the period with no vaccinations should be extended until 
measurable concentration of NI-0501 are no longer detectable.  
6.4 
EMERGENCY TREATMENT 
Severe allergic reactions such as anaphylactic shock require prompt IV treatment with adrenaline and 
antihistamines. Oxygen shall be supplied through a face mask. Patients must have an appropriately sized 
IV line that allows rapid infusion of colloid volume substitution. In case of an anaphylactic reaction 
patients shall be transferred as soon as possible to the intensive care unit of the hospital.  
Following the first administration of NI-0501 and before leaving their reference centre, each patient 
(and/or patient’s legal representative) will be given a card to carry at all times in case of any emergency. 
The card gives details of the name of the drug, name of the responsible physician, and the address and 
telephone number of the study site; this card will be collected by the Investigator from the patient after 
the end of the study. 
6.5 
RESCUE THERAPY 
Patients who are withdrawn from the study due to a safety issue or for lack of efficacy (i.e. worsening of 
HLH or no response to NI-0501; see Section 10.1.3) will be treated with rescue therapy, according to the 
standard of care at the site.  
7 
ENDPOINTS 
7.1 
SAFETY ENDPOINTS 
Safety and tolerability of multiple IV infusions of NI-0501 will be assessed as follows: 
 
Incidence, severity, causality and outcomes of AEs (serious and non-serious), with particular 
attention being paid to infections 
 
Evolution of laboratory parameters such as complete blood cell count (CBC), with focus on red cells 
(haemoglobin), neutrophils and platelets, liver tests, renal function tests and coagulation 
 
Number of patients withdrawn for safety issues 
 
Level (if any) of circulating antibodies against NI-0501 to determine immunogenicity; i.e. the 
development of anti-drug antibodies (ADAs). 
The detection of ADA (Anti-Drug Antibodies) in human serum will be assessed with a GYROLAB-
based assay. This homogeneous assay utilises a bridging format composed of a biotinylated NI-0501 
antibody, streptavidin coated beads and an Alexa-Fluor labelled NI-0501 antibody as the detection 
antibody. The fluorescent signal produced is proportional to the amount of ADA present in the 
human serum sample.  
7.2 
EFFICACY ENDPOINTS 
Primary efficacy endpoint 
 
Overall Response Rate, i.e. achievement of either Complete or Partial Response or HLH 
Improvement, at End of Treatment (EoT). 

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Criteria for the definition of Overall Response Rate are reported in Table 1.  
Secondary efficacy endpoints: 
 
Time to Response any time during the study  
 
Durability of Response, i.e. maintenance of response achieved any time during the study until EoT 
and beyond (including data collected in the long-term follow-up study NI-0501-05) 
 
Number of patients who reduce glucocorticoids by 50% or more of the baseline dose 
 
Number of patients able to proceed to HSCT, when deemed indicated  
 
Survival at Week 8 (or EoT) and at the end of the study Long-term survival (in particular D+30 and 
D+100 post-HSCT survival) will be assessed in the context of long-term study NI-0501-05 
7.3 
PHARMACOKINETIC ENDPOINTS 
All PK data will be summarised using appropriate graphical and tabular presentations. Descriptive non-
compartmental pharmacokinetic analysis (NCA) will be applied: Cmax (concentration corresponding to 
Tmax), Tmax (time of maximum observed concentration), CEOI (concentration at the end of infusion), Ctrough 
(concentration just before administration), AUC (area under curve of a dosing interval), AUClast (area 
under curve from the time of dosing to the last measurable concentration), λz (first order rate constant 
associated with the terminal (log-linear) portion of the curve, estimated via linear regression of time 
versus log concentration), t½ (plasma half-life), CL (systemic drug clearance), Vss (volume of distribution 
at steady state). Individual and mean PK parameters will be tabulated. Exploratory compartmental 
pharmacokinetic analysis and population pharmacokinetic analysis will be undertaken to investigate 
linear and non-linear (TMDD) kinetics. Pharmacokinetic-pharmacodynamic analysis will also be 
undertaken. 
7.4 
PHARMACODYNAMIC ENDPOINTS 
Determination of PD parameters will include, but will not be limited to, the following: 
 
Levels of circulating free IFN at predose, and of total IFNγ (free + bound) at any subsequent 
time-point 
 
Markers of IFNγ neutralization, namely CXCL-9, CXCL-10, CXCL-11 
 
Other biomarkers (e.g. sCD25, IL-10). 
8 
OUTLINE OF STUDY PROCEDURES 
Patients will be recruited from specialised study sites, with an intensive care unit. 
For a detailed description of the schedule of visits and assessments, please refer to the Schedule of 
Assessment Error! Reference source not found. (Screening and Treatment Period 1) and  

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Table 3 (Treatment Period 2 and Follow-up Period). 
The informed consent form must be signed by the patient or his/her legally authorized representative 
prior to any study-related procedures, with the assent of patients who are legally capable of providing it.  
Some procedures are not to be done systematically but only if clinically relevant.  
For example: 
 ECG is only mandatory at screening, after first infusion, after last infusion and at the end of the 
study, but can also be done at any other time point, if relevant,  
 Brain MRI should be done in case of neurological symptoms occurrence, 
 Lumbar puncture for CSF analysis is done (providing that coagulation allows) only at screening 
but should be repeated during the study course if the initial analysis at screening was abnormal or 
in case of occurrence of neurological symptoms,  
 Search for pathogens during the study should be done if there is any suspicion of infection, 
 Chest X-ray during the study should be done more frequently than indicated in case of clinical 
suspicion of a pulmonary infection.  
Analysis done on blood samples will favour as much as possible the use of micro-sampling techniques.  
In case of a need for prioritization of blood analysis, laboratory safety parameters (which would have 
been done as normal disease monitoring) will be prioritized. For details on blood sampling, please refer 
to Appendix C. 
For safety laboratory and search for pathogens, the planned schedule of assessment is in accordance with 
recommendations for the monitoring of disease evolution and potential for infection in these severely sick 
patients (HLH-2004 protocol of the Histiocyte Societyiii). This has been agreed by the study’s Scientific 
Steering Committee (SSC).  
The additional amounts of blood which will be drawn for study mandatory specific assessments represent 
only 24.5 mL for PK assessments and 1.5 mL for immunogenicity monitoring. A maximum of 29 ml of 
blood  are required for PD assessments, and will be only taken if the amount of blood required is 
acceptable in the context of the EMA guidelineiv. 
The following situations will not be considered as protocol deviations: 
- Missing data if not occurring at 2 consecutive time-points, 
- Missing urinalysis, except for the test to be performed at Screening (or SD0), EoT and Study 
Completion, 
- Vital signs measured within no more than 1 minute before or after the planned time-point when 
measured every 5, 10 or 15 minutes, within no more than 10 minutes before or after the planned time-
                                                 
 
iii Treatment protocol of the second international HLH study 2004 available online at http://www.uni-
ulm.de/expane/docs/HLH%202004%20Study%20Protocol.pdf 
iv ETHICAL CONSIDERATIONS FOR CLINICAL TRIALS ON MEDICINAL PRODUCTS CONDUCTED 
WITH THE PAEDIATRIC POPULATION (2008) - Recommendations of the ad hoc group for the development of 
implementing guidelines for Directive 2001/20/EC relating to good clinical practice in the conduct of clinical trials 
on medicinal products for human use 

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point when measured every hour or 2 hours, and within no more than 15 minutes before or after the 
planned time-point when measured every 4 or 8 hours. 
- Infusion start delayed by no more than 3 hours,  
- Physical examination prior to each infusion performed in the late afternoon of the previous day 
instead of the morning of the infusion (the data will be captured on the infusion day of the eCRF), 
- Assessments performed within no more than 48h before or after the planned time-point during the 
Follow-up Period. 
8.1 
SCREENING 
Patients will be screened for eligibility prior to enrolment into the study. The Investigator must keep a log 
of the patients screened for the study and reasons for non-eligibility, if applicable. 
Screening evaluations should be completed within 1 week prior to the first administration of study drug 
(SD0) as detailed below. In the event that a patient’s medical condition warrants rapid treatment 
initiation, and to avoid unnecessary repetition of recent interventions, results of tests which have been 
performed as part of the normal patient’s care at the site not more than 12 days prior to first NI-0501 
infusion, may be considered for screening purposes (inclusion/exclusion criteria checks) with the 
agreement of both the Sponsor and Investigator. 
The following information must be collected and the following procedures must be performed: 
Patient information: 
 
 Demographic and medical history 
 Medications at screening 
 HLH induction treatment received 
 Date of HLH diagnosis 
 Molecular diagnosis and perforin expression granule release assay 
and other functional tests performed for the diagnosis of HLH if 
available  
 Date and criteria of eligibility  
Clinical Assessment: 
 
 Physical examination, including liver and spleen size (in cm from 
costal grill) as well as height (in cm) and weight (in kg) to 
measure Body Surface Area (BSA) 
Procedure: 
 Electrocardiogram (ECG) 
Imaging: 
 
 3D abdominal ultrasound  with measurements of spleen and liver 
size 
 Chest X-ray   
 Brain magnetic resonance imaging (MRI): only if reactivation due 
to CNS symptoms 
Search for infections: 
 
 Tuberculosis (via IFNγ-release assay or PPD test. In a patient 
having received BCG vaccination a PPD test must be performed 
and combined with IFNγ-release assay if the PPD result is ≥5mm. 
In addition, search for Tuberculosis via polymerase chain reaction 
[PCR] in any relevant specimen should be performed to have a 
baseline, as this test will be used during the course of the study to 

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perform regular TB monitoring.  
 Adenoviruses, EBV, CMV by quantitative PCR  
 Herpes Simplex Virus (HSV), Herpes Zoster Virus (HZV), 
Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Human 
Immune Deficiency Virus (HIV) by PCR monitoring or serology 
 Atypical mycobacteria, Histoplasma Capsulatum, Shigella, 
Salmonella, Campylobacter and Leishmania,  as appropriatev. The 
presence of Leishmania can also be ascertained by direct bone 
marrow observation 
Laboratory: 
 Complete blood count (CBC) with differential count in order to 
define an absolute lymphocyte count, and a dedicated lymphocyte 
subsets count 
 Triglycerides (fasting)  
 Coagulation tests: activated partial thromboplastin, prothrombin 
time, D-dimers and fibrinogen 
 Biochemistry: glucose and electrolytes, ferritin, C-Reactive 
Protein (CRP), Aspartate Aminotransferase (AST), Alanine 
Aminotransferase (ALT), gamma Glutamyl Transferase (γGT), 
Alkaline Phosphatase (ALP), Lactate Dehydrogenase (LDH), 
bilirubin, albumin, creatinine and urea 
 IgG level 
 Urinalysis: glucose, blood, protein, leucocytes, ketones, pH and 
specific gravity 
 Pregnancy test (blood or urine), if applicable 
Histopathology: 
 
 Lumbar puncture for cerebrospinal fluid (CSF), if the coagulation 
function allows 
Immunogenicity: 
 Baseline assessment for anti-drug antibodies (ADAs) 
8.2 
STUDY DAY-1 (SD-1) 
If not already hospitalized, the patient will enter the hospital on the day prior to the first NI-0501 infusion 
(i.e. on SD-1).  
On this day, the following treatments will be administered:   
 
Dexamethasone will be administered daily, as described in Section 6.1 
 
Prophylactic treatment, as described in Section 6.2 
                                                 
 
v A patient with a clinical assessment (including chest X-ray) not indicative of the presence of an active infection, 
provided that a usable specimen has been taken, and the microbiological analysis is ongoing, can be enrolled prior 
to the availability of the results. 

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Clinical assessments: 
 
 Vital signs: temperature, heart and respiratory rate, blood pressure 
and oxygen saturation  
 Physical examination, including spleen and liver size (in cm from 
costal grill) as well as the weight 
8.3 
STUDY DAY 0 (SD0, Day of first infusion of NI-0501)  
8.3.1 
Pre-NI-0501 infusion 
The following baseline assessments are conducted on SD0, before NI-0501 is administered:  
Clinical assessments: 
 
 Vital signs: temperature, heart and respiratory rate, blood pressure 
and oxygen saturation  
 Physical examination, including spleen and liver size (in cm from 
costal grill) as well as the weight 
 Initiation of continuous cardiac monitoring and pulse oxymetry 
Laboratory: 
 Complete blood count (CBC) with differential count in order to 
define an absolute lymphocyte count  
 Triglycerides (fasting)  
 Coagulation tests: aPTT, PT, D-dimers and fibrinogen 
 Biochemistry: glucose and electrolytes, ferritin, CRP, AST, ALT, 
γGT, ALP, LDH, bilirubin, albumin, creatinine and urea 
 Urinalysis: glucose, blood, protein, leucocytes, ketones, pH and 
specific gravity (if not done at screening) 
Pharmacokinetics: 
 NI-0501 serum concentration 
Pharmacodynamics/ 
Exploratory parameters: 
 sCD25, IL-10, CXCL-9, CXCL-10 and CXCL-11 
 Free IFNγ  
8.3.2 
During NI-0501 infusion  
Immediately after the infusion of NI-0501 has started, the following assessments will be conducted: 
Clinical assessment: 
 
 Vital signs (blood pressure, heart and respiratory rate and oxygen 
saturation) and skin aspect (rash, coloration, sweating): 
- every 5 minutes during the first 15 minutes of the infusion and 
then 
- every 10 minutes until completion of infusion  
 Continuous cardiac and pulse oxymetry monitoring. 
8.3.3 
At the end of NI-0501 infusion 
At the end of the infusion of NI-0501, the following assessments will be conducted: 
Pharmacokinetics: 
 NI-0501 serum concentration 

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8.3.4 
During the 24 hours following NI-0501 infusion 
During the 24 hours following NI-0501 infusion, the following procedures will be carried out: 
Clinical assessments: 
 
 Vital signs (blood pressure, heart and respiratory rate and oxygen 
saturation), temperature, and skin aspect (rash, coloration and 
sweating): 
- every hour for the first 4 hours after infusion and then 
- every 2 hours for the next 12 hours after infusion and then  
- every 4 hours until completion of 24-hour monitoring 
 Continuous cardiac and pulse oxymetry monitoring 
Procedure: 
 ECG (in the afternoon) 
8.4 
STUDY DAY 1 (SD1) 
The following assessments will be carried out 24 hours after the first NI-0501 infusion on SD1 (the day 
after the first infusion of NI-0501): 
Clinical assessments: 
 
 Vital signs: temperature, heart rate, blood pressure and respiratory 
rate every 8 hours  
 Physical examination, including spleen and liver size (in cm from 
costal grill) 
Laboratory : 
 CBC with differential count in order to define an absolute 
lymphocyte count will be performed. In case of a 5-fold increase 
in lymphocyte count compared to baseline (SD0 pre infusion) or 
of a total lymphocyte count greater than the upper limit of normal 
for age, additional investigations will be required, e.g. blood flow 
cytometry 
  Triglycerides (fasting)  
 Coagulation tests: aPTT, PT, D-dimers and fibrinogen 
 Biochemistry: glucose and electrolytes, ferritin, CRP, AST, ALT, 
γGT, ALP, LDH, bilirubin, albumin, creatinine and urea 
 Urinalysis: glucose, blood, protein, leucocytes, ketones, pH and 
specific gravity 
Pharmacokinetics: 
 NI-0501 serum concentration from blood sample taken around 24 
h after start of NI-0501 infusion 
Pharmacodynamics/ 
Exploratory Parameters: 
 sCD25, IL-10, CXCL-9, CXCL-10 and CXCL-11 
 Total IFNγ 
8.5 
STUDY DAY 2 (SD2) 
48 hours after the first administration of NI-0501, the same procedure performed on SD1 (see Section 
8.4) must be repeated, with PK sample taken around 48h after start of NI-0501 infusion.  

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8.6 
FROM SD3 TO SD15 (REMAINDER OF TREATMENT PERIOD 1) 
8.6.1 
Assessments to be performed pre-NI-0501 infusion on SD3, SD6, SD9, SD12 and SD15 
The following procedures will be performed prior to the start of the NI-0501 infusion. Please note some 
assessments will only be performed at selected visits as indicated below:  
Clinical assessments: 
Mandatory at each visit 
(namely SD3, SD6, SD9 , 
SD12 and SD15) 
 
 Vital signs (blood pressure, oxygen saturation, heart and 
respiratory rate), temperature, and skin aspect (rash, coloration and 
sweating) 
 Physical examination, including spleen and liver size (in cm from 
costal grill) as well as weight 
 Initiation of continuous cardiac monitoring and pulse oxymetry 
Laboratory: 
Mandatory only on SD3 
and SD6 
 
 CBC with differential count in order to define an absolute 
lymphocyte count and a dedicated lymphocyte subsets count. In 
case of a 5-fold increase in lymphocyte count compared to 
baseline (SD0 pre infusion) or of a total lymphocyte count greater 
than the upper limit of normal for age, additional investigations 
will be required, e.g. blood flow cytometry.  
 Triglycerides (fasting)  
 Coagulation tests: aPTT, PT, D-dimers and fibrinogen 
 Biochemistry: glucose and electrolytes, ferritin, CRP, AST, ALT, 
γGT, ALP, LDH, bilirubin, albumin, creatinine and urea 
 Urinalysis: glucose, blood, protein, leucocytes, ketones, pH and 
specific gravity 
Search for infections: 
Mandatory only on SD12 
 Tuberculosis via polymerase chain reaction [PCR] in any relevant 
specimen 
 Adenoviruses, EBV, CMV by quantitative PCR  
Imaging: 
Mandatory only on SD15 
 3D abdominal ultrasound with measurements of spleen and liver 
size 
Pharmacokinetics: 
Mandatory at each visit  
 NI-0501 serum concentration 
Pharmacodynamics/ 
Exploratory parameters: 
Mandatory at each visit  
 sCD25, IL-10, CXCL-9, CXCL-10 and CXCL-11  
 Total IFNγ  
8.6.2 
During and immediately after NI-0501 infusion  
Following completion of all pre-infusion assessments as listed above, on SD3, SD6, SD9, SD12 and 
SD15, patients will receive NI-0501 by IV infusion over a period of 1 hour (or more depending on the 
volume to infuse). 
The following procedures will be carried out (or continued) during or immediately after the infusion of 
NI-0501 at each visit: 

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Clinical assessments: 
 
 Vital signs (blood pressure, oxygen saturation, heart and 
respiratory rate), temperature, and skin aspect (rash, coloration and 
sweating): 
- about every 15 minutes until completion of infusion  
 Continuous cardiac and pulse oxymetry monitoring 
Pharmacokinetics: 
Mandatory at each visit 
after end of NI-0501 
infusion   
 NI-0501: serum concentration  
8.6.3 
During the 24 hours following NI-0501 infusion  
The following assessments will also be performed during the 24 hours after the infusion of NI-0501 at 
each visit:  
Clinical assessments: 
 
 Vital signs (blood pressure, oxygen saturation, heart and 
respiratory rate), temperature, and skin aspect (rash, coloration and 
sweating):  
- about every 4 hours until completion of 24-hour monitoring 
 Continuous cardiac and pulse oxymetry monitoring 
8.6.4 
Assessments to be performed on the day before the infusion 
Assessments will also be performed in-between infusion days between SD3 and SD15. Please note that 
some assessments will only be performed at selected time-points:  
Clinical assessments: 
Mandatory at each visit  
 Vital signs (blood pressure, heart and respiratory rate), 
temperature, and skin aspect (rash, coloration and sweating):  
- every 8 hours  
 Physical examination, including spleen and liver size (in cm from 
costal grill) 
Laboratory: 
Mandatory at each visit  
 CBC with differential count 
 Triglycerides (fasting)  
 Coagulation tests: aPTT, PT, D-dimers and fibrinogen 
 Biochemistry: glucose and electrolytes, ferritin, CRP, AST, ALT, 
γGT, ALP, LDH, bilirubin, albumin, creatinine and urea 
 Urinalysis: glucose, blood, protein, leucocytes, ketones, pH and 
specific gravity 
Search for infections: 
Mandatory only on SD5 
 Tuberculosis through PCR in any relevant specimen 
 Adenoviruses, EBV, CMV by quantitative PCR  
Pharmacokinetics: 
Mandatory only on SD5 
and SD8 
 NI-0501 serum concentrations from blood taken around 48 h after 
start of previous NI-0501 infusion 

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Pharmacodynamics/ 
Exploratory parameters: 
Mandatory only on SD5 
and SD8 
 sCD25, IL-10, CXCL-9, CXCL-10 and CXCL-11  
 Total IFNγ  
8.7 
TREATMENT PERIOD 2 (Weeks 3 to 8)  
Treatment period 2 includes the next infusions that will be performed twice a week, no closer together 
than 3 days. 
 The safety and efficacy monitoring/assessment visits should occur every 6 days in Treatment Period 2, 
with an allowed time-window of  48 hours in order to be able to combine these visits with NI-0501 
infusions. In case a dose modification is deemed necessary, the required clinical and laboratory data must 
be recorded/reported.  
If patients are no longer hospitalized, they must return to the sites to receive their NI-0501 infusions and 
to perform the planned assessments as per protocol. Patients in out-patient status must remain at the site 
for 8 hours following each NI-0501 infusion.  
8.7.1 
Assessments to be performed on all Infusion Days  
8.7.1.1 Prior to Infusion 
The following procedures will be performed on infusion days prior to the start of NI-0501 infusion: 
Clinical assessments: 
Mandatory prior to each 
infusion  
 Vital signs (blood pressure, oxygen saturation, heart and 
respiratory rate), temperature, and skin aspect (rash, coloration and 
sweating)  
 Physical examination, including spleen and liver size (measure in 
cm from costal grill) as well as weight 
 Initiation of continuous cardiac monitoring and pulse oxymetry 
Pharmacokinetics: 
At maximum, every 
infusion 
 NI-0501 serum concentration will be measured if required, 
depending 
on 
patient 
weight, 
condition, 
previous 
drug 
concentration and potential change in dosing regimen. Sampling 
schedule will be proposed by the Sponsor and discussed with the 
site. 
Pharmacodynamics/ 
Exploratory parameters: 
At maximum, every 
infusion 
 
 sCD25, IL-10, CXCL-9, CXCL-10 and CXCL-11  
 Total IFNγ  
These parameters will be measured if required, depending on 
patient weight, condition, previous drug concentration and 
potential change in dosing regimen. Sampling schedule will be 
proposed by the Sponsor and discussed with the site. 
8.7.1.2 During Infusion and at the end of infusion 
Following completion of all pre-infusion assessments as listed above, patients will receive NI-0501 by IV 
infusion over a period of 1 hour (or more depending on the volume to infuse). 
The following procedures will be carried out (or continued) during infusion of NI-0501 or just after its 
end: 

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Clinical assessments: 
 
 
 Vital signs (blood pressure, oxygen saturation, heart and 
respiratory rate), temperature, and skin aspect (rash, coloration and 
sweating):  
- every 15 minutes until completion of infusion  
 Continuous cardiac and pulse oxymetry monitoring 
Pharmacokinetics at the 
end of infusion: 
At maximum, every 
infusion 
 NI-0501 serum concentration will be measured if required, 
depending 
on 
patient 
weight, 
condition, 
previous 
drug 
concentration and potential change in dosing regimen. Sampling 
schedule will be proposed by the Sponsor and discussed with the 
site. 
8.7.1.3 Post Infusion 
Until the patient is discharged, the assessments detailed in Section 8.3.4 above (for SD0 post-infusion) 
can be performed over 24 hours or 8 hours, depending on the Investigator’s judgment and patient’s 
condition, but in any case with the time intervals reduced to 4-hourly monitoring. 
From patient’s discharge until last infusion, the assessments detailed in Section 8.3.4 above (for SD0 
post-infusion) will be performed over the 8 hours post NI-0501 infusion with the time intervals reduced 
to 4-hourly monitoring. 
Clinical assessments: 
 
 Vital signs (blood pressure, heart and respiratory rate and oxygen 
saturation), temperature, and skin aspect (rash, coloration and 
sweating): 
- every 4 hours until completion of either 8 or 24-hour monitoring 
 Continuous cardiac and pulse oxymetry monitoring 
8.7.2 
Efficacy and safety assessments  
These assessments will be carried out systematically as described in section 8.7.  
 In case of an early transplant (after 4 weeks of treatment), the follow-up visit schedule should be 
commenced after the last infusion. 
Some assessments will only be performed at selected visits as indicated: 
Clinical assessments: 
Mandatory at each visit  
 Vital signs (blood pressure, heart and respiratory), temperature and 
skin aspect (rash, coloration and sweating) 
 Physical examination, including spleen and liver size (in cm from 
costal grill) 
Laboratory: 
Mandatory at each visit 
 CBC with differential count 
 Triglycerides (fasting)  
 Coagulation tests: aPTT, PT, D-dimers and fibrinogen 
 Biochemistry: glucose and electrolytes, ferritin, CRP, AST, ALT, 
γGT, ALP, LDH, bilirubin, albumin, creatinine and urea 
 Urinalysis: glucose, blood, protein, leucocytes, ketones, pH and 
specific gravity 

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Search for infections: 
Mandatory every 2 weeks 
(unless required more 
frequently by the 
presence of a documented 
or suspected infection) 
 Tuberculosis via PCR in any relevant specimen  
 Adenoviruses, EBV, CMV by quantitative PCR  
Imaging: 
 
 Chest X-Ray (every 4 weeks) 
 3D abdominal ultrasound with measurements of spleen and liver 
size (every 2 weeks) 
8.7.3 
End of Treatment visit: three days after the last NI-0501 infusion   
The end of treatment visit should always be carried out 3 days (1 day) after last NI-0501 infusion. 
This visit will include the following: 
Clinical assessment: 
 
 Vital signs (blood pressure, oxygen saturation, heart and 
respiratory rate) and temperature 
 Physical examination, including spleen and liver size (measure in 
cm from costal grill) as well as height and weight 
Procedure: 
 ECG 
Laboratory: 
 
 CBC with differential count 
 Triglycerides (fasting)  
 Coagulation tests: aPTT, PT, D-dimers and fibrinogen 
 Biochemistry: glucose and electrolytes, ferritin, CRP, AST, ALT, 
γGT, ALP, LDH, bilirubin, albumin, creatinine and urea 
 Urinalysis: glucose, blood, protein, leucocytes, ketones, pH and 
specific gravity 
Search for infections 
 Tuberculosis via PCR   
Imaging: 
 Chest X-ray 
 3D abdominal ultrasound  with measurements of spleen and liver 
size 
Pharmacokinetics: 
 
 NI-0501 serum concentration  
Pharmacodynamics/ 
Exploratory parameters: 
 
 sCD25, IL-10, CXCL-9, CXCL-10 and CXCL-11  
 Total IFNγ  
Immunogenicity: 
 Presence of anti-NI-0501 antibodies (ADA) 
8.8 
FOLLOW-UP VISITS (WEEKLY POST LAST NI-0501 INFUSION) 
The follow-up period consists of weekly visits, to be performed approximately two (2) and three (3) 
weeks after the last NI-0501 infusion. 

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In case the patient starts conditioning during the 4-week follow-up, the closer weekly follow-up visit will 
be combined with the pre-conditioning visit scheduled at the site, so that clinical and laboratory 
parameters can be recorded before the administration of the conditioning drugs.  
Combining the pre-transplant visit with the weekly follow-up visit should also be attempted if transplant 
takes place during the follow-up period.   
Some assessments will only be performed at selected visits as indicated below: 
Clinical assessments: 
 
 
Vital signs (blood pressure, oxygen saturation, heart and 
respiratory rate) and temperature 
 
Physical examination, including spleen and liver size (measure in 
cm from costal grill) as well as weight 
Laboratory: 
 
 
CBC with differential count 
 
Triglycerides (fasting)  
 
Coagulation tests: aPTT, PT, D-dimers and fibrinogen 
 
Biochemistry: glucose and electrolytes, ferritin, CRP, AST, ALT, 
γGT, ALP, LDH, bilirubin, albumin, creatinine and urea 
 
Urinalysis: glucose, blood, protein, leucocytes, ketones, pH and 
specific gravity 
Search for infection: 
Mandatory only on week 
2 post last infusion 
 
Tuberculosis via PCR 
 
Adenoviruses, EBV, CMV by quantitative PCR 
Imaging: 
Mandatory only at pre-
conditioning visit 
 
3D Abdominal ultrasound with measurements of spleen and liver 
size 
Pharmacokinetics: 
 
NI-0501 serum concentration 
Pharmacodynamics/ 
Exploratory parameters: 
 
sCD25, IL-10, CXCL-9, CXCL-10 and CXCL-11  
 
Total IFNγ  
8.9 
STUDY COMPLETION VISIT (4TH WEEK AFTER THE LAST NI-0501 INFUSION) 
OR WITHDRAWAL VISIT 
Patients will attend a final study completion visit, four weeks after the last NI-0501 administration. In 
case a patient enters the NI-0501-05 study while still receiving NI-0501, the study completion visit is 
replaced by the EoT visit under the NI-0501-04 study. 
The same assessment procedures should also be followed by the Investigator for any patient who is 
withdrawn prematurely from the study as soon as possible after the decision to withdraw is made. For 
patients who withdraw from the study as a result of their own decision or the decision of their 
parent/guardian, the Investigator should contact the patient (or parent/guardian) and ask them to attend a 
withdrawal visit as soon as possible. Withdrawal (WD) visits should be scheduled within 30 days of 
termination whenever possible. 
Patients who are withdrawn due to a serious adverse event (SAE) should be followed-up until the 
resolution of the event or until the outcome of the event is known and stable. 

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The following assessments will be performed at the Study Completion Visit or WD visit: 
Clinical assessments: 
 
 Vital signs (blood pressure, oxygen saturation, heart and 
respiratory rate) and temperature 
 Physical examination, including spleen and liver size (measure in 
cm from costal grill) as well as height and weight 
Procedure: 
 ECG 
Laboratory: 
 
 CBC with differential count 
 Triglycerides (fasting) 
 Coagulation tests: aPTT, PT, D-dimers and fibrinogen 
 Biochemistry: glucose and electrolytes, ferritin, CRP, AST, ALT, 
γGT, ALP, LDH,  bilirubin, albumin, creatinine and urea 
 Urinalysis: glucose, blood, protein, leucocytes, ketones, pH and 
specific gravity 
Imaging: 
 Chest X-ray 
Search for infection: 
 
 Tuberculosis via PCRAdenoviruses, EBV, CMV by quantitative 
PCR 
Pharmacokinetics: 
 NI-0501 serum concentration 
Pharmacodynamics/ 
Exploratory parameters: 
 sCD25, IL-10, CXCL-9, CXCL-10 and CXCL-11  
 Total IFNγ  
Immunogenicity: 
 Presence of anti-NI-0501 antibodies (ADA) 
8.10 ASSESSMENTS IN CASE OF UNPLANNED (UNSCHEDULED) VISITS 
Unplanned visits may occur should the patient need to be assessed or treated for any clinical condition 
that arises during the study. This may include the evaluation and follow-up of AEs, SAEs or laboratory 
tests. The following assessments (as detailed in the Schedule of Assessments) should always be 
performed at minimum, but additional assessments may be added according to the clinical judgment of 
the Investigator. 
Clinical assessments: 
 
 Vital signs (blood pressure, heart and respiratory rate and oxygen 
saturation) and temperature 
 Physical examination, including spleen and liver size ( in cm from 
costal grill) as well as weight 
8.11 UNPLANNED ASSESSMENTS 
Additional PK/PD samples may be required to better characterize the PK/PD profile and/or for safety 
reasons.  
The number of additional samples taken will depend on the weight and health status of the patient. 
Sampling schedule will be proposed by the Sponsor and discussed with the site. 

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9 
SAFETY MONITORING 
9.1 
STUDY SCIENTIFIC OVERSIGHT 
A Scientific Steering Committee (SSC) composed of international experts in primary and secondary HLH 
has been involved in the preparation of study design and protocol writing. 
This SSC has also been consulted for the composition of the DMC, the selection of its members and the 
elaboration of the DMC Charter (see Section 9.5.1).  
The SSC will continue to play an advisory role throughout the course of the study and will perform 
evaluations of the results for the Sponsor as well as for the DMC. Please refer to Appendix D for full 
details of membership of the SSC. 
The 
DMC, 
composed 
of 
relevant 
experts 
(2 
pediatric 
onco-hematologists, 
2 
pediatric 
immunodeficiency/infectious disease specialists, a bio-statistician and a specialist in ethics), will oversee 
the study conduct and evaluate safety and relevant efficacy parameters. See Section 9.5.1 for further 
details of the DMC.  
9.2 
DESCRIPTION OF SAFETY PARAMETERS 
Evaluation of NI-0501 tolerability and safety will be based on the following parameters: 
 
Adverse events (AEs), with special attention being paid to events potentially related to the 
infusion of NI-0501 (events occurring during the infusions and within 24 hours post infusion) 
and to the occurrence of infections 
 
Laboratory parameters:   
- 
Complete blood count (CBC), 
- 
Coagulation tests (activated partial thromboplastin, prothrombin time), d-Dimer and 
fibrinogen 
- 
Biochemistry: glucose and electrolytes, ferritin, C-reactive protein (CRP), aspartate 
aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), 
γGT, LDH, triglycerides, bilirubin, albumin, creatinine and urea. 
- 
Urinalysis 
 
Vital signs: temperature, heart and respiratory rate, blood pressure, oxygen saturation 
 
Physical examination with particular attention paid to: 
- weight evolution, occurrence of oedema or ascite 
- occurrence of skin rashes, jaundice, purpura, bleeding, edema 
- signs of infections (e.g tonsillitis, lymphadenopathies, cough and/or dyspnea),  
- neurological examination  
- liver and spleen size 
 
Immunogenicity: development of anti-NI-0501antibodies  
9.3 
RECORDING AND REPORTING SAFETY PARAMETERS 
9.3.1 
 Adverse events 
Adverse events (AEs) are defined as any undesirable experience occurring to a subject during the study, 
whether or not considered related to the investigational product. All adverse events (AEs) reported 
spontaneously by the patients or his/her relatives or observed by the Investigator or his staff during the 

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clinical study from the signature of the ICF up to and including the end-of-study visit will be reported on 
the AE data collection form.  
Medical conditions present at screening should be recorded in the medical history section of the eCRF. 
An AE which occurs between start of screening visit and start of first IMP administration will be 
considered as a pre-treatment AE.  
Any AE that occurs after the start of the first IMP administration will be considered as a Treatment 
Emergent Adverse Event (TEAE). 
However, if a pre-existing medical condition recorded in the medical history worsens (clinically 
significant change in intensity or frequency), it must be recorded as an AE in the eCRF and, depending 
on the time of its occurrence, will be considered as a pre-treatment AE or a TEAE. If a medical condition 
recorded as a pre-treatment AE worsens post IMP administration, it will be recorded in the eCRF as a 
separate TEAE. 
For all AEs, the following will be assessed and recorded: intensity, relationship to IMP, action taken 
regarding IMP, any treatment received and outcome to date.  
Intensity of adverse events will be graded on a three-points scale (mild, moderate, severe) using the 
modified WHO (World Health Organization) toxicity scale (Grade 3 and 4 are considered to be the 
severe grade). If AE severity is not mentioned in the scale, assessment will be made using the following 
definitions: 
 
Mild: Discomfort noticed but no disruption of normal activity 
 
Moderate: Discomfort sufficient to reduce or affect normal daily activity 
 
Severe: Inability to work or perform normal daily activity. 
For a given AE, the assessment of its intensity should reflect the highest grade (on the 3 points scale 
mentioned above) reported during its course (except when the intensity of a pre-treatment AE increases 
after treatment initiation, as indicated above). 
AEs characterized as intermittent require documentation of onset and duration of each episode. 
The relationship of adverse events to the Investigational Medicinal Product (IMP) will be assessed by the 
Investigator using a “Yes/No” classification. A “Yes” relationship infers that there is a reasonable 
suspected causal relationship to the trial medication. The expression “reasonable causal relationship” is 
meant to convey that there are facts, evidence or arguments to suggest a causal relationship. In this study 
NI-0501 is the only IMP. 
9.3.2 
Serious Adverse Events 
A serious adverse event (SAE) is any untoward medical occurrence that: 
 
results in death (note: death is an outcome, not an event); 
 
is life-threatening; (note: the term "life-threatening" refers to an event in which the patient 
was at immediate risk of death at the time of the event; it does not refer to an event which 
could hypothetically have caused a death had it been more severe); 
 
requires in-patient hospitalization or prolongs an existing hospitalization; 
 
results in persistent or significant disability/incapacity; 
 
is a congenital anomaly/birth defect; 
 
is medically significant or requires intervention to prevent one or other of the outcomes listed 
above (note: examples are intensive treatment in an emergency room or at home for allergic 
bronchospasm; blood dyscrasias or convulsions that do not result in hospitalization).  
SAEs are to be reported to NovImmune immediately. 

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The term severe is a measure of intensity/severity: thus a severe adverse event is not necessarily serious. 
For example, nausea of several hours’ duration may be rated as severe, but may not be clinically serious. 
For the purposes of this study, the following will not be considered as serious adverse events: 
 
Elective hospitalizations or surgical procedures that are a result of a patient’s pre-existing 
condition(s) which have not worsened since receiving IMP. Such events should still be 
recorded as adverse events in the eCRF; 
 
Hospitalization as requested per protocol for NI-0501infusion and study visits. 
Any serious clinical adverse event or clinically significant abnormal laboratory test value that occurs 
during the course of the study, irrespective of the treatment received by the subject, must be 
communicated by the Investigator to NovImmune, by fax or electronic transmission, within 24 hours of 
awareness. 
For the initial SAE report, the Investigator should report all available case details concerning the patient 
and the event, using the NovImmune SAE reporting standard form (see Appendix F).  
NovImmune contact information for SAE reporting: 
Relevant follow-up information on SAEs should be forwarded to NovImmune as soon as it becomes 
available. In addition, the Investigator must be available to answer without delay any request for follow-
up information or questions NovImmune may have regarding the SAE. 
All SAEs will be recorded on the appropriate page of the eCRF. They will be reviewed, evaluated and 
followed through to resolution by a study physician- 
Relationship to the study drug will be established by the Investigator in order to define the need for 
expedited reporting. 
9.3.3 
 SUSAR reporting 
Unexpected adverse reactions are all untoward and unintended responses to an investigational product 
related to any dose administered 
These reactions are SUSARs if the following two conditions are met: 
1) the event must be serious (see section 9.3.2); 
2) there must be a certain degree of probability that the event is a harmful and an undesirable reaction to 
the medicinal product under investigation, regardless of the administered dose; 
NovImmune will report directly or through delegation to a third party all SUSARs to the investigators 
and the relevant Ethics Committees, in writing as soon as practical, but at least within 15 days. Fatal and 
life-threatening suspected SUSARs will be reported within 7 calendar days, with another 8 days for 
completion of the report. 
NovImmune will report all SUSARs to the EMA's EudraVigilance database within 15 days, as well as to 
the relevant National Competent Authorities when required. Fatal and life-threatening suspected SUSARs 
will be reported within 7 calendar days, with another 8 days for completion of the report.  

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9.3.4 
 Managing Abnormal Laboratory Test Values  
All safety laboratory tests (haematology and blood biochemistry), for each visit time-point, should be 
captured in the database from the local laboratory and should not be reported as AEs unless specific 
treatment is given for the abnormality (e.g. a blood transfusion is given for a low haemoglobin) or a 
laboratory abnormality leads to further investigation and the diagnosis of a new clinical event (e.g. a high 
white cell count is found to be due to incidental leukaemia). In this event the clinical diagnosis should be 
reported on the AE form, not the laboratory abnormality leading to the diagnosis.  
9.4 
FOLLOW-UP OF SAFETY PARAMETERS 
9.4.1 
 Treatment and Follow-up of Adverse Events 
Adverse events, especially those for which the relationship to the study drug has been assessed as ‘Yes’, 
should be followed-up until the event has returned to baseline status or has stabilised. If a clear 
explanation is established, it should be recorded on the CRF. 
All SAEs must be followed-up until the event has either resolved or reached a stable clinical outcome. 
9.4.2 
 Follow-up of Abnormal Laboratory Test Values 
In the event of unexplained clinically relevant abnormal laboratory test values, the tests should be 
repeated immediately and followed-up until the values have returned to within normal range and/or an 
adequate explanation of the abnormality is found. If a clear explanation is established, it should be 
recorded on the eCRF. 
9.4.3 
 Pregnancy 
In the event that a pregnancy occurs during the trial course, it must be reported to NovImmune within 24 
hours of awareness. This includes pregnancies occurring in partners of male enrolled patients. All 
information pertaining to the pregnancy should be reported using the NovImmune Pregnancy form (see 
Appendix F). Pregnancies should be followed until conclusion to obtain outcome information. 
Occurrence of a pregnancy in a study participant will preclude any further IMP administration and the 
patient will be withdrawn.  
On withdrawal the assessments presented in the Schedule of Assessments are to be performed (see 
Section 8.9). 
9.5 
BENEFIT/RISK MANAGEMENT 
9.5.1 
 Safety Surveillance Management 
The main responsibility of the DMC is to review all safety and efficacy data as they are generated to 
ensure that no patient is exposed to unnecessary risk and to continuously assess the benefit/risk profile of 
NI-0501. 
The DMC can recommend treatment discontinuation for individual patients as well as to halt the entire 
study temporarily or permanently. Predefined stopping rules will guide the DMC review process. For 
more details, see stopping rules in Section 10. 
9.5.2 
 General Benefit/Risk Considerations  
9.5.2.1 Potential benefits 
On the basis of the data available to date28, NI-0501 administration has shown the potential to improve or 
resolve relevant clinical and laboratory abnormalities of HLH, including CNS signs and symptoms when 
present, allowing most of the patients to proceed to HSCT (9 out of 15 patients who have completed the 

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study with 3 additional patient ready for HSCT pending donor availability). Three patients underwent 
HSCT only after 4 weeks of NI-0501 treatment. The response to NI-0501 seems independent of: 
- the presence and type of causative mutations  
- the presence and type of an infectious trigger 
- the line of treatment, although data obtained in patients in first line are still limited.  
For more details refer to the latest Investigator’s Brochure (presently version 5.0, dated 20 January 2016). 
9.5.2.2 Risks analysis 
 
Risks related to NI-0501 
NI-0501 is a monoclonal antibody of IgG1. 
Upon the administration of mAbs, which are proteins, acute infusion reactions can occur. These may 
happen during the infusion or in the subsequent hours (usually within the first 24 hours)29. 
These reactions are either IgE-mediated type I hypersensitivity reactions (anaphylactic reactions), or 
anaphylactoid reactions not mediated by IgE. True anaphylactic reactions usually do not occur upon 
initial infusion and require a certain sensitization. In contrast, the pathophysiology of anaphylactoid 
reactions appears to be secondary to the release of cytokines consequent to a mAb binding to circulating 
antigen-expressing cells. However, the clinical manifestations of anaphylactic and anaphylactoid 
reactions overlap, and both may lead to life-threatening conditions, involving cardiovascular, respiratory, 
central nervous, gastro-intestinal, and cutaneous systems. The management of anaphylactic and 
anaphylactoid reactions involves immediate administration of oxygen, epinephrine, vasopressors, 
bronchodilators, corticosteroids, and/or antihistamines.  
After 14 single infusions to HVs up to and including the dose of 3 mg/kg and more than 380  infusions 
administered to HLH patients (either in the context of the NI-0501-04 and NI-0501-05 studies or in 
patients who received NI-0501 in compassionate use) up to and including the dose of 10 mg/kg, no 
significant infusion related reaction has been observed. Only transient erythematous rashes localized to 
the extremities (feet and/or hands) resolving spontaneously have been observed in a few patients during 
the first infusions of NI-0501 in the NI-0501 study. On a few occasions, administration of NI-0501 has 
been performed through a peripheral venous access and all infusions were uneventful.   
 
When administered to humans, most mAb therapeutics elicit some level of antibody response 
(anti-drug antibodies or ADAs) against the therapeutic product, as early as after the first 
exposure. No sign of immunogenicity has been reported in the NI-0501 study in healthy 
volunteers. The presence of  ADAs will be measured throughout this study as per regulatory 
recommendations. The full analysis is planned to be performed at the end of the NI-0501-04 
study.   Data accumulated so far (in particular PK profiles and a negative ADA search 
performed in the only patient who developed hemolytic anemia during conditioning) have 
not led to suspect the presence of ADA.  Risks related to the target 
The impact on the immune defense caused by the neutralization of IFNγ is known from patients with 
inborn errors of the IL-12/23-IFN-γ circuit, particularly patients with complete or partial IFNγ receptor 
(R) deficiency, and subjects developing neutralizing auto anti-IFNγ antibodies. 
 
Patients with IFNγ R deficiency are prone to developing mycobacterial infections and, although to a 
lesser extent, Salmonella infections30,31. 
The mean age of the first environmental mycobacterial infection is 3.1 and 13.4 years in patients with 
complete and partial deficiency, respectively32. No systematic prophylaxis has been recommended in 
these patients.  

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If an infection occurs, appropriate antibiotherapy based on sensitivity of isolated species is prescribed. 
Individuals with anti-IFNγ auto-antibodies are also susceptible to develop mycobacterial infections (for 
the vast majority atypical mycobacterial infections), but also opportunistic infections (e.g. by 
Histoplasma Capsulatum, Salmonella, Herpes Zoster virus infections)6.  
Toxicological studies carried out with NI-0501 have shown an increased susceptibility of the monkeys 
having received NI-0501 to enteral pathogen infections when the pathogen is present into the intestinal 
tract prior to NI-0501 administration. Presence of infections due to Shigella, Salmonella and 
Campylobacter is part of the exclusion criteria. 
NI-0501 has been administered to 14 healthy volunteers in a single ascending dose study, which 
confirmed the absence of off-target toxicity. However a reactivation of herpes zoster virus, at a dose of 3 
mg/kg, observed in one healthy volunteer, may have been due to the pharmacodynamics effect of the 
drug (see clinical information section 1.1.3). It is difficult to draw a firm conclusion from one case, but it 
may be prudent, in the context of this pilot study, to include herpes zoster virus (HZV) prophylaxis for all 
patients.  
Preliminary data on infections reported in 17 patients enrolled in the NI-0501-04 study allow the 
following conclusions to be drawn:   
- Active infections, in particular EBV or CMV infections, which are often the trigger of the HLH initial 
episode or reactivation/worsening, were present  at the first administration of NI-0501. During NI-0501 
administration these infections resolved with appropriate antimicrobial treatment and while achieving 
control of HLH. 
- Patients developed infections during the course of NI-0501 treatment. However in the presence of a 
satisfactory control of HLH, and upon appropriate anti-microbial treatment, infections resolved.   
- None of the bacterial, viral or fungal infections reported were due to pathogens known to be favored by 
IFNγ neutralization. 
- The severity and duration of neutropenia, a hallmark of HLH as well as a potential consequence of 
previous HLH treatments, seemed to contribute significantly to the development of infections.  
A long and profound generalized immune suppression caused by HLH treatments administered prior to 
the initiation of NI-0501 constitutes a higher risk for infection development.  
- The patients who have received NI-0501 treatment as first line HLH therapy, no infection was reported 
during the NI-0501-04 study. 
- Systematic search for tuberculosis was negative and no atypical mycobacteria were detected in any of 
the patients. Stool/blood cultures were negative for Salmonella, Shigella or Campylobacter in all patients. 
For more details refer to the latest Investigator’s Brochure (presently version 5.0, dated 20 January 2016). 
 
Risk related to the study population 
Most of the patients are expected to be children of a young age affected by a life-threatening disease and 
are expected to have already received HLH treatments; therefore they carry variable degree of toxicities 
caused by those treatments. The data collected to date show that administration of NI-0501 does not 
aggravate these toxicities while showing, in general, a favorable impact on disease activity.  
All information collected with regards to disease stage and previous treatments will be taken into account 
for the analysis of adverse events.  
Toxicities of concomitant treatments, authorized or recommended during the administration of NI-0501, 
may also potentially expose the patients to adverse events; however their benefits may outweigh their 
risks. No safety concern related to the concomitant administration of NI-0501 with other treatments (e.g., 

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antimicrobial agents, anti-hypertensive drugs) has been reported so far. Corticosteroids have already been 
administered with IFNγ therapy in Crohn’s Disease without any particular safety concerns4. Of interest, 
tapering of glucocorticoids had no impact on safety and tolerability of NI-0501 infusions and has shown 
benefit for patients with steroids-related hypertension and generalized immunosuppression. 
Treatment-naïve patients are not exposed to risks associated with the drugs used conventionally to treat 
HLH (e.g., generalized immune suppression).  
As the risk that the NI-0501 treatment will not be able to control the disease may exist, thepossibility to 
receive additional HLH therapy to NI-0501 or to receive rescue therapy upon discontinuation of NI-0501 
is foreseen.  Risks associated with the administration of other therapies  after having received NI-0501 
seems to be very low, since no particular safety concerns related to the administration of NI-0501 were 
observed in patients receiving NI-0501 as second line therapy. Furthermore, two primary HLH patients 
have received other HLH therapies (e.g., etoposide and alemtuzumab) after NI-0501 discontinuation with 
no particular safety concern. For one of them, NI-0501 was re-initiated in Compassionate Use as the 
patient continued to worsen after the reintroduction of etoposide and the independent DMC judged the 
benefit risk profile of NI-0501 positive for this particular patient. Both these patients underwent HSCT. 
9.5.2.3 Risk minimization measures 
In view of the expected benefits the above listed risks are considered to be manageable in this patient 
population, if adequate minimization measures are put in place. An overview of specific measures to 
minimize the subject’s risk is provided below: 
 
Study designed with HLH experts forming the SSC 
 
Patients are hospitalized in specialized centers for the treatment of HLH, and therefore with 
all necessary emergency assistance equipment 
 
Inclusion/exclusion criteria: patients with malformations or severely altered functions (either 
due to the disease stage or to a concomitant disease), as well as patients with evidence of 
patent or latent TB infections or active mycobacteria, Shigella, Salmonella, Campylobacter  
or Leishmania infections, will not be included in the study (for details see Section 4.1)  
 
Infusion Related Reaction (IRR) monitoring: patients will be very closely monitored during 
the study drug infusions and for 24 hours following them to immediately identify if the 
subject is experiencing any IRRs. Each of the specialized centers will have physicians 
adequately trained in IRR management (please see NI-0501-04 Study Specific Risk 
Management Plan for further details). 
 
Recommendations on prophylaxis for Pneumocystis jiroveci, fungal infections, Herpes 
Zoster virus for all patients and Tuberculosis for a defined subpopulation (see section 6.2) in 
the protocol to avoid occurrence of these infections  
 
Close monitoring of potential infections through careful physical examination, laboratory 
parameters, active search for EBV, CMV, Adenoviruses, detection of tuberculosis  
 
Study safety surveillance by a Data Monitoring Committee 
The Development Risk Management Plan addresses risks, identify signals for early detection of safety 
concerns and propose mitigating actions. It will be part of the study documentation shared with 
Investigators and any relevant third party involved in the study. 
Stopping rules have been also developed to ensure individual patient safety and determine whether the 
study should be put on hold or terminated prematurely. 

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10 STOPPING RULES 
10.1 AT PATIENT LEVEL 
10.1.1 Decision to slow down or stop NI-0501 infusion due to systemic reaction 
During the infusion of NI-0501, any significant change compared to pre-infusion values in vital signs, 
such as those listed below, should trigger appropriate immediate care:  
 
Sudden and sustained increase or paradoxical decrease of heart rate (duration of more than 1 
minute) compared to pre-infusion value 
 
Respiratory rate abnormality (significant change compared to measure prior to infusion) 
 
Blood pressure drop or peak compared to the value prior to infusion for at least 2 consecutive 
measurements 
 
Significant skin modifications (change in color or abundant sweating) 
 
Sustained (an episode of more than 3 minutes duration or more than 3 episodes of shorter 
duration i.e. 1 minute) oxygen desaturation (below 90%) 
The decision to slow down the infusion will be taken by the physician in the event of any of the above 
mentioned occurrences. 
The decision to stop the infusion will be based on the evolution of patient status after appropriate 
symptomatic measures, e.g. oxygenation, and upon physician’s own medical judgment.  
All changes in infusion rate will be recorded in the eCRF: each time with a rate modification as well as 
end of the premature or delayed termination of the infusion.  
10.1.2 Local reaction to NI-0501 infusion  
Unless related to a hypersensitivity reaction, a local infusion issue such as catheter displacement, 
obstruction or product extravasation, will trigger the infusion of the remaining quantity through a new 
venous access as soon as possible. All information related to the incident will be recorded accurately. 
This includes reasons, volume of IMP potentially lost (in order to calculate the quantity of drug infused), 
time at which the infusion stopped, time at which the infusion was resumed and time of end of the 
infusion.  
To avoid this type of incident, it is preferable for a central venous access to be used: this will improve 
patient’s comfort and ensure a reliable drug administration in particular in infants and toddlers or in case 
of foreseen difficulties with peripheral venous access.  
10.1.3 Decision to Discontinue Treatment 
An Investigator can decide at any time during the study to discontinue the treatment for an individual 
patient based on his/her own medical judgment, taking into account the individual benefit risk ratio for 
his/her patient. In addition, the patient (or their legal representative) can decide at any time to withdraw 
from the study.  
In any case the decision to withdraw or be withdrawn will have no impact on the patient’s care and 
further treatments administered to him/her after withdrawal. The management of these patients is 
described in Section 10.3. 
Nevertheless some situations should trigger an immediate decision to permanently discontinue treatment: 

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10.1.3.1 Treatment Discontinuation for a Safety Reason 
A patient should be discontinued from study treatment if a SAE occurring after NI-0501 administration 
is: 
1. Considered by the Investigator to be related to NI-0501 (with guidance from the DMC if needed) 
AND 
2. is a life-threatening event. 
All other AEs will be judged by the DMC on a case-by-case basis taking into account the disease 
evolution (such as signs of improvement in HLH) and the possibility of managing the AE and ensuring 
that no patient is exposed to unnecessary risks. 
10.1.3.2  Treatment Discontinuation for Lack of Efficacy 
A patient should be withdrawn from the NI-0501-04 study if, after having added an additional therapy 
concomitantly to NI-0501, no response or lack of improvement is observed. 
However, at the request of the investigator, the DMC can agree to maintain the patient in the study if, 
after having determined a favorable benefit/risk for NI-0501 in this patient through a thorough review of 
patient’s data, it is considered that loss of neutralization of IFNγ could expose patient to the risk of HLH 
worsening. The DMC may propose continuing the administration of NI-0501 under certain conditions 
which have to be accepted and implemented by the Investigator at the site. 
10.2 AT STUDY LEVEL 
10.2.1 Recruitment Suspension 
Recruitment may be suspended in the following situations: 
 
Any occurrence of death or life-threatening SAE related to the drug  
 
At the DMC’s own request as an outcome of their regular study review 
Patients already enrolled in the study should continue receiving NI-0501 as per protocol unless decided 
otherwise by the Investigator. 
The suspension will allow the DMC to analyse the data already generated and consider a 
recommendation. 
After re-evaluation of benefit/risk profile, the DMC may recommend any of the following:  
 
To resume recruitment without any change 
 
To implement minimisation measures that may require protocol amendment 
 
To implement conditions for study termination: e.g. next occurrence of a particular serious drug 
reaction  
10.2.2 Study Termination 
Occurrence of two deaths suggesting a reasonably possible relationship with continuous exposure to NI-
0501 and occurring in similar conditions will trigger the decision to terminate the study. 
This process will involve both the DMC and the Investigators. The management of patients already 
enrolled in the study will also be part of the DMC recommendations. 
 
10.3 MANAGEMENT OF TREATMENT DISCONTINUATION 
All patients who are withdrawn from the study will be treated, according to the standard care at the site. 
They should be assessed as indicated in Section 8.9. 

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11 STATISTICAL CONSIDERATIONS AND ANALYTICAL PLAN 
Full details of all statistical issues and planned statistical analyses will be specified in a separate 
Statistical Analysis Plan (SAP), which will be finalised prior to the locking of the study database. This 
section contains an overview of the planned methods of analysis. 
11.1 SAMPLE SIZE  
Sample size estimation has been done for the pivotal cohort of the study, i.e. patients receiving NI-0501 
in second line. 
A minimum of 28 patients treated with NI-0501 in second line will be enrolled in the study. Sample size 
calculation is based on the primary efficacy endpoint of “Overall Response Rate”. Assuming an Overall 
Response Rate of 70%, the study will have 90% power to show a significant improvement above 40% 
using an exact binomial test33 at a one-sided significance level of 2.5%. 
Due to the rarity of primary HLH, the recruitment is competitive across all EU and US sites in order to 
gather data in a reasonable timeframe.  
11.2 ANALYSIS SETS   
All analysis sets will be defined prior to final database closure. In addition to the analysis sets listed 
below, further exploratory analyses may be performed using other subgroups of patients. 
11.2.1 Safety Analysis Set 
The safety analysis set will include all patients who receive any part of an infusion of study drug. 
11.2.2 Intent-to-Treat Analysis Set 
The intent-to-treat (ITT) analysis set will include all patients who receive any part of an infusion of study 
drug. 
11.2.3 Per-Protocol Analysis Set 
The per-protocol analysis set will consist of all ITT patients who complete the study without violations of 
the study protocol. Details of the analysis will be defined in the SAP prior to locking of the final 
database. 
11.3 STATISTICAL AND ANALYTICAL METHODS 
For measurements of continuous endpoints, summary statistics will include n, mean, median, standard 
deviation, minimum and maximum values. For binary data (proportions of patients showing a defined 
response for example) numbers and percentages will be tabulated. For time to event data, Kaplan-Meier 
plots will be provided together with the median should this be available. Finally 95% confidence intervals 
will be calculated for suitable summary statistics associated with endpoints of interest. 
All efficacy analyses will be undertaken on both the ITT and PP analysis sets although the primary 
efficacy analyses will focus on the subgroup of second line patients. All safety analyses will be conducted 
on the safety set. 
11.3.1 Efficacy Data 
The analysis of the primary endpoint, Overall Response Rate will utilize an exact binomial test to 
evaluate the null hypothesis that the response rate is at most 40%. This test will be undertaken at the one-
sided 0.025 level.  

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Time to Response, Durability of Response, and Survival time will be presented using Kaplan-Meier 
curves with medians calculated if available. Ninety-five percent confidence intervals will be calculated 
for the median for each of these endpoints.  
For maintenance of response achieved any time during study until EoT and beyond (including data 
collected in the long-term follow-up study NI-0501-05) different follow-up periods will be considered, 
firstly censoring at i) EoT and ii) the day prior to starting conditioning; and secondly by taking the 
complete follow-up period beyond HSCT. 
Additional endpoints based on binary outcomes including number of patients who reduce glucocorticoids 
by 50% or more, and number of patients able to proceed to HSCT will be converted to proportions and 
associated 95% confidence intervals calculated. 
Statistical significance in terms of p-values will only be obtained for the primary endpoint in both the ITT 
and PP analysis sets. All other endpoints will be viewed as supportive for the primary endpoint and as a 
consequence no formal hierarchy of endpoints will be declared. 
11.3.2 Safety Data 
All data relating to safety will be listed and summarised using descriptive statistics.  
AEs will be coded and tabulated by body system, and by individual events within each body system. AEs 
will also be tabulated by severity and relationship to the study medication. Summaries will also be 
produced of SAEs, and AEs leading to withdrawal from the study. 
For each clinical laboratory test, individual patient values will be listed and summarised and change from 
pre-treatment baseline values calculated and summarised. Any values outside the standard reference 
range will be flagged. Summaries of marked abnormalities and shift tables will be tabulated for each 
laboratory test. 
In addition, other exploratory analyses of safety data, including summaries for different subsets of 
patients, may be conducted. 
11.3.3 Pharmacodynamic Data 
All PD data will be summarised using appropriate graphical and tabular presentations. 
Exploratory statistical models will be fitted, and correlation analyses undertaken, to investigate the 
relationships between PD data and other biomarkers and the clinical measures of response. ROC curves 
may be used to summarise any relationships that are found. 
In addition, other exploratory analyses of pharmacodynamic endpoints, including summaries for different 
subsets of patients, may be conducted. 
11.3.4 Immunogenicity Data 
The numbers of patients with anti-drug antibodies present at each assessment point will be summarised. 
11.3.5 Missing Data 
No imputations of missing data will be performed.  However, the following rules will be applied to 
ensure that all patients can be included in the final analysis: 
 
Patients who are withdrawn from the study prior to Week 8 because of safety concerns or poor 
efficacy will be classified as non-responders from the time of their withdrawal in all analyses of 
response status, and their data will be censored at time of withdrawal in all time-to-event 
analyses. For continuous endpoints in such patients, all analyses for time points beyond the point 
of withdrawal will exclude missing data for these patients.  

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 
Patients who do not reach Week 8 because of early transplant will be classified as responders 
beyond their time of withdrawal in all analyses of response status, and their data will be censored 
at time of withdrawal.  
11.4 REPLACEMENT POLICY 
11.4.1 For Patients 
Any patient withdrawn from the study for reasons other than safety or efficacy concerns will be replaced. 
11.4.2 For Centres 
A centre may be replaced for the following administrative reasons: excessively slow recruitment, poor 
protocol adherence.  

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PART II 
12 ETHICAL AND LEGAL ASPECTS 
12.1 GOOD CLINICAL PRACTICE 
The procedures set out in this study protocol pertaining to the conduct, evaluation, and documentation of 
this study are designed to ensure that NovImmune, its authorised representative, and Investigator abide 
by Good Clinical Practice (GCP), as described in International Conference on Harmonization (ICH) 
Guideline E6 and in accordance with the general ethical principles outlined in the Declaration of 
Helsinki. The study will receive approval from an Independent Ethics Committee (IEC) prior to 
commencement and where applicable by law also from National Competent Authorities. The Investigator 
will conduct all aspects of this study in accordance with applicable national, state, and local laws of the 
pertinent regulatory authorities. 
12.2 RESPONSIBILITIES 
Investigator 
The Investigator should ensure that all persons assisting with the trial are appropriately qualified and 
adequately informed about the protocol, amendments, study treatments, as well as study-related duties 
and functions. The Investigator should maintain a list of sub-investigators and other appropriately 
qualified persons to whom he or she has delegated significant study-related duties. 
The Investigator is responsible for keeping a record of all patients (or their legally authorised 
representative) who sign an informed consent document and are screened for entry into the study. 
Patients who fail screening must have the reason(s) recorded in their source documents and the study-
screening log. 
The Investigator, or a designated member of the Investigators’ staff, must be available during monitoring 
visits, audits and inspections to review data, resolve queries and allow direct access to subjects’ records 
(e.g. medical/hospital records, office charts, hospital charts, and study related charts) for source data and 
other type of verification. The Investigator must ensure timely and accurate completion of CRFs and 
queries. 
12.3 CONSENT 
Before being admitted to the clinical study, the patient must consent to participate after the nature, scope, 
and possible consequences of the clinical study have been explained in a form understandable to him or 
her. An informed consent document that includes both information about the study and the consent form 
will be prepared and given to the patient. This document will contain all ICH, GCP, and locally required 
regulatory elements (whichever is more stringent). The document must be in a language understandable 
to the patient and must specify who informed the patient, and when the informed consent was obtained.  
Information to patients will be split into a Patient Information Sheet that provides detailed information 
about the trial and its benefits and risks, and the Informed Consent Form that summarises the content of 
the Patient Information Sheet and is used to obtain the dated signature from the patient as evidence of the 
patient’s agreement to partake in the study. 
If applicable, since minors are involved in the trial, assent must be obtained from the minor and informed 
consent from at least one of the parents or as mandated by local rules (individual or judicial or other body 
authorised under applicable law to consent on behalf of a prospective patient to the patient’s participation 
in the procedures involved in the research). The language used in the Assent Form is adapted to the 

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maturity level of the minor involved in the trial. Since minors of different age groups are likely to be 
entered into the trial different versions of the Assent Form will be provided. The modalities for obtaining 
informed consent from the parents and Assent from the minor will be defined at the site initiation visit 
and documented in the clinical trial centre Trial Master File (TMF). 
After reading and understanding the informed consent document, the patient (or their legally authorised 
representative) must give consent in writing. The written informed consent will be obtained prior to 
conducting any study-related procedures or tests. The patient’s consent (or the consent of the patient’s 
legally authorised representative) must be confirmed at the time of consent by the personally dated 
signature of the person conducting the informed consent discussions. A copy of the signed consent 
document must be given to the patient or their legally authorised representative. The Investigator will 
retain the original signed consent document. The Investigator will not undertake any measures 
specifically required only for the clinical study until valid consent has been obtained. 
If an amended protocol impacts the content of the informed consent document, the consent document 
must be revised. Patients already participating in the study when the amended protocol is implemented 
must be re-consented with the revised version of the informed consent document. A copy of the revised 
informed consent document must be given to the patient or their legally authorised representative. The 
Investigator will retain the original signed updated consent document in the study files. 
12.4 CONFIDENTIALITY AND DATA PRIVACY 
NovImmune affirms the patient's right to protection against invasion of privacy and to be in compliance 
with ICH and other local regulations (whichever is more stringent). NovImmune requires the Investigator 
to permit NovImmune representatives and when necessary, representatives from regulatory authorities, to 
review and/or copy any medical records relevant to the study in accordance with local laws (any copies of 
patients’ records must be duly anonymised to protect patients’ confidentiality). 
Should direct access to medical records require a waiver or authorisation separate from the patient’s 
statement of informed consent, it is the responsibility of the Investigator to obtain such permission in 
writing from the appropriate individual. 
12.5 PROTOCOL AMENDMENTS 
Substantial amendments will be submitted to the IEC for written approval and where applicable to 
National Competent Authorities. Written approval must be obtained before implementation of the 
amended version occurs. The written signed approval from the IEC should specifically reference the 
Principal Investigator’s name, protocol number, study title and amendment number(s) that is/are 
applicable. 
12.6 APPROVAL OF THE CLINICAL STUDY PROTOCOL AND AMENDMENTS 
Before the start of the study, the study protocol, informed consent document, and any other appropriate 
documents will be submitted to the IEC with a cover letter or a form listing the documents submitted, 
their dates of issue, and the site (or region or area of jurisdiction, as applicable) for which approval is 
sought. If applicable, the documents will also be submitted to the authorities in accordance with local 
legal requirements. 
NovImmune can only supply study drug to an Investigator after NovImmune or their authorised 
representative, an international CRO, has received documentation on all ethical and legal requirements 
for starting the study. This documentation must also include a list of the members of the IEC and their 
occupation and qualifications. If the IEC will not disclose the names of the committee members, it should 
be asked to issue a statement confirming that the composition of the committee is in accordance with 
GCP. Formal approval by the IEC should preferably mention the study title, study code, study site, and 

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any other documents reviewed. It must mention the date on which the decision was made and must be 
officially signed by a committee member (chairman or secretary of the IEC. Before the first patient is 
enrolled in the study, all ethical and legal requirements must be met. 
The IEC and, if applicable, the authorities, must be informed of all subsequent protocol amendments in 
accordance with local legal requirements. Amendments must be evaluated to determine whether formal 
approval must be sought and whether the informed consent document should also be revised. 
The Investigator must keep a record of all communication with the IEC and, if applicable, between a 
coordinating Investigator and the IEC. This statement also applies to any communication between the 
Investigator (or coordinating Investigator, if applicable) and regulatory authorities. 
All documents handed over to patients or their legal representative prior to use must first be reviewed and 
approved by NovImmune, and upon approval by NovImmune submitted to and reviewed and approved 
by, the competent IEC. This includes but is not limited to the informed consent form, patient information 
sheet, assent form, advertisements, training materials, etc. 
12.7 ONGOING INFORMATION FOR INDEPENDENT ETHICS COMMITTEE 
If required by legislation or the IEC, the investigator must submit to the IEC: 
 
Information on SAEs or SUSARs as per local applicable rules and timelines;  
 
Periodic reports on the progress of the study; 
 
Deviations from the protocol or anything that may involve added risk to subjects. 
12.8 CLOSURE OF THE STUDY 
NovImmune reserves the right to terminate this study at any time for reasonable medical or 
administrative reasons. Any premature discontinuation will be appropriately documented according to 
local requirements (e.g., IRB/IEC, regulatory authorities). 
In addition, the Investigator or NovImmune has the right to discontinue a single site at any time during 
the study for medical or administrative reasons such as: 
 
Significant non-compliance with contractual enrolment timelines and targets 
 
Serious or continued GCP non-compliance 
 
Inaccurate, incomplete or delayed data collection 
 
Failure to adhere to the study protocol 
 
Failure to provide requested follow-up information for data queries 
12.9 RECORD RETENTION 
The investigator will ensure that essential records are kept in a secure archiving facility for the retention 
period stipulated in the study contract. Essential documents include, but are not limited to, the following: 
 
Signed informed consent documents for all subjects 
 
Subject identification code list, screening log (if applicable), and enrolment log 
 
Record of all communications between the investigator and the IEC 
 
Composition of the IEC 
 
Record of all communications between the investigator, NovImmune and their authorised 
representative 
 
List of sub-investigators and other appropriately qualified persons to whom the investigator has 
delegated significant trial-related duties, together with their roles in the study, curricula vitae and 
their signatures 
 
Copies of CRFs and of documentation of corrections for all subjects 

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 
“Drug accountability” records 
 
Record of any body fluids or tissue samples retained 
 
All other source documents (subject records, hospital records, laboratory records, etc.) 
 
All other documents as listed in Section 8 of the ICH consolidated guideline on GCP (Essential 
Documents for the Conduct of a Clinical Trial) 
Normally, these records will be held in the Investigator’s archives. If the Investigator is unable to meet 
this obligation, the Investigator must ask NovImmune for permission to make alternative arrangements. 
Details of these arrangements should be documented in the clinical trial centre TMF. 
12.10 LIABILITY AND INSURANCE 
Liability and insurance provisions for this study are provided in the investigator contract. 
12.11 FINANCIAL DISCLOSURE 
Investigators are required to provide financial disclosure information to allow NovImmune to submit 
complete and accurate certification or disclosure statements in accordance with applicable national and 
local regulations. In addition, investigators must provide NovImmune with a commitment to promptly 
update this information if any relevant changes occur during the course of the investigation and for 1 year 
following the completion of the study. 
12.12 DISCLOSURE OF PROTOCOL AND STUDY RESULTS AND PUBLICATION POLICY 
Information about this trial will be posted following the principles of the International Committee of 
Medical Journal Editors (ICMJE), the International Federation of Pharmaceutical Manufacturers & 
Associations (IFPMA) Industry Position Paper and applicable national or regional regulations and laws.  
The results of this study may be published or presented at scientific meetings. If this is foreseen, the 
Investigator agrees to submit all manuscripts or abstracts to NovImmune prior to submission. This allows 
NovImmune to protect proprietary information and to provide comments based on information from other 
studies that may not yet be available to the investigator. 
NovImmune will comply with the requirements for publication of study results. In accordance with 
standard editorial and ethical practice, the NovImmune will support publication of multicentre trials only 
in their entirety and not as individual centre data. In this case, a coordinating investigator will be 
designated by mutual agreement prior to the start of the trial. 
Authorship will be determined by mutual agreement and in line with ICMJE authorship requirements. 
Any formal publication of the study in which contribution of NovImmune personnel exceeded that of 
conventional monitoring will be considered as a joint publication by the investigator and the appropriate 
NovImmune personnel. 
So-called ‘ghost writing’ is not permitted. All contributors who do not meet the criteria for authorship 
should be listed in an acknowledgments section. Examples of those who might be acknowledged include 
a person who provided purely technical help, writing assistance, or a department chairperson who 
provided only general support. 
Any inventions and resulting patents, improvements, and/or know-how originating from the use of data 
from this study will become and remain the exclusive and unburdened property of NovImmune, except 
where agreed otherwise. 

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13 MONITORING AND AUDITING 
All aspects of the study will be monitored by NovImmune or its representative for this study 
(NovImmune authorised representative), for compliance with applicable government regulations with 
respect to current GCP and standard operating procedures. Direct access to the on-site study 
documentation and medical records must be ensured. 
13.1 STUDY MONITORING AND SOURCE DATA VERIFICATION 
As part of the responsibilities commensurate with participating in the study, the investigator agrees to 
maintain and have available for monitoring, adequate case records (accurate source documents and 
CRFs) for the patients treated under this protocol. In addition, the investigator agrees to maintain all 
administrative documents (e.g. IEC correspondence, investigational product and supplies shipment 
manifests, monitoring logs, or correspondence with NovImmune and with any of its representative for 
this study). 
13.2 ON-SITE AUDITS 
Investigators and institutions involved in the study will permit trial-related monitoring, audits, IEC 
review, and domestic or foreign regulatory inspection(s) by providing direct access to source documents, 
CRFs, and all other study documentation. 
The Investigator should promptly notify NovImmune of any inspections scheduled by any regulatory 
authorities and promptly forward to NovImmune copies of any audit reports received. 
13.3 SERIOUS GCP BREACHES 
NovImmune is required to report a serious GCP Breach within 7 days to applicable health authorities. 
Therefore, should an Investigator become aware of a possible serious GCP breach, e.g. a protocol 
violation, or non-reporting of critical safety information that has the potential of jeopardising patients’ 
safety, NovImmune must be notified within 24 hours. 
14 DOCUMENTATION AND USE OF STUDY FINDINGS 
14.1 DOCUMENTATION OF STUDY RESULTS 
An electronic CRF is used in this study and a specific electronic CRF will correspond to each subject.  
All required information must be entered on the CRFs. If an item is not available or is not applicable, this 
fact should be indicated and no blank spaces must be left. The data collected on the CRF will be entered 
into the study database. If the investigator authorises other personnel to enter data into the CRF, the 
names, positions, signatures, and initials of these persons must be supplied to NovImmune or their 
authorised representative before these individuals start completing CRF information.  
The CRF pages must be reviewed and signed by the Investigator named in the study protocol or by a 
designated sub-investigator. NovImmune will ensure that the CRF copy left with the Investigator (print-
outs and/or CD-ROM) has never been under the direct or indirect control of NovImmune. 
14.2 USE OF COMPUTERISED SYSTEMS AT THE CLINICAL TRIAL CENTRE 
When clinical observations are entered directly into an investigational site’s computerised medical record 
system (i.e. in lieu of original hardcopy records), the electronic record can serve as the source document 
if the system has been validated in accordance with health authority requirements pertaining to 
computerised systems used in clinical research. An acceptable computerised data collection system 
allows preservation of the original entry of data. If original data are modified, the system should maintain 

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a viewable audit trail that shows the original data as well as the reason for the change, name of the person 
making the change, and date of the change. 
The system must allow the clinical research associate, auditors or inspectors to verify source data without 
infringing privacy rights of other patients, e.g. access must be restricted to records pertaining to the study 
patients and access to other patients must not be possible. 

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15 
REFERENCES 
1. 
Billiau A. Interferon-gamma: biology and role in pathogenesis. Adv.Immunol. 1996;62:61-130. 
2. 
Schoenborn JR, Wilson CB. Regulation of interferon-gamma during innate and adaptive immune 
responses. Adv.Immunol. 2007;96:41-101. 
3. 
Zhang SY, Boisson-Dupuis S, Chapgier A et al. Inborn errors of interferon (IFN)-mediated 
immunity in humans: insights into the respective roles of IFN-alpha/beta, IFN-gamma, and IFN-
lambda in host defense. Immunol.Rev. 2008;226:29-40. 
4. 
Hommes DW, Mikhajlova TL, Stoinov S et al. Fontolizumab, a humanised anti-interferon gamma 
antibody, demonstrates safety and clinical activity in patients with moderate to severe Crohn's 
disease. Gut 2006;55:1131-1137. 
5. 
Reinisch W, de VW, Bene L et al. Fontolizumab in moderate to severe Crohn's disease: a phase 2, 
randomized, 
double-blind, 
placebo-controlled, 
multiple-dose 
study. 
Inflamm.Bowel.Dis. 
2010;16:233-242. 
6. 
Browne SK et al. Adult-Onset Immunodeficiency in Thailand and Taiwan N Engl J Med 2012; 
367:725-734August 23, 2012. 
7. 
Henter JI, Elinder G, Soder O et al. Hypercytokinemia in familial hemophagocytic 
lymphohistiocytosis. Blood 1991;78:2918-2922. 
8. 
Henter JI, Elinder G, Soder O, Ost A. Incidence in Sweden and clinical features of familial 
hemophagocytic lymphohistiocytosis. Acta Paediatr.Scand. 1991;80:428-435. 
9. 
Janka GE. Familial hemophagocytic lymphohistiocytosis. Eur.J.Pediatr. 1983;140:221-230. 
10. 
Aricò M, Janka G, Fischer A, Henter JI, Blanche S, Elinder G, Martinetti M, Rusca MP 
Hemophagocytic lymphohistiocytosis Report of 122 children from the International Registry. FHL 
Study Group of the Histiocyte Society. Leukemia. 1996 Feb;10(2):197-203.  
11. 
Dhote R, Simon J, Papo T et al. Reactive hemophagocytic syndrome in adult systemic disease: 
report of twenty-six cases and literature review. Arthritis Rheum. 2003;49:633-639. 
12. 
Risdall RJ, McKenna RW, Nesbit ME et al. Virus-associated hemophagocytic syndrome: a benign 
histiocytic proliferation distinct from malignant histiocytosis. Cancer 1979;44:993-1002. 
13. 
Risdall RJ, Brunning RD, Hernandez JI, Gordon DH. Bacteria-associated hemophagocytic 
syndrome. Cancer 1984;54:2968-2972. 
14. 
Jordan MB, Hildeman D, Kappler J, Marrack P. An animal model of hemophagocytic 
lymphohistiocytosis (HLH): CD8+ T cells and interferon gamma are essential for the disorder. 
Blood 2004;104:735-743. 
15. 
Pachlopnik SJ, Ho CH, Chretien F et al. Neutralization of IFNgamma defeats haemophagocytosis 
in LCMV-infected perforin- and Rab27a-deficient mice. EMBO Mol.Med. 2009;1:112-124. 
16. 
Kögl T, Müller J, Jessen B  et al. Hemophagocytic lymphohistiocytosis in syntaxin-11–deficient 
mice: T-cell exhaustion limits fatal disease. Blood. 2013; 121:604-613. 
17. 
Sepulveda FE, Debeume F, Menasché G et al. Distinct severity of HLH in both human and murine 
mutants with complete loss of cytotoxic effector PRF1, RAB27A, and STX11 Blood. 
2013;121:595-603. 

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18. 
Minoia F, Davi S, Horne AC et al. Clinical Features, Treatment, and Outcome of Macrophage 
Activation Syndrome Complicating Systemic Juvenile Idiopathic Arthritis: A Multinational, 
Multicenter Study of 362 Patients. Arthritis & Rheumatism 2014; 66: 3160–3169.  
19. 
Henter JI, Horne AC, Arico´ M,  Egeler RM, Filipovich AH,  Imashuku S Ladisch S, McClain K, 
Webb D, Winiarski J,  and Janka Diagnostic and Therapeutic Guidelines for Hemophagocytic  
Lymphohistiocytosis  Blood Cancer 2007;48:124–13.1. 
20. 
Henter JI, Samuelsson-Horne A, Arico M et al. Treatment of hemophagocytic lymphohistiocytosis 
with HLH-94 immunochemotherapy and bone marrow transplantation. Blood 2002;100:2367-2373. 
21. 
Jordan MB, Allen CE, Weitzman S, Filipovich AH, McClain KL. How I treat hemophagocytic 
lymphohistiocytosis. Blood 2011;118:4041-4052. 
22. 
Horne A, Janka G, Maarten ER et al. Haematopoietic stem cell transplantation in haemophagocytic 
lymphohistiocytosis. Br.J.Haematol. 2005;129:622-630.  
23. 
Trottestam H, Horne A, Arico M et al. Chemoimmunotherapy for hemophagocytic 
lymphohistiocytosis: long-term results of the HLH-94 treatment protocol. Blood 2011;118:4577-
4584. 
24. 
Behrens EM, Canna SW, Slade K et al. Repeated TLR9 stimulation results in macrophage 
activation syndrome-like disease in mice. J.Clin.Invest 2011;121:2264-2277. 
25. 
Xu XJ, Tang YM, Song H, MD, Yang SL, Xu WQ,  Zhao N, Shi SW, Shen HP, Mao JQ, Zhang 
LY, and Pan BH, Diagnostic Accuracy of a Specific Cytokine Pattern in Hemophagocytic 
Lymphohistiocytosis in Children J Pediatr 2011. 
26. 
Risma K, Jordan MB. Hemophagocytic lymphohistiocytosis: updates and evolving concepts. 
Curr.Opin.Pediatr. 2012;24:9-15. 
27. 
Strippolli R, Carvallo F, Scianaro R et al. Amplification of the response to Toll-like receptor 
ligands by prolonged exposure to interleukin-6 in mice: Implication for the pathogenesis of 
macrophage activation syndrome. Arthritis & Rheumatism 2012; 64: 1680–1688. 
28. 
Jordan M, Locatelli F, Allen C et al. A novel targeted approach to the treatment of 
Hemophagocytic Lymphohistiocytosis (HLH) with an anti-Interferon Gamma (IFNγ) monoclonal 
Antibody (mAb), NI-0501: First results from a pilot phase 2 study in children with primary HLH. 
57th American Society of Hematology Annual Meeting – ASH 2015; 2015 Dec 5-8; Orlando, FL. 
Blood 2015 126:LBA-3. 
29. 
Maggi E, Vultaggio A, Matucci A. Acute infusion reactions induced by monoclonal antibody 
therapy. Expert Rev Clin Immunol. 2011;7:55-63. 
30. 
Dorman SE, Holland SM. Interferon-gamma and interleukin-12 pathway defects and human 
disease. Cytokine Growth Factor Rev. 2000;11:321-333. 
31. 
Jouanguy E, Altare F, Lamhamedi-Cherradi S, Casanova JL. Infections in IFNGR-1-deficient 
children. J.Interferon Cytokine Res. 1997;17:583-587. 
32. 
Remus N, Reichenbach J, Picard C et al. Impaired interferon gamma-mediated immunity and 
susceptibility to mycobacterial infection in childhood. Pediatr.Res. 2001;50:8-13. 
33. 
A’Hern RPA Sample size tables for exact single-stage phase II designs. Statistics in Medicine 
2001; 20:859-866. 

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APPENDICES 
 
Appendix A - NI-0501 dose justification in HLH patients 
Appendix B - Decision making process on dose increase 
Appendix C – Detail of estimated blood volumes to be drawn during the study 
Appendix D –Membership of the Study Scientific Committee (SSC) 
Appendix E – NovImmune SAE Reporting Form 
Appendix F – NovImmune Pregnancy Form 
 

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APPENDIX A: NI-0501 DOSE JUSTIFICATION IN HLH PATIENTS 
Based on the evidence accumulated during the past years, it can be concluded that the over-production of 
IFNγ in HLH patients has a pivotal pathogenic role in this disease. Based on the key role played by IFN 
in the HLH, the investigation of the use of an anti-IFN mAb in HLH is deemed justified. 
NI-0501 is a fully human anti-IFNγ monoclonal antibody (mAb) which binds and neutralizes IFNγ. The 
dose of NI-0501 required for reaching and maintaining over time a certain percentage of inhibition of 
IFNγ depends on the amount of IFNγ produced, circulating as well as present in tissues. The NI-0501 
concentrations that inhibit the effect of IFNγ and the doses that reach and maintain these NI-
0501concentrations have been predicted. 
 
 
Figure 1:  Schematic representation of the interaction between IFNγ, NI-0501 and CXCL9 
Figure 1 schematically represents the intended interaction between IFNγ and NI-0501. In HLH patients, 
the production of IFNγ (red) is exacerbated and leads to high circulating concentrations of free IFNγ. NI-
0501 (blue) can be administered to these patients with the goal to bind to free IFNγ and reduce its 
concentration and consequently its damaging effects. The binding of NI-0501 to IFNγ leads to the 
production of an IFNγ-NI-0501 complex (violet) which is in equilibrium with the free moieties. To 
confirm the neutralization of IFNγ by NI-0501, the decrease in serum concentration of CXCL-9 (green), 
one of the cytokines specifically produced through the activation of the IFNγ receptor, can be monitored. 
All the components described above (i.e. free IFNγ, free NI-0501, IFNγ-NI-0501 complex and CXCL-9) 
have their own intrinsic clearance and their concentrations correspond to an equilibrium between 
production and elimination. Furthermore, for NI-0501, the formation of the complex corresponds to an 
additional target mediated clearance proportional to the IFNγ production. In HLH patients receiving NI-
0501, serum concentrations of free NI-0501, total IFNγ (i.e. free IFNγ + IFNγ-NI-0501 complex) and 
CXCL-9 have been measured. 
Data from in vitro experiments investigating the binding of NI-0501 to human IFNγ and the functional 
inhibition of human IFNγ by NI-0501 have been used for predicting the concentrations of NI-0501 that 
inhibit (e.g., 99%) the effect of circulating IFNγ concentrations. The results indicate that these NI-0501 
concentrations highly depend on the IFNγ concentrations themselves.  
Based on the calculated neutralizing concentrations of NI-0501 (e.g., for 99% inhibition of the effect of a 
baseline IFNγ concentration of 0.1 nM, 3400 pg/mL), on the PK parameters of NI-0501 in Healthy 

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Volunteers and on the PK information from recombinant IFNγ in human, predictions were performed 
regarding the dose that would inhibit in the majority of patients the effect of circulating and newly 
formed IFNγ over a period of 3 days (i.e. dosing interval). Based on these predictions, the starting dose in 
HLH patients was determined to be 1 mg/kg. This dose, predicted to inhibit for 3 days at least 99% of 
IFNγ effect in patients with baseline IFNγ concentrations lower or equal to 3400 pg/mL, was mainly 
driven by the estimated production of IFNγ which impacts the clearance of NI-0501 and varies 
considerably between patients as already indicated by the wide range of baseline IFNγ concentrations 
observed in HLH patients. 
The originally planned dosing strategy foresaw that, after the initial administration of NI-0501 at 1 
mg/kg, the dose could have been adapted depending on PK and clinical response (fever and 
thrombocytopenia), with clinical response overriding PK, in case of a favorable response to treatment.  
The rationale for choosing the initial interval of administration of 3 days for the pilot Phase 2 study, at 
least until steady state has been achieved, was based on the expected need to adjust in a short period of 
time and in an informed manner the dose of NI-0501.  
The selection of an interval of administration of 3 days has allowed: 
- Having a fast initial assessment of the patient’s PK (concentration measured at the end of NI-0501 
infusion, 24 h and 48 h post infusion), confirming, after the first dose, whether the assumptions used in 
the mathematical Models were correct. The PK samples mentioned above have been analyzed so far in 
a timely manner, so that the results were available for an informed decision on the selection of the 
subsequent dose to be administered (provided no safety concerns and no worsening were observed); 
- The possibility to rapidly adjust the dose of NI-0501 depending on PK and clinical response; 
- Overcoming the expected effect of TMDD of IFNγ turnover on the bioavailability of NI-0501 in HLH 
patients; 
- To avoid in patient with high clearance due to TMDD to have high peak and trough fluctuations which 
would have been the case with longer dosing intervals. 
- To satisfy the request of the Scientific Steering Committee of the study to ensure a fast and safe dose 
finding process in this fragile and severe patient population, in parallel to the close laboratory and 
clinical monitoring of patients. 
Data gathered so far in the Phase 2 study have shown that an initial dose regimen of 1 mg/kg every 3 days 
was appropriate to obtain a rapid onset of NI-0501 effects on HLH parameters in the majority of the 
patients treated so far. However, it has also been observed that in patients having a high production of 
IFNγ, evidenced by high circulating total IFNγ concentrations, a higher dose of NI-0501 was required, 
demonstrating the presence of  a target mediated drug disposition (TMDD) with NI-0501. This 
phenomenon has shown to induce a pronounced increased clearance of NI-0501 due to the high 
production of IFNγ. The presence of TMDD, while requiring the administration of NI-0501 doses higher 
than 1 mg/kg, prevents NI-0501 accumulation to occur. 
Based on experience gained from the first 16 evaluable primary HLH patients treated with NI-0501, and 
the excellent safety and tolerability profile of NI-0501, the possibility that a dose increase could be 
required at different times during treatment has been confirmed and therefore a standardized approach to 
guide dose changes has been introduced through this amendment. 
From the available data it has also been possible to estimate the total production of IFNγ in HLH patients.  
In fact, it is not possible to estimate the total amount of a given cytokine produced in the body simply 
based on its free circulating concentrations. However, once an anti-IFNγ antibody is administered, it 
moves from the circulation to tissues and organs where it binds to IFNγ, and then returns into circulation. 
It is at this point that the amount of IFNγ bound to the antibody and present in blood reflects the total 
production of IFNγ. This is what we measure as “Total IFNγ” (Finkelman and Morris, 1999). Applying 
this principle, from a preliminary analysis of the data from the Phase 2 study, it can be concluded that the 
production rate of IFNγ is extremely high in patients with HLH, as demonstrated by the elevated 
concentrations of total IFNγ detected in the vast majority of the HLH patients receiving NI-0501 

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(reaching the concentration of several hundred thousand pg/mL) and that inflamed tissues are certainly a 
main source of the produced IFNγ. 
A significant INFγ production was present in all patients in whom a dose increase was applied during the 
ongoing Phase 2 study. Importantly, it was also demonstrated that the production of IFNγ can vary during 
the course of the disease, particularly influenced by the presence of infections, as proven by the high 
inter- and intra-patient variability of IFNγ levels (from 1 to 10,000 pM) shown in the patients treated so 
far with NI-0501  (Figure 2). 
 
Figure 2: 
Total IFNγ concentrations (log scale) in HLH patients treated with NI-0501. 
Concentrations before day 3 are omitted because there are not yet at steady state. 
All this taken together, in protocol Version 5 of study NI-0501-04, after the initial administration of 1 
mg/kg of NI-0501, dose adjustments can be applied. In particular, a dose increase to 3 mg/kg (and, if 
needed, to 6 mg/kg) will be possible according to pre-defined criteria guided by clinical and laboratory 
response in each patient (see Table 4 and Appendix B).  
Infusions will be performed every 3 days until SD15 (infusion #6), and twice per week thereafter. 
Elongation of the dosing interval to 1 week can occur only after the first 4 weeks of treatment, if the 
patient has achieved and maintained Complete Response for at least 1 week. Dose increases to 3 and 6 
mg/kg are possible at any time during the study. More than 4 administrations at 6 mg/kg, or the 
introduction of a dose higher than 6 mg/kg may be proposed by the Investigator based on a positive 
benefit/risk assessment. However, the implementation of the above has to be discussed and approved by 
the Data Monitoring Committee after thorough assessment of available data, including PK and PD. 

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Predictions to guide the initial and subsequent NI-0501 doses in HLH patients 
 The original calculation of the first NI-0501 dose in HLH patients was based on: 
 
The affinity of NI-0501 for human IFNγ (Report NI-0501-MIF-01) 
 
Inhibition of human IFNγ-induced STAT-1 induction by NI-0501 (Report NI-0501-
PHARMACO-01) 
 
NI-0501 population pharmacokinetic parameters estimated in Healthy Volunteers (SAD study 
NI-0501-03) (Modeling and Simulation support to NI-0501: PK analysis of study NI-0501-003) 
(Draft Report available) 
 
Literature 
information 
on 
the 
in 
vivo 
PK 
of 
recombinant 
IFNγ 
in 
human 
(http://www.drugs.com/pro/actimmune.html) 
The data from the in vitro experiments have been used for predicting the NI-0501 concentrations that 
inhibit up to 90 or 99% the effect of high IFNγ concentrations (i.e. 0.1 and 0.01 nM) (Fig. 3, Table 1). 
Figure 3: Inhibition by NI-0501 of the effect induced by different concentrations of IFNγ. The 
parameters used in the simulations are given in Table 4 assuming 1 binding site per antibody. 
 
 
 
 
 
 
 
 

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Table 5: Simulations of inhibition of IFNγ-induced STAT-1 induction by NI-0501 
  
Simulation based on KD 
and IC50 assuming one 
binding site per Ab 
(Model 1) 
Simulation based on 
estimated parameters 
(Model 2) 
KD (nM) 
0.0014 
0.0014 
0.0017 
0.0017 
IC50 (nM) 
0.4 
0.4 
0.523 
0.523 
GA 
1 
1 
0.737 
0.737 
BS Binding sites per NI-0501 molecule 
1 
1 
1.58 
1.58 
IFNγc concentration (nM) 
0.1 
0.01 
0.1 
0.01 
IFNγ effect (fraction of maximum effect) 
0.200 
0.0244 
0.228 
0.0514 
EFF1F (fraction of IFNγ effect) 
0.01 
0.01 
0.01 
0.01 
EFF1 (fraction of maximum effect) 
0.00200 
0.00024 
0.00228 
0.00051 
EFF2F (fraction of IFNγ effect) 
0.1 
0.1 
0.1 
0.1 
EFF2 (fraction of maximum effect) 
0.02000 
0.00244 
0.02281 
0.00514 
Free IFNγ for EFF1 
0.00080 
0.00010 
0.00014 
0.00002 
Free IFNγ for EFF2 
0.00816 
0.00098 
0.00319 
0.00041 
Bound IFNγ for EFF1 
0.09920 
0.00990 
0.09986 
0.00998 
Bound IFNγ for EFF2 
0.09184 
0.00902 
0.09681 
0.00959 
Total NI-0501 (nM) for EFF1 (1%) 
0.272 
0.152 
0.850 
0.603 
Total NI-0501 (nM) for EFF2 (10%) 
0.108 
0.0219 
0.0939 
0.0311 
Free NI-0501 (nM) for EFF1 (1%) 
0.173 
0.142 
0.787 
0.596 
Free NI-0501 (nM) for EFF2 (10%) 
0.0158 
0.0129 
0.0326 
0.0250 
Parameters are derived from the IB or estimated by modeling of the experiment. 
- 
Two levels of IFNγ (0.1 and 0.01 nM) are simulated with two levels of inhibition each (99%, i.e. EFF1F = 
0.01 and 90%, i.e. EFF2F = 0.1). 
- 
IFNγ effect = IFNγc^GA / (IC50^GA +IFNγc^GA). 
- 
EFFx = IFNγ effect* EFFxF. 
- 
Free IFNγ = exp(ln(EFFx*(IC50^GA)/(1-EFFx))/GA). 
- 
Bound IFNγ = IFNγc-free IFNγ. 
- 
Total NI-0501 = bound IFNγ*(KD+free IFNγ)/free IFNγ/BS. 
- 
Free NI-0501 = Total NI-0501-(bound IFNγ /BS). 
Note: the residual effect after inhibition is a percentage of the baseline effect (not an absolute residual 
effect). 
Based on the predicted IFNγ-neutralizing concentrations of NI-0501 (Table 1), on PK parameters of NI-
0501 in healthy volunteers and on PK parameters from recombinant IFNγ in human, calculations were 
performed to predict the doses that inhibit the effect of circulating and newly formed IFNγ up to 99% 
over a period of 3 days (dosing interval) in HLH patients (Table 6Error! Reference source not found.). 

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Table 6: Predictions of the first dose of NI-0501 in HLH patients for ‘neutralizing’ circulating and 
produced IFNγ.  
  
Simulation based on KD 
and IC50 assuming one 
binding site per Ab 
(Model 1) 
Simulation based on 
estimated parameters 
(Model 2) 
IFNγ  (nM) 
0.1 
0.01 
0.1 
0.01 
MW of IFNγ  
34000 
34000 
34000 
34000 
IFNγ  (pg/mL) 
3400 
340 
3400 
340 
Volume of distribution of IFNγ  (L/kg) 
1.10 
1.10 
1.10 
1.10 
Clearance of IFNγ  (L/h/kg) 
1.2 
1.2 
1.2 
1.2 
Total NI-0501 conc. for 99% inhibition of 
IFNγ effect (nM) 
0.272 
0.152 
0.850 
0.603 
MW of NI-0501 (Dalton) 
147987 
147987 
147987 
147987 
Total NI-0501 conc. for 99% inhibition of 
IFNγ effect (ng/mL or ug/L) 
40 
22 
126 
89 
Volume of distribution of NI-0501 (L/kg) 
0.079 
0.079 
0.079 
0.079 
Neutralizing dose of NI-0501 (mg/kg) 
0.00318 
0.00178 
0.0099 
0.00705 
Neutralizing dose of NI-0501 corrected for 
difference in volume of distribution between 
IFNγ and NI-0501 (mg/kg) 
0.0441 
0.0247 
0.138 
0.0978 
Maintenance dose of NI-0501 (mg/kg/h) 
0.018 
0.0018 
0.011 
0.0011 
Maintenance dose of NI-0501 (mg/kg for 3 
days) 
1.28 
0.128 
0.809 
0.0809 
Loading dose (mg/kg) 
1.32 
0.153 
0.947 
0.179 
 
- 
IFNγc = anticipated plasma concentration in HLH patients. 
- 
MW = molecular weight. 
- 
Volume of distribution of IFNγ = 1.4 L/min /(0.693/38 min)/70 kg. 
- 
Clearance of IFNγ = 1.4 L/min*60 min/70 kg. 
- 
Total NI-0501 conc. for 99% inhibition (nM) of IFNγ effect is obtained from Table 4. 
- 
Volume of distribution of NI-0501 is from preliminary POP PK analysis of SAD data in healthy volunteers. 
- 
Neutralizing dose of NI-0501 = total NI-0501 conc * Volume of distribution of NI-0501. 
- 
Correcting factor for the difference in volume of distribution = volume of IFNγ / volume of NI-0501. 
- 
Maintenance dose of NI-0501 = IFNγc (nM) * Clearance of IFNγ * MW of NI-0501 / 106/number of binding 
sites per molecule of NI-0501 (BS from Table 4). 
- 
The loading dose is the sum of the neutralizing dose of NI-0501 corrected for difference in volume of 
distribution between IFNγ and NI-0501 and the maintenance dose of NI-0501 for 3 days. 
- 
Note: the amount of NI-0501 eliminated over a period of 3 days after the first dose and assuming no TMDD is 
predicted to be lower than 36 % of the administered dose (e.g. for a body weight of 5 kg and a dose of 1 mg/kg 
the approximate calculation based on Cmax (end infusion) is: 22.9 mg/L x 0.00102 L/h x 24h x 3 = 1.7 mg x 100 
/ 5 mg = 34%).  

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Based on the predicted ‘IFNγ-neutralizing’ doses of NI-0501 presented in Table 6, the proposed starting 
dose in HLH patients was 1 mg/kg. During the Phase 2 study (Study NI-0501-04 Protocol Version 4), due 
to the uncertainty in the predictions, especially from the target mediated drug disposition effect of IFNγ 
turnover on the clearance of NI-0501 in HLH patients, subsequent doses could be adapted based on NI-
0501 concentrations measured at the end of the infusion (Cend infusion) and at subsequent time-points (e.g., 
24h (C24h)/48h (C48h) after administration and on clinical response. The observed concentrations and their 
ratios were compared to predicted concentrations and ratios obtained from the population PK model of 
NI-0501 in Healthy Volunteers after allometric scaling and assuming linear (i.e. without TMDD see 
Figures Error! Reference source not found.4 and 5 top graphs) or non-linear (i.e. with TMDD see 
Figures 4 and 5 bottom graphs) kinetics. If the observed concentrations and ratios were markedly low and 
below predicted reference values (see Figures 4, and 5, and Table 3), marked TMDD could be assumed 
and a dose increase could be recommended. Figure 6 shows the predictions of NI-0501 concentration-
time profiles after the first administration of 1 mg/kg NI-0501 in HLH patients. 
Prior to the initiation of the NI-0501-04 study, it was established that during treatment with NI-0501, the 
minimal NI-0501 concentration to be achieved should have been the one required to neutralize 0.1 nmol 
of INFγ for 3 days, while the initial maximal concentration (“ceiling”) should have not exceeded an 
arbitrary concentration corresponding to the median maximal concentration reached in Healthy 
Volunteers following the single administration of the NI-0501 at the highest dose tested (3 mg/kg). The 
experience gathered during the conduct of the Phase 2 study has allowed to determine that, in the 
presence of a high INFγ production, there is fast clearance of NI-0501 (TMDD) and NI-0501 dose 
increases greater than 3 mg/kg are required.  
So far, during the conduct of the study, as well as in patients receiving NI-0501 in Compassionate Use, 
the safety and tolerability profile of NI-0501 was very good. In particular, to date, in no circumstances an 
increase in the NI-0501 dose was associated with the occurrence of safety concerns. No SAEs related to 
NI-0501 and no increased severity or frequency of non-serious AEs was reported.  All infusions were 
uneventful.  
Taking all these data together, it can be concluded that, applying the dosing strategy proposed for the 
continuation of the Phase 2 study as a Phase 2/3 study, HLH patients will be exposed to NI-0501 
concentrations already achieved during the Phase 2 study, at which no safety concern has emerged to date 
and well within the exposure achieved during the toxicology studies, with a safety margin of approx. 7.5 
as to Cmax. In particular, as the administration of more than 4 NI-0501 doses at 6 mg/kg can only occur 
after a review of the PK and PD data, the possibility that an accumulation of NI-0501 occurs is to be 
excluded.    

Study NI-0501-04 
 
NI-0501 in Primary HLH 
Page 79 of 99 
Protocol NI-0501-04-EU-EudraCT#2012-003632-23 – Version 6.0 – February 26, 2016   CONFIDENTIAL 
Simulations to help in characterizing the PK in HLH patients and recommending dose adjustment  
Method 
The PK model used in the simulations below is a two compartment model with linear elimination 
assuming allometric scaling based on body weight (BW) to which an additional non-linear (TMDD) 
elimination pathway characterized by a VMAX and a KM has been added.  
Parameters used in the simulations are from a population pharmacokinetic analysis of study NI-0501-03 
and assuming allometric scaling. VMAX is the IFNγ concentration (0.1 nM) multiplied by the 
recombinant IFNγ clearance (1.2 L/h/kg) divided by the number of binding sites (1 for model 1 or 1.58 
for model 2, Table 4) per antibody. KM is assumed to be equal to KD. 
CL  
= 0.00737*(BW/70)+0.75 L/h 
 
V1  
= 3.03*((BW/70)+1) L 
Q  
= 0.0218*(BW/70)+0.75 L/h  
V2  
= 2.98*(BW/70)+1 L 
VMAX = 0.12*BW nmol/h (model 1) or 0.076*BW nmol/h (model 2) 
KM  
= 0.0014 nM (considered to be approximately the same for both 
                models 1 and 2 and other VMAX values) 
 
The VMAX value of 0.076 nmol/h/kg from model 2 is considered to be pivotal for the dose of 1 mg/kg 
NI-0501. At higher VMAX, the dose of 1 mg/kg NI-0501 is predicted not to optimally neutralize the 
effect of IFNγ 0.1 nM. 
On the graphs: 
The pink lines represent the median NI-0501 maximum concentration observed in study NI-0501-03 
(SAD study) for the highest dose tested 3 mg/kg (78508 ng/mL or 533.85 nM).The red lines represent 
total NI-0501 concentration (40 ng/mL or 0.272 nM) that inhibits 99% of IFNγ (free concentration of 
3400 pg/mL or 0.1 nM) in blood. The orange lines indicate the reference values on day 2 for model 2 
with VMAX=0.076 nmol/h/kg.  

Study NI-0501-04 
 
NI-0501 in Primary HLH 
Page 80 of 99 
Protocol NI-0501-04-EU-EudraCT#2012-003632-23 – Version 6.0 – February 26, 2016   CONFIDENTIAL 
Results 
Figure 4: Predicted NI-0501 plasma concentration-time profiles after administration (1-hour 
infusion) of 1mg/kg NI-0501 every 3 days in a HLH patient of 7 kg assuming VMAX values equal to 
0, (no TMDD, top graphs: semi-log scales on the left, linear scales on the right), 0.12 (model 1, 
bottom left graph) or 0.076 (model 2, bottom right graph) nmol/h/kg. 
Time (Day)
NI-0501 concentration (ug/mL)
0
10
20
30
40
50
0.01
0.10
1.00
10.00
NI-0501 1 mg/kg - 7 kg
VMAX = 0 nmol/h/kg
Time (Day)
NI-0501 concentration (ug/mL)
0
10
20
30
40
50
0
20
40
60
80
100
NI-0501 1 mg/kg - 7 kg
VMAX = 0 nmol/h/kg
Time (Day)
NI-0501 concentration (ug/mL)
0
10
20
30
40
50
0.01
0.10
1.00
10.00
NI-0501 1 mg/kg - 7 kg
VMAX of model 1: 0.12 nmol/h/kg for IFNg = 0.1 nM
Time (Day)
NI-0501 concentration (ug/mL)
0
10
20
30
40
50
0.01
0.10
1.00
10.00
NI-0501 1 mg/kg - 7 kg
VMAX of model 2: 0.076 nmol/h/kg for IFNg = 0.1 nM
 

Study NI-0501-04 
 
NI-0501 in Primary HLH 
Page 81 of 99 
Protocol NI-0501-04-EU-EudraCT#2012-003632-23 – Version 6.0 – February 26, 2016   CONFIDENTIAL 
Figure 5: Predicted NI-0501 plasma concentration-time profiles after administration (1-hour 
infusion) of 1mg/kg NI-0501 every 3 days in a HLH patient of 23 kg assuming VMAX values equal 
to 0 (no TMDD, top graphs: semi-log scales on the left, linear scales on the right), 0.12 (model 1, 
bottom left graph) or 0.076 (model 2, bottom right graph) nmol/h/kg. 
Time (Day)
NI-0501 concentration (ug/mL)
0
10
20
30
40
50
0.01
0.10
1.00
10.00
NI-0501 1 mg/kg - 23 kg
VMAX = 0 nmol/h/kg
Time (Day)
NI-0501 concentration (ug/mL)
0
10
20
30
40
50
0
20
40
60
80
100
NI-0501 1 mg/kg - 23 kg
VMAX = 0 nmol/h/kg
Time (Day)
NI-0501 concentration (ug/mL)
0
10
20
30
40
50
0.01
0.10
1.00
10.00
NI-0501 1 mg/kg - 23 kg
VMAX of model 1: 0.12 nmol/h/kg for IFNg = 0.1 nM
Time (Day)
NI-0501 concentration (ug/mL)
0
10
20
30
40
50
0.01
0.10
1.00
10.00
NI-0501 1 mg/kg - 23 kg
VMAX of model 2: 0.076 nmol/h/kg for IFNg = 0.1 nM
 
Figure 6: Predictions of NI-0501 concentration-time profiles after the first administration of 1 
mg/kg NI-0501 in HLH patients of 23 kg with various levels of VMAX. From bottom to top 
VMAX=0.12 (model 1), 0.076 (model 2), 0.06, 0.03, 0.015, 0.0075, 0.00375, 0.001875 and 0 (no 
TMDD) nmol/h/kg. 
Time (Day)
NI-0501 concentration (ug/mL)
0.0
0.5
1.0
1.5
2.0
2.5
3.0
0.01
0.10
1.00
10.00
100.00
NI-0501 1 mg/kg - 23 kg
Time (Day)
NI-0501 concentration (ug/mL)
0.0
0.5
1.0
1.5
2.0
2.5
3.0
0
5
10
15
20
25
NI-0501 1 mg/kg - 23 kg
 
 

Study NI-0501-04 
 
NI-0501 in Primary HLH 
Page 82 of 99 
Protocol NI-0501-04-EU-EudraCT#2012-003632-23 – Version 6.0 – February 26, 2016   CONFIDENTIAL 
Table 7: NI-0501 concentrations at 48h (C48h) and C48h/Cend infusion ratios below which a dose 
higher than 1 mg/kg might be required. These values are predicted after the first administration of 
1 mg/kg NI-0501 in HLH patients assuming a VMAX of 0.076 nmol/h/kg for a baseline IFNγ 
concentration of 0.1 nM (3400 pg/mL). 
BW (kg) 
C48h (ug/mL) 
C48h / Cend infusion 
5 
3.14 
0.14 
10 
3.69 
0.16 
15 
4.03 
0.18 
20 
4.28 
0.19 
25 
4.48 
0.20 
30 
4.63 
0.20 
35 
4.77 
0.21 
40 
4.88 
0.21 
45 
4.99 
0.22 
50 
5.08 
0.22 
55 
5.16 
0.23 
60 
5.24 
0.23 
65 
5.30 
0.23 
70 
5.37 
0.24 
Interim (up to December 2, 2015) PK-PD data from studies NI-0501-04 and NI-0501-05 in HLH patients 
and in Compassionate Use patients receiving NI-0501 have been analysed in order to explore the 
structural and quantitative relationships between NI-0501, total IFNγ (free + complex with NI-0501) and 
CXCL-9 a chemonokine specifically induced by IFNγ.  
The results of this PK-PD exploratory analysis indicated that: 
- CXCL-9 concentration is a good surrogate of IFNγ activity. In patients treated with NI-0501, CXCL-9 
concentrations depend on the total IFNγ concentration (free + complex with NI-0501) and free 
concentration of NI-0501. 
- Total IFNγ concentration at steady-state is an expression of IFNγ production: the higher the total 
concentration of IFNγ in serum, the higher the IFNγ production. 
- Total IFNγ concentration/production in HLH patients shows a high inter- and intra-individual 
variability. 
- The kinetics of NI-0501 in HLH patients show target mediated disposition: 
o At total IFNγ concentration lower than 300 pM the kinetics of NI-0501 is rather linear. 
o At total IFNγ concentration higher than 300 pM the clearance of NI-0501 increases to become 
proportional to the total IFNγ concentration/ production. 
- The higher the total concentration of IFNγ in serum: 
o The higher the concentration of NI-0501 to neutralize IFNγ (evidenced by a higher CXCL9 
concentration to inhibit). 
o The higher the dose of NI-0501 to reach the neutralizing concentration of IFNγ (evidenced by a 
higher target mediated clearance of NI-0501). 

Study NI-0501-04 
 
NI-0501 in Primary HLH 
Page 83 of 99 
Protocol NI-0501-04-EU-EudraCT#2012-003632-23 – Version 6.0 – February 26, 2016   CONFIDENTIAL 
Although the PK/PD analysis performed so far was based on interim data, and for this reason it should be 
considered exploratory, the derived information is deemed enough explanatory to guide the selection of a 
safe and efficacious dosing algorithm of NI-0501 in HLH, allowing to perform explorative simulations to 
anticipate the exposure to be expected if the proposed new dosing strategy would be applied. 
These quantitative findings have been used to evaluate an amended dosing strategy of NI-0501 in HLH 
patients. The goal of the adapted dosing strategy is to allow dose increases based on clinical judgment 
only in patients who deteriorate or have no clinical improvement after the first administration(s) of NI-
0501 at 1 mg/kg/3days.  
To evaluate the impact of these dose increases on concentration levels, simulations have been performed. 
In these simulations, a time aggressive scheme consisting of increasing the dose from 1 to 3 mg/kg on 
day 3 and, if necessary, to 6 mg/kg on day 6 have been simulated. The doses were assumed to be given 
every 3 days till day 15 and afterwards bi-weekly (intervals of 4 and 3 days). Since patients with 
insufficient response are potentially patients with significant levels of total IFNγ productions, simulations 
have been performed with different clearance levels based on the estimated correlation that exists 
between NI-0501 clearance and total IFNγ and for various plausible levels of total IFNγ concentrations as 
observed in study NI-0501-04 and NI-0501-05 (see Figure 7 below).  

Study NI-0501-04 
 
NI-0501 in Primary HLH 
Page 84 of 99 
Protocol NI-0501-04-EU-EudraCT#2012-003632-23 – Version 6.0 – February 26, 2016   CONFIDENTIAL 
Figure 7:    Simulated NI-0501 serum concentrations as a function of time for different dosing and 
total IFNγ concentration scenarios. Doses are administered every 3 days till day 15 and bi-weekly 
afterwards. Dose regimens are: 1 mg/kg from day 0 (1 mg/kg); 1 mg/kg on day 0 followed by 3 
mg/kg from day 3 on (3 mg/kg); 1 mg/kg on day 0 followed by 3 mg/kg on day 3 and followed by 6 
mg/kg from day 6 on (6 mg/kg). Simulations are performed using PK parameters from patients 
assuming total IFNγ concentrations of 1000 pM (A), 3000 pM (B) and 10000 pM (C). The blue 
shaded area represents the interval between the highest (i.e. mean of the 3 highest values in the 
database) peak and trough NI-0501 concentrations observed so far in studies NI-0501-04 and NI-
0501-05 in HLH patients and in Compassionate Use patients. 
 
Although patients receiving 3 and 6 mg/kg will have significantly higher concentrations, as observed in 
study NI-0501-04 and NI-0501-05, patients who usually require higher doses are patients with increased 
clearance due to high circulating IFNγ. Patients who will probably be subject to a dose increase to 3 
mg/kg are most likely patients with a total IFNγ concentration around 1000 pM and patients who will 
require a dose increase to 6 mg/kg are most likely patients with total IFNγ concentration higher than 3000 
pM. 
Predictions for the proposed NI-0501 dose increase to 6 mg/kg allowed in Version 5 of the NI-0501 study 
protocol are represented in Figure 8 below. 

Study NI-0501-04 
 
NI-0501 in Primary HLH 
Page 85 of 99 
Protocol NI-0501-04-EU-EudraCT#2012-003632-23 – Version 6.0 – February 26, 2016   CONFIDENTIAL 
Figure 8: Simulated NI-0501 serum concentrations as a function of time for the proposed NI-0501 
dose increase to 6 mg/kg allowed in Version 5 of the NI-0501-04 study protocol and for a constant 
total IFNγ concentration of 1000 pM. The simulated dosing regimen is: 1 mg/kg on day 0; 3 mg/kg 
on days 3 and 6; 6 mg/kg on days 9, 12, 15 and 18, followed by 3 mg/kg on day 21 and then bi-
weekly (e.g., days 24, 28, 31, 35). The blue shaded area represents the interval between the highest 
(i.e. mean of the 3 highest values in the database) peak and trough NI-0501 concentrations  
observed so far in studies NI-0501-04 and NI-0501-05 in HLH patients and in Compassionate Use 
patients. 
 
  
In conclusion, since dose increases will most probably occur in patients with increased clearance due to a 
high production of IFNγ, the exposure will be less than dose proportional and is predicted to remain 
within (or close to) the concentration range that has already been observed in study NI-0501-04 and NI-
0501-05. 

Study NI-0501-04 
 
NI-0501 in Primary HLH 
Page 86 of 99 
Protocol NI-0501-04-EU-EudraCT#2012-003632-23 – Version 6.0 – February 26, 2016   CONFIDENTIAL 
APPENDIX B: DECISION MAKING PROCESS ON DOSE INCREASE 
This document has the objective of: 
1. guiding the Investigator on the clinical and laboratory parameters for the assessment on 
whether NI-0501 dose has to be increased 
2. giving a clear overview of the decision making process for dose increase during the study. 
Figure 1 gives an example of the flow for assessing a potential NI-0501 dose increase occurring at the 
start of the study.  
 
Figure 1 – Flow-chart of the decision making process on dose increase 
 
 
Please note: 
- 
Dose increase may occur any time during the study, if the clinical and laboratory criteria reported 
on SD6 are met. 
- 
When NI-0501 dose is increased to 6 mg/kg, a maximum of four infusions at this dose levels will 
be administered. Thereafter, reassessment needs to occur by the Investigator and the DMC, in 
order to establish the appropriate regimen for continuation of NI-0501 treatment (see below) 

Study NI-0501-04 
NI-0501 in Primary HLH 
Page 87 of 99 
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CONFIDENTIAL 
 
Study Day 0 ______________________________________________________________ 
The parameters collected at this time point constitute the baseline. 
The initial dose of NI-0501 to be administered is 1 mg/kg. 
 
Study Day 3 ______________________________________________________________ 
Parameters to consider: 
- 
body temperature 
- 
patient’s clinical conditions 
Decision to be taken by the Investigator*: 
Is there a need to increase NI-0501 dose to 3 mg/kg?  
- 
if fever,  present at baseline, persists or reoccurs, NI-0501 dose needs to be increased 
- 
if there is a significant worsening of the patient’s clinical conditions, NI-0501 dose needs to be 
increased  
*Note: the Investigator can decide at any time during the study to discontinue NI-0501 treatment based 
on the individual benefit/risk assessment. 
 
Study Day 6   ______________________________________________________________ 
Parameters to consider: 
- 
patient’s clinical conditions 
- 
clinical and laboratory response parameters (as presented in Table 4) 
Decisions to be taken by the Investigator: 
a) If the patient is receiving NI-0501 at the dose of 1 mg/kg, should the dose be increased to 3 mg/kg?  
- 
if no satisfactory improvement in clinical conditions is assessed by the Investigator  
and 
- 
if any of the clinical and laboratory criteria presented in Table 4 and Figure 1 is met  
NI-0501 dose needs to be increased 
If the above criteria do not apply, then the patient should continue with NI-0501 dose of 1 mg/kg.  
b) If NI-0501 dose has been increased on SD3, the dose of 3 mg/kg should be maintained 
 
Study Day 9   ______________________________________________________________ 
Parameters to consider: 
- 
patient’s clinical conditions 
- 
clinical and laboratory response parameters (as presented in Table 4 and Figure 1) 
Decisions to be taken by the Investigator: 
a) If the patient is receiving NI-0501 at the dose of 1 mg/kg, should the dose be increased to 3 mg/kg?  
- 
if no satisfactory improvement in clinical conditions is assessed by the Investigator  

Study NI-0501-04 
NI-0501 in Primary HLH 
Page 88 of 99 
Protocol NI-0501-04-EU-EudraCT#2012-003632-23 – Version 6.0 – February 26, 2016  
CONFIDENTIAL 
and 
- 
if any of the clinical and laboratory criteria presented in Table 4 is met  
NI-0501 dose needs to be increased 
If the above criteria do not apply, then the patient should continue with NI-0501 dose of 1 mg/kg.  
b) If NI-0501 dose has been increased on SD3, should the dose be increased to 6 mg/kg?  
- 
if no satisfactory improvement in clinical conditions is assessed by the Investigator  
and 
- 
if any of the clinical and laboratory criteria presented in Table 4 and Figure 1 is met  
NI-0501 dose needs to be increased 
If the above criteria do not apply, then the patient should continue with NI-0501 dose of 3 mg/kg.  
 
Study Day 12   ______________________________________________________________ 
Parameters to consider: 
- 
patient’s clinical conditions 
- 
clinical and laboratory response parameters (as presented in Table 4) 
Decisions to be taken by the Investigator: 
c) If the patient is receiving NI-0501 at the dose of 1 mg/kg, should the dose be increased to 3 mg/kg?  
- 
if no satisfactory improvement in clinical conditions is assessed by the Investigator  
and 
- 
if any of the clinical and laboratory criteria presented in Table 4 is met  
NI-0501 dose needs to be increased 
If the above criteria do not apply, then the patient should continue with NI-0501 dose of 1 mg/kg.  
d) If NI-0501 dose has been increased on SD6, should the dose be increased to 6 mg/kg?  
- 
if no satisfactory improvement in clinical conditions is assessed by the Investigator  
and 
- 
if any of the clinical and laboratory criteria presented in Table 4 is met  
NI-0501 dose needs to be increased 
If the above criteria do not apply, then the patient should continue with NI-0501 dose of 3 mg/kg.  

Study NI-0501-04 
NI-0501 in Primary HLH 
Page 89 of 99 
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CONFIDENTIAL 
 
MANAGEMENT OF THE PATIENTS AFTER NI-0501 DOSE INCREASE TO 6 mg/kg 
After the patient has received four infusions at the dose of 6 mg/kg with a regular monitoring of the 
clinical and laboratory HLH parameters, a thorough assessment has to be made by the Investigator with 
regard to: 
- 
clinical and laboratory response criteria presented in Table 4 and Figure 1 
- 
PK and PD data available  
 
If clinical and laboratory response criteria are no longer applicable, the dose of NI-0501 will be decreased 
back to 3 mg/kg. 
On the other hand, if criteria still apply, based on careful benefit/risk assessment, the Investigator may 
propose either 
i) to continue treatment at 6 mg/kg for additional infusions  
        or  
ii) to increase NI-0501 dose above 6 mg/kg, if PK and PD evidence indicates extremely high IFN levels 
and, consequently, fast NI-0501 elimination. 
However, the Investigator’s proposal of either continuing 6 mg/kg infusions or increasing the dose above 
6 mg/kg has to be discussed and approved by the DMC, after thorough assessment of all available data, 
including PK and PD. 
 

Study NI-0501-04 
 
NI-0501 in Primary HLH 
Page 90 of 99 
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CONFIDENTIAL 
APPENDIX C: DETAIL OF ESTIMATED BLOOD VOLUMES TO BE DRAWN DURING THE STUDY 
Volume of blood per visit (in mL)
(every 6-7 days) (every 2 weeks)
CBC
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
21
Coagulation, fibrinogen
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
21
Biochemistry, Triglycerides
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
42
IgG level
0.5
0.5
Search for CMV, EBV, 
Adenoviruses, TB
0.5
0.5
0.5
0.5
0.5
0.5
0.5
4.5
Search for HIV, HepB, HepC, 
HZV, HSV
0.5
0.5
Search for other pathogens 
1
1
6.5
4
4
4
4
4.5
4
4
0
4
0.5
4
0
0
4
0.5
4.5
4.5
4
4
4.5
90.5
46
22.5
17
1
0.5
0.5
1
0.5
1
0.5
1
1
1
1
0.5
0.5
0.5
0.5
0.5
24.5
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
29
0.5
0.5
0.5
1.5
Total per visit
7
6
5.5
5.5
6
6
6
5.5
2
4
2.5
4
2
2
4
0.5
6.5
6
5.5
5.5
6.5
Total per month 
68
31.5
23.5
130
Assessment
Screening (over a 
week)
Treatment Period 1
Treatment Period 2
Follow-Up Period 
INF visit3
 End of treat. visit
SD0
SD1
3 = maximum 14 infusions visits, which would mean maximum 14 mL for PK and maximum 14 mL for PD
Safety 
Laboratory1
Infections
Subtotal
Subtotal per Month
PK 
PD2
Immunogenicity
TOTAL OVERALL STUDY (maximum)
1 = calculation made without specific micro sampling techniques
2 = if possible - can be reduced 
Total max
SD2
SD3
SD5
SD6
SD8
SD9
Efficacy/   Safety Visits
Pre-conditioning
Wk3
Wk2
SD11
SD12
SD14
SD15
Wk4/ Study 
Compl.
 Visit or WD
 
 

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NI-0501 in Primary HLH 
Page 91 of 99 
 
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CONFIDENTIAL 
 
APPENDIX D: MEMBERSHIP OF THE STUDY SCIENTIFIC COMMITTEE (SSC) 
 
 
 
 
 
 
 

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APPENDIX E: NOVIMMUNE SAE REPORTING FORM 
 

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Study NI-0501-04 
NI-0501 in Primary HLH 
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APPENDIX F: NOVIMMUNE PREGNANCY FORM 
 

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