A Phase 3b, Randomized, Double-blind, Controlled Study Evaluating the Efficacy and Safety of VX-445/Tezacaftor/Ivacaftor in Cystic Fibrosis Subjects, Homozygous for F508del
Phase: PHASE3
Conditions: Cystic Fibrosis
Sponsor: Vertex Pharmaceuticals Incorporated

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1 
TITLE PAGE 
 
VERTEX PHARMACEUTICALS INCORPORATED 
Clinical Study Protocol 
A Phase 3b, Randomized, Double-blind, Controlled 
Study Evaluating the Efficacy and Safety of  
VX-445/Tezacaftor/Ivacaftor in Cystic Fibrosis 
Subjects, Homozygous for F508del  
Vertex Study Number: VX18-445-109 
EudraCT Number: 2019-001735-31  
Date of Protocol: 30 May 2019 (Version 1.0)  
  
Vertex Pharmaceuticals Incorporated  
50 Northern Avenue 
Boston, MA 02210-1862, USA 
 
 
CONFIDENTIAL 
This document contains confidential information. Any use, distribution, or disclosure without the prior written consent 
of Vertex Pharmaceuticals Incorporated is strictly prohibited except to the extent required under applicable laws or 
regulations. Persons to whom the information is disclosed must be informed that the information is confidential and 
may not be further disclosed by them. 

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2 
PROTOCOL SYNOPSIS 
Title 
A Phase 3b, Randomized, Double-blind, Controlled Study Evaluating the Efficacy 
and Safety of VX-445/Tezacaftor/Ivacaftor in Cystic Fibrosis Subjects, Homozygous 
for F508del 
 
 
Brief Title 
A Study Evaluating the Efficacy and Safety of VX-445/Tezacaftor/Ivacaftor in Cystic 
Fibrosis Subjects, Homozygous for F508del  
 
 
Clinical Phase and 
Clinical Study Type  
Phase 3b, efficacy and safety  
 
 
Objectives 
Primary Objective 
To evaluate the efficacy of VX-445/tezacaftor (TEZ)/ivacaftor (IVA) in cystic 
fibrosis (CF) subjects, homozygous for F508del (F/F).  
Secondary Objectives 
• 
To evaluate the safety of VX-445/TEZ/IVA 
• 
To evaluate the pharmacodynamics (PD) of VX-445/TEZ/IVA  
 
 
Endpoints 
Primary Endpoint 
• 
Absolute change in CF Questionnaire-Revised (CFQ-R) respiratory domain score 
from baseline through Week 24 
Key Secondary Endpoint 
• 
Absolute change in percent predicted forced expiratory volume in 1 second 
(ppFEV1) from baseline through Week 24 
Secondary Endpoints 
• 
Absolute change in sweat chloride (SwCl) from baseline through Week 24  
• 
Safety and tolerability assessments based on adverse events (AEs), clinical 
laboratory values, ECGs, vital signs, and pulse oximetry  
 
 
Number of Subjects 
Up to approximately 158 subjects will be randomized (1:1) to either the 
VX-445/TEZ/IVA group or the TEZ/IVA group.  
 
 
Study Population 
Male and female CF subjects who are 12 years of age or older and have an F/F 
genotype 
 
 
Investigational Drug 
During the TEZ/IVA Run-in Period, study drug refers to TEZ/IVA and IVA.  
During the Treatment Period, study drug refers to VX-445/TEZ/IVA and matching 
placebo, TEZ/IVA and matching placebo, and IVA.  
Active study drugs will be orally administered as fixed-dose combination (FDC) 
film-coated tablets (either VX-445/TEZ/IVA or TEZ/IVA) in the morning and as a 
film-coated IVA tablet in the evening.  
 
Active substance: VX-445/TEZ (VX-661)/IVA (VX-770) 

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Activity: CFTR corrector, CFTR corrector, and CFTR potentiator 
 
Strength: 100 mg/50 mg/75 mg 
 
 
 
Active substance: TEZ (VX-661)/ IVA (VX-770) 
 
Activity: CFTR corrector and CFTR potentiator 
 
Strength: 100 mg/150 mg 
 
 
 
Active substance: IVA (VX-770) 
 
Activity: CFTR potentiator 
 
Strength: 150 mg 
 
 
Study Duration 
The total study duration is approximately 36 weeks (4 weeks for the Screening 
Period, 4 weeks for the TEZ/IVA Run-in Period, 24 weeks for the Treatment Period, 
and 4 weeks for the Safety Follow-up Period).  
 
 
Study Design 
This is a Phase 3b, randomized, double-blind, active-controlled, parallel-group, 
multicenter study (Figure 2-1).  
Figure 2-1 
Schematic of the Study Design 
 
IVA: ivacaftor; N: number of subjects; TEZ: tezacaftor 
Note: The Safety Follow-up Visit is not required for subjects who complete the Week 24 
Visit and have enrolled in an open-label study within 28 days after the last dose of study 
drug. 
In the TEZ/IVA Run-in Period, all subjects will receive TEZ 100 mg once daily 
(qd)/IVA 150 mg every 12 hours (q12h). After completing the TEZ/IVA Run-in 
Period, subjects will be randomized (1:1) to the VX-445/TEZ/IVA group or TEZ/IVA 
group for the Treatment Period (Table 2-1).  
Table 2-1 
Treatment Period Groups and Dosages 
Treatment Group 
VX-445 Dosage 
TEZ Dosage 
IVA Dosage 
VX-445/TEZ/IVA 
200 mg qd 
100 mg qd 
150 mg q12h 
TEZ/IVA 
0 mg qd 
100 mg qd 
150 mg q12h 
IVA: ivacaftor; q12h: every 12 hours; qd: once daily; TEZ: tezacaftor  
Randomization will be stratified by ppFEV1 determined during the TEZ/IVA Run-in 
Period (Day -14 assessment; <70 versus ≥70), age at the Screening Visit (<18 versus 
≥18 years of age), and whether the subject is receiving CFTR modulator treatment at 
the Screening Visit (yes versus no). If the Day -14 ppFEV1 value is not valid or not 

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available, the most recent available ppFEV1 value will be used for stratification. 
 
 
Assessments 
Efficacy: CFQ-R, spirometry 
PD: SwCl 
Safety: AEs, clinical laboratory assessments, ECGs, vital signs, pulse oximetry, 
ophthalmologic examinations, and physical examinations  
 
 
Statistical Analyses 
Statistical Methods/Analyses 
The baseline value, unless otherwise specified, will be defined as the most recent 
non-missing measurement collected before the first dose of study drug in the 
Treatment Period (i.e., the Day 1 Visit). The TEZ/IVA Run-in Period is intended to 
establish a reliable on-treatment (TEZ/IVA) baseline for comparison during the 
Treatment Period. 
The primary efficacy endpoint is the absolute change in CFQ-R respiratory domain 
score from baseline through Week 24. The primary null hypothesis to be tested is that 
the mean absolute change in CFQ-R respiratory domain score from baseline through 
Week 24 is the same for the VX-445/TEZ/IVA and TEZ/IVA groups. The null 
hypothesis will be tested at a 2-sided significance level of 0.05. 
Assuming a within-group SD of 18 and a treatment difference of 10 between 
VX-445/TEZ/IVA and TEZ/IVA, a sample size of 71 subjects completing the 
Treatment Period in each group for a total of 142 subjects will have approximately 
90% power for the CFQ-R respiratory domain score hypothesis testing, based on a 2-
sample t-test at a significance level of 0.05. Assuming a 10% dropout rate, up to 
approximately 158 subjects will be enrolled.  
The primary analysis for CFQ-R will be based on a mixed-effects model for repeated 
measures (MMRM). The primary result obtained from the model will be the 
estimated treatment difference through Week 24. The treatment difference at each 
post-baseline visit, obtained from the model, will also be provided. 
A hierarchical fixed-sequence testing procedure will be used to control the overall 
family-wise type I error for the testing of the primary endpoint and key secondary 
endpoint. 
The safety endpoints include AEs, clinical laboratory values, ECGs, vital signs, and 
pulse oximetry through the Safety Follow-up Visit. The safety analysis will be 
descriptive only. 
 
 

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3 
SCHEDULE OF ASSESSMENTS 
Schedules of assessments are in Table 3-1 and Table 3-2. 
All visits are to be scheduled relative to the Day 1 Visit (first dose of randomized study drug in 
the Treatment Period). For example, the Week 4 (± 5 days) Visit would occur after 4 weeks of 
study drug administration in the Treatment Period has been completed. 
The Cystic Fibrosis Questionnaire–Revised (CFQ-R) must be completed before any other 
assessment (except signing of ICF) at relevant clinic visits. Remaining assessments may be 
performed in any order when more than 1 assessment is required at a particular time point. All 
assessments will be performed before study drug dosing (Section 9.6.1), unless noted otherwise. 

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Table 3-1 
Study VX18-445-109: Screening 
Event/Assessment 
Screening Visit 
Day -56 to Day -29 
 
Comments 
ICF and assent (when applicable) 
X 
 
Inclusion and exclusion criteria 
review 
X  
 
Demographics 
X 
 
Medical history 
X 
 
CFQ-R 
X 
Completed before the start of any other assessments 
(except signing ICF) scheduled for that visit. 
CFTR genotype 
X 
If the screening CFTR genotype result is not received 
before enrollment, a previous CFTR genotype laboratory 
report may be used to establish eligibility. Subjects who 
have been enrolled and whose screening genotype does not 
confirm eligibility must be discontinued from the study. 
FSH 
X 
Measured for any suspected postmenopausal female with at 
least 12 months of continuous spontaneous amenorrhea.  
Serum pregnancy test (all female 
subjects)  
X 
 
Hematology 
X 
 
Coagulation 
X 
 
Serum chemistry 
X 
 
Urinalysis 
X 
 
Weight and height 
X 
Measured with shoes off. 
Ophthalmologic examination 
X 
Only conducted for subjects who are <18 years of age on 
the date of informed consent.  
Complete physical examination 
X 
 
Vital signs and pulse oximetry 
X 
Collected after the subject has been at rest for at least 
5 minutes.  
Standard 12-lead ECG 
X 
Performed after the subject has been at rest for at least 
5 minutes. 
Spirometry 
X 
Performed pre- or post-bronchodilator.  
Medications review 
X 
 
Sweat chloride 
X 
 
AEs and SAEs  
Continuous from signing 
of ICF through Safety 
Follow-up Visit 
 
AE: adverse event; CFQ-R: Cystic Fibrosis Questionnaire-Revised; FSH: follicle stimulating hormone; ICF: informed consent 
form; SAE: serious adverse event 

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Table 3-2 
Study VX18-445-109: Treatment Period and Safety Follow-up Visit 
Event/ 
Assessmenta 
TEZ/IVA Run-in 
Period (4 weeks) 
Treatment Period (24 weeks) 
ETT 
Visitb  
Safety 
Follow-up 
Visitc 
(28 ± 7 Days 
After Last 
Dose of 
Study Drug) 
Comments 
Day -28 
± 1 day 
Day -14 
(Day -15 
to 
Day -3) 
Day 1d 
Day 15 
± 3 days 
Week 4 
± 5 days 
Week 8 
± 5 days 
Week 12 
± 5 days 
Week 16 
± 5 days 
Week 20 
± 5 days 
Week 24 
± 5 days 
Clinic visit 
X 
X 
X 
X 
X 
X 
 
X 
 
X 
X 
X 
 
Telephone contact 
 
 
 
 
 
 
X 
 
X 
 
 
 
Assess the subject’s status, 
any AEs, concomitant 
medications, treatments, and 
procedures. 
Inclusion and 
exclusion criteria 
confirmation 
X 
 
 
 
 
 
 
 
 
 
 
 
 
CFQ-R 
 
 
X 
 
X 
X 
 
X 
 
X 
X 
X 
Completed before any other 
assessments scheduled at 
relevant visits (Section 
11.4.1). 
Weight and height 
X 
 
X 
X 
X 
X 
 
X 
 
X 
X 
X 
Measured with shoes off. 
Height will only be collected 
for subjects ≤21 years of age 
on the date of informed 
consent (Section 11.4.3). 
Ophthalmologic 
examination 
 
 
 
 
 
 
 
 
 
X 
X 
 
Subjects <18 years of age on 
the date of informed consent 
and who completed at least 
12 weeks of study drug 
treatment will have a single 
ophthalmologic examination 
at either the ETT or Week 24 
Visit, whichever comes first 
(Section 11.5.6). 
Complete physical 
examination 
X 
 
X 
 
X 
 
 
 
 
X 
X 
 
Symptom directed physical 
examinations may be 
performed at any time if 
deemed necessary by the 
investigator (Section 11.5.3). 
 a 
All assessments will be performed before dosing unless noted otherwise. 
b  If a subject prematurely discontinues study drug treatment, an ETT Visit should be scheduled as soon as possible after the decision to discontinue treatment. Subjects who prematurely discontinue 
treatment during the Treatment Period will continue to complete all scheduled study visits for assessments following completion of the ETT Visit. 
c  The Safety Follow-up Visit is required for all subjects, unless the subject completes the Week 24 Visit and has enrolled in a separate open-label study within 28 days after the last dose of study drug. If 
an ETT Visit occurs 3 weeks or later following the last dose of study drug, then the ETT Visit replaces the Safety Follow-up Visit.  
d  To enter the Treatment Period, conditions for entry must be satisfied. 

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Table 3-2 
Study VX18-445-109: Treatment Period and Safety Follow-up Visit 
Event/ 
Assessmenta 
TEZ/IVA Run-in 
Period (4 weeks) 
Treatment Period (24 weeks) 
ETT 
Visitb  
Safety 
Follow-up 
Visitc 
(28 ± 7 Days 
After Last 
Dose of 
Study Drug) 
Comments 
Day -28 
± 1 day 
Day -14 
(Day -15 
to 
Day -3) 
Day 1d 
Day 15 
± 3 days 
Week 4 
± 5 days 
Week 8 
± 5 days 
Week 12 
± 5 days 
Week 16 
± 5 days 
Week 20 
± 5 days 
Week 24 
± 5 days 
Pregnancy testing 
(all female 
subjects) 
urine 
 
urine 
urine 
urine 
urine 
urine 
urine 
urine 
urine 
serum 
serum 
At telephone contacts, a urine 
pregnancy test will be 
performed with a home kit 
provided by the study site. 
Results will be reported to the 
site by telephone. 
Standard 12-lead 
ECG 
X 
 
X 
 
 
X 
 
 
 
X 
X 
X 
Performed after subject has 
been at rest for at least 
5 minutes (Section 11.5.5). 
Vital signs and 
pulse oximetry 
X 
 
X 
X 
X 
X 
 
X 
 
X 
X 
X 
Performed after subject has 
been at rest for at least 
5 minutes (Sections 11.5.3 
and 11.5.4). 
Spirometry 
 
X 
X 
X 
X 
X 
 
X 
 
X 
X 
X 
Should be performed 
pre-bronchodilator and at 
approximately the same time 
at each visit (Section 11.4.2). 
Sweat chloride  
 
X 
X 
 
X 
X 
 
 
 
X 
X 
 
At each time point, 2 samples 
will be collected (1 from each 
arm, Section 11.3). 
Urinalysis 
X 
 
X 
 
 
 
 
 
 
X 
X 
 
 
Hematology 
X 
 
X 
X 
X 
X 
 
X 
 
X 
X 
X 
 
Coagulation 
X 
 
X 
 
 
 
 
 
 
X 
X 
X 
 
Serum chemistry 
X 
 
X 
X 
X 
X 
 
X 
 
X 
X 
X 
 
Run-in TEZ/IVA 
dosing 
Day -28 to evening 
on Day -1 
 
 
 
 
 
 
 
 
 
 
 
Run-in TEZ/IVA 
drug count  
X 
X 
X 
 
 
 
 
 
 
 
 
 
 
Randomization 
 
 
X 
 
 
 
 
 
 
 
 
 
May occur on Day -1 or 
Day 1 after eligibility for 
entry into the Treatment 
Period has been satisfied. 
Randomized study 
drug dosing 
 
 
Day 1 through evening before Week 24 Visit 
 
 
 
 
Randomized study 
drug count 
 
 
X 
X 
X 
X 
 
X 
 
X 
X 
 
 

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Table 3-2 
Study VX18-445-109: Treatment Period and Safety Follow-up Visit 
Event/ 
Assessmenta 
TEZ/IVA Run-in 
Period (4 weeks) 
Treatment Period (24 weeks) 
ETT 
Visitb  
Safety 
Follow-up 
Visitc 
(28 ± 7 Days 
After Last 
Dose of 
Study Drug) 
Comments 
Day -28 
± 1 day 
Day -14 
(Day -15 
to 
Day -3) 
Day 1d 
Day 15 
± 3 days 
Week 4 
± 5 days 
Week 8 
± 5 days 
Week 12 
± 5 days 
Week 16 
± 5 days 
Week 20 
± 5 days 
Week 24 
± 5 days 
Medications 
review 
Continuous from signing of ICF through completion of study participation 
Completion of study 
participation is defined in 
Section 9.1.7.  
Treatment and 
procedures review 
Continuous from signing of ICF through completion of study participation 
Completion of study 
participation is defined in 
Section 9.1.7.  
AEs and SAEs 
Continuous from signing of ICF through completion of study participation 
Completion of study 
participation is defined in 
Section 9.1.7.  
AE: adverse event; CFQ-R: Cystic Fibrosis Questionnaire-Revised; ETT: Early Termination of Treatment; ICF: informed consent form; IVA: ivacaftor; SAE: serious adverse event; TEZ: tezacaftor 
 

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4 
TABLE OF CONTENTS 
1 
Title Page ................................................................................................................................ 1 
2 
Protocol Synopsis ................................................................................................................... 2 
3 
Schedule of Assessments........................................................................................................ 5 
4 
Table of Contents ................................................................................................................. 10 
List of Tables............................................................................................................................ 13 
List of Figures .......................................................................................................................... 13 
List of Abbreviations................................................................................................................ 14 
5 
Introduction.......................................................................................................................... 16 
5.1 
Background ..................................................................................................................... 16 
5.2 
Rationale for the Present Study ...................................................................................... 16 
6 
Study Objectives .................................................................................................................. 17 
6.1 
Primary Objective ........................................................................................................... 17 
6.2 
Secondary Objectives ..................................................................................................... 17 
7 
Study Endpoints ................................................................................................................... 17 
7.1 
Primary Endpoint ............................................................................................................ 17 
7.2 
Key Secondary Endpoint ................................................................................................ 17 
7.3 
Secondary Endpoints ...................................................................................................... 17 
8 
Study Population .................................................................................................................. 17 
8.1 
Inclusion Criteria ............................................................................................................ 17 
8.2 
Exclusion Criteria ........................................................................................................... 18 
9 
Study Implementation ......................................................................................................... 19 
9.1 
Study Design .................................................................................................................. 19 
9.1.1 
Screening ................................................................................................................ 20 
9.1.1.1 
Repetition of Screening Assessment(s) ............................................................ 21 
9.1.1.2 
Rescreening ...................................................................................................... 21 
9.1.1.3 
Extension of Screening Period Window .......................................................... 21 
9.1.2 
Tezacaftor/Ivacaftor Run-in Period ........................................................................ 21 
9.1.3 
Treatment Period .................................................................................................... 21 
9.1.4 
Follow-up................................................................................................................ 22 
9.1.5 
Early Termination of Treatment ............................................................................. 22 
9.1.5.1 
Discontinuation During the Run-in Period ...................................................... 22 
9.1.5.2 
Discontinuation During the Treatment Period ................................................. 22 
9.1.6 
Lost to Follow-up ................................................................................................... 23 
9.1.7 
Completion of Study Participation ......................................................................... 23 
9.2 
Method of Assigning Subjects to Treatment Groups ..................................................... 23 
9.3 
Rationale for Study Elements ......................................................................................... 24 
9.3.1 
Study Design........................................................................................................... 24 
9.3.2 
Study Population..................................................................................................... 24 
9.3.3 
Study Drug Dose .................................................................................................... 24 
9.3.4 
Rationale for Study Assessments ........................................................................... 24 
9.4 
Study Restrictions ........................................................................................................... 25 
9.4.1 
Prohibited Medications ........................................................................................... 25 
9.5 
Prior and Concomitant Medications ............................................................................... 25 
9.6 
Administration ................................................................................................................ 26 

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9.6.1 
Dosing ..................................................................................................................... 26 
9.6.2 
Missed Doses .......................................................................................................... 27 
9.7 
Dose Modification for Toxicity ...................................................................................... 27 
9.8 
Study Drug Interruption and Stopping Rules ................................................................. 27 
9.8.1 
Liver Function Tests ............................................................................................... 27 
9.8.2 
Rash ........................................................................................................................ 28 
9.9 
Removal of Subjects ....................................................................................................... 29 
9.10 Replacement of Subjects ................................................................................................ 29 
10 Study Drug Information and Management ....................................................................... 29 
10.1 Preparation and Dispensing ............................................................................................ 30 
10.2 Packaging and Labeling ................................................................................................. 30 
10.3 Study Drug Supply, Storage, and Handling ................................................................... 30 
10.4 Drug Accountability ....................................................................................................... 30 
10.5 Disposal, Return, or Retention of Unused Drug ............................................................. 31 
10.6 Compliance ..................................................................................................................... 31 
10.7 Blinding and Unblinding ................................................................................................ 31 
10.7.1 
Blinding .................................................................................................................. 31 
10.7.2 
Unblinding .............................................................................................................. 32 
11 Assessments .......................................................................................................................... 33 
11.1 Timing of Assessments ................................................................................................... 33 
11.2 Subject and Disease Characteristics ............................................................................... 33 
11.3 Pharmacodynamics: Sweat Chloride .............................................................................. 33 
11.4 Efficacy ........................................................................................................................... 33 
11.4.1 
Cystic Fibrosis Questionnaire-Revised .................................................................. 33 
11.4.2 
Spirometry .............................................................................................................. 34 
11.4.3 
Height and Weight .................................................................................................. 35 
11.5 Safety .............................................................................................................................. 35 
11.5.1 
Adverse Events ....................................................................................................... 35 
11.5.2 
Clinical Laboratory Assessments ........................................................................... 35 
11.5.3 
Physical Examinations and Vital Signs .................................................................. 37 
11.5.4 
Pulse Oximetry ....................................................................................................... 37 
11.5.5 
Electrocardiograms ................................................................................................. 37 
11.5.6 
Ophthalmologic Examination ................................................................................. 38 
11.5.7 
Contraception and Pregnancy ................................................................................. 38 
11.5.7.1 Contraception ................................................................................................... 38 
11.5.7.2 Pregnancy ......................................................................................................... 40 
12 Statistical and Analytical Plans .......................................................................................... 40 
12.1 Sample Size and Power .................................................................................................. 40 
12.2 Analysis Sets .................................................................................................................. 41 
12.3 Statistical Analysis ......................................................................................................... 41 
12.3.1 
General Considerations ........................................................................................... 41 
12.3.2 
Background Characteristics .................................................................................... 42 
12.3.2.1 Subject Disposition .......................................................................................... 42 
12.3.2.2 Demographics and Baseline Characteristics .................................................... 42 
12.3.2.3 Prior and Concomitant Medications................................................................. 42 
12.3.2.4 Study Drug Exposure and Compliance ............................................................ 43 

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12.3.2.5 Important Protocol Deviations ......................................................................... 43 
12.3.3 
Efficacy and Pharmacodynamic Analyses ............................................................. 43 
12.3.3.1 Analysis of Primary Endpoint .......................................................................... 43 
12.3.3.2 Analysis of Key Secondary Endpoint .............................................................. 44 
12.3.3.3 Analysis of Secondary Endpoint ...................................................................... 44 
12.3.3.4 Multiplicity Adjustment ................................................................................... 44 
12.3.4 
Safety Analysis ....................................................................................................... 45 
12.3.4.1 Adverse Events................................................................................................. 45 
12.3.4.2 Clinical Laboratory Assessments ..................................................................... 46 
12.3.4.3 Electrocardiogram ............................................................................................ 46 
12.3.4.4 Vital Signs ........................................................................................................ 47 
12.3.4.5 Pulse Oximetry ................................................................................................. 47 
12.3.4.6 Physical Examination ....................................................................................... 47 
12.3.5 
Interim and IDMC Analyses ................................................................................... 47 
12.3.5.1 Interim Analysis ............................................................................................... 47 
12.3.5.2 IDMC Analysis ................................................................................................ 47 
13 Procedural, Ethical, Regulatory, and Administrative Considerations ........................... 48 
13.1 Adverse Event and Serious Adverse Event Documentation, Severity Grading, and 
Reporting ........................................................................................................................ 48 
13.1.1 
Adverse Events ....................................................................................................... 48 
13.1.1.1 Definition of an Adverse Event........................................................................ 48 
13.1.1.2 Clinically Significant Assessments .................................................................. 48 
13.1.1.3 Documentation of Adverse Events................................................................... 48 
13.1.1.4 Adverse Event Severity .................................................................................... 49 
13.1.1.5 Adverse Event Causality .................................................................................. 49 
13.1.1.6 Study Drug Action Taken ................................................................................ 50 
13.1.1.7 Adverse Event Outcome .................................................................................. 50 
13.1.1.8 Treatment Given............................................................................................... 50 
13.1.2 
Serious Adverse Events .......................................................................................... 51 
13.1.2.1 Definition of a Serious Adverse Event............................................................. 51 
13.1.2.2 Reporting and Documentation of Serious Adverse Events .............................. 51 
13.1.2.3 Expedited Reporting and Investigator Safety Letters ...................................... 52 
13.2 Administrative Requirements ......................................................................................... 52 
13.2.1 
Ethical Considerations ............................................................................................ 52 
13.2.2 
Subject Information and Informed Consent ........................................................... 52 
13.2.3 
Investigator Compliance ......................................................................................... 53 
13.2.4 
Access to Records ................................................................................................... 53 
13.2.5 
Subject Privacy ....................................................................................................... 53 
13.2.6 
Record Retention .................................................................................................... 53 
13.2.7 
Study Termination .................................................................................................. 53 
13.2.8 
End of Study ........................................................................................................... 54 
13.3 Data Quality Assurance .................................................................................................. 54 
13.4 Monitoring ...................................................................................................................... 54 
13.5 Electronic Data Capture ................................................................................................. 54 
13.6 Confidentiality and Disclosure ....................................................................................... 55 
13.7 Publications and Clinical Study Report .......................................................................... 55 

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13.7.1 
Publication of Study Results ................................................................................... 55 
13.7.2 
Clinical Study Report ............................................................................................. 56 
14 References ............................................................................................................................. 57 
15 Protocol Signature Pages .................................................................................................... 59 
15.1 Sponsor Signature Page .................................................................................................. 59 
15.2 Investigator Signature Page ............................................................................................ 60 
 
List of Tables 
Table 2-1 
Treatment Period Groups and Dosages ................................................................... 3 
Table 3-1 
Study VX18-445-109: Screening ............................................................................ 6 
Table 3-2 
Study VX18-445-109: Treatment Period and Safety Follow-up Visit ................... 7 
Table 9-1 
Treatment Period Groups and Dosages ................................................................. 20 
Table 9-2 
Prohibited Medications ......................................................................................... 25 
Table 10-1 
Study Drug: Strength/Dosing Form/Route ........................................................... 30 
Table 11-1 
Safety Laboratory Test Panels .............................................................................. 36 
Table 11-2 
Acceptable Methods of Contraception.................................................................. 39 
Table 13-1 
Grading of AE Severity ........................................................................................ 49 
Table 13-2 
Classifications for AE Causality ........................................................................... 49 
Table 13-3 
Classifications for Study Drug Action Taken With Regard to an AE .................. 50 
Table 13-4 
Classifications for Outcome of an AE .................................................................. 50 
List of Figures 
Figure 2-1 
Schematic of the Study Design ............................................................................... 3 
Figure 9-1 
Schematic of the Study Design ............................................................................. 20 
 

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List of Abbreviations 
Abbreviation 
Definition 
AE 
adverse event 
ALP 
alkaline phosphatase 
ALT 
alanine transaminase 
AST 
aspartate transaminase 
CF 
cystic fibrosis 
CFQ-R 
Cystic Fibrosis Questionnaire-Revised 
CFTR 
CF transmembrane conductance regulator protein 
CFTR 
CF transmembrane conductance regulator gene 
CI 
confidence interval 
CRF 
case report form 
CSR 
clinical study report 
CTCAE 
Common Terminology Criteria for Adverse Events 
CYP 
cytochrome P450 
ECG 
electrocardiogram 
EDC 
electronic data capture 
EENT 
eyes, ears, nose, and throat 
ETT 
Early Termination of Treatment 
EU 
European Union 
F/F 
homozygous for the F508del CFTR mutation 
F/MF 
heterozygous for the F508del and a minimal function CFTR mutation 
F508del 
CFTR gene mutation with an in-frame deletion of a phenylalanine codon 
corresponding to position 508 of the wild-type protein 
FAS 
Full Analysis Set 
FDA 
Food and Drug Administration 
FDC 
fixed-dose combination 
FEF25%-75% 
forced expiratory flow, midexpiratory phase 
FEV1 
forced expiratory volume in 1 second 
FSH 
follicle-stimulating hormone 
FVC 
forced vital capacity 
GCP 
Good Clinical Practice 
GGT 
gamma-glutamyl transferase 
GLI 
Global Lung Function Initiative 
GPS 
Global Patient Safety 
HR 
heart rate 
IA 
interim analysis 
ICF 
informed consent form 
ICH 
International Council for Harmonization 
ICMJE 
International Committee of Medical Journal Editors 
IDMC 
independent data monitoring committee 
IEC 
independent ethics committee 
IPD 
important protocol deviation 
IRB 
institutional review board 

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IVA 
ivacaftor 
IWRS 
interactive web response system 
LS 
least squares 
LUM 
lumacaftor 
max 
maximum value 
MedDRA 
Medical Dictionary for Regulatory Activities 
min 
minimum value 
MMRM 
mixed-effects model for repeated measures 
OATP1B1/3 
organic anion transporting polypeptide 1B1/3 
P 
probability 
PD 
pharmacodynamics 
PE 
physical examination 
PEx 
pulmonary exacerbation 
p-gp 
P-glycoprotein 
ppFEV1 
percent predicted forced expiratory volume in 1 second 
PR 
PR interval, segment 
PT 
Preferred Term 
q12h 
every 12 hours 
qd 
once daily 
QRS 
the portion of an ECG comprising the Q, R, and S waves, together representing 
ventricular depolarization 
QT 
QT interval 
QTcF 
QT interval corrected by Fridericia’s formula 
RR 
interval from the onset of 1 QRS complex to the next; use R-R if using with 
“intervals”, i.e., “R-R interval” 
SAE 
serious adverse event 
SAP 
statistical analysis plan 
SD 
standard deviation 
SOC 
System Organ Class 
SUSAR 
suspected, unexpected, serious adverse reaction 
SwCl 
sweat chloride 
TC 
triple combination 
TE 
treatment-emergent 
TEAE 
treatment-emergent adverse event 
TEZ 
tezacaftor 
ULN 
upper limit of normal 
US 
United States 
 

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5 
INTRODUCTION 
5.1 
Background 
Cystic fibrosis (CF) is an autosomal recessive chronic disease with serious morbidities and 
frequent premature mortality. CF affects more than 70,000 individuals worldwide1 
(approximately 30,000 in the US2 and 45,000 in the EU3). Based on its prevalence, CF qualifies 
as an orphan disease.4, 5 
CF is caused by decreased quantity and/or function of the CFTR protein due to mutations in the 
CFTR gene.6 CFTR is an ion channel that regulates the flow of chloride and other ions across 
epithelia in various tissues, including the lungs, pancreas and other gastrointestinal organs, and 
sweat glands.7 Decreased CFTR quantity or function results in the failure to regulate chloride 
transport in these tissues, leading to the multisystem pathology associated with CF.8 In the lungs, 
obstruction of airways with thick mucus, establishment of a chronic bacterial infection in the 
airways, and damaging inflammatory responses are all thought to play a role in causing 
irreversible structural changes in the lungs, leading to respiratory failure. Progressive loss of lung 
function is the leading cause of mortality.9  
The most common disease-causing CFTR mutation is F508del, which accounts for 
approximately 70% of the identified alleles in people with CF.10 Approximately 40% to 45% of 
people with CF are homozygous for F508del (F/F), and approximately 85% have at least 
1 F508del allele. 2, 3  
Based on the understanding of the molecular defects caused by CFTR mutations, 
2 complementary approaches have been developed to address the decreased quantity and/or 
function of CFTR in order to enhance chloride transport in patients with CF. Correctors facilitate 
the cellular processing and trafficking to increase the quantity of CFTR at the cell surface. 
Potentiators increase the channel open probability (channel gating activity) of the CFTR protein 
delivered to the cell surface to enhance ion transport. With differing mechanisms of action, a 
combination of correctors and potentiators increases F508del CFTR-mediated chloride transport 
more than either type of modulator alone. 
The therapeutic activity of CFTR modulators has been established with products developed by 
Vertex and approved for the treatment of CF: ivacaftor (IVA) monotherapy (Kalydeco), 
lumacaftor (LUM)/IVA (Orkambi®), and tezacaftor (TEZ)/IVA (Symdeko/Symkevi®).   
VX-445 is a next-generation CFTR corrector. In vitro, the triple combination (TC) of VX-445, 
TEZ, and IVA (VX-445/TEZ/IVA) increased CFTR chloride transport more than any of the dual 
combinations (VX-445/TEZ, VX-445/IVA, and TEZ/IVA) or individual components (VX-445, 
TEZ, and IVA) when added to human bronchial epithelial cells derived from 2 groups of CF 
patients: those heterozygous for F508del with a second CFTR allele carrying a minimal function 
(MF) mutation that is not responsive to TEZ, IVA, and TEZ/IVA (F/MF genotypes); and those 
homozygous for F508del (F/F genotypes). 
Additional information about VX-445/TEZ/IVA can be found in the Investigator’s Brochure. 
5.2 
Rationale for the Present Study 
This study will evaluate the efficacy and safety of VX-445/TEZ/IVA in subjects with CF who 
have an F/F genotype. The potential for benefit in these patients is supported by in vitro data and 

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Phase 3 clinical data in subjects with F/F genotypes. In addition, VX-445/TEZ/IVA is generally 
safe and well tolerated (refer to VX-445 Investigator’s Brochure). 
The primary endpoint of this study is a widely accepted quality of life measure for subjects with 
CF; these data are intended to enrich the body of evidence showing that VX-445/TEZ/IVA 
provides additional benefit to subjects with F/F genotypes over currently available CFTR 
modulators.  
6 
STUDY OBJECTIVES 
6.1 
Primary Objective 
To evaluate the efficacy of VX-445/TEZ/IVA in CF subjects, homozygous for F508del (F/F).  
6.2 
Secondary Objectives 
 To evaluate the safety of VX-445/TEZ/IVA 
 To evaluate the pharmacodynamics (PD) of VX-445/TEZ/IVA 
7 
STUDY ENDPOINTS 
7.1 
Primary Endpoint 
 Absolute change in CF Questionnaire-Revised (CFQ-R) respiratory domain score from 
baseline through Week 24 
7.2 
Key Secondary Endpoint 
 Absolute change in percent predicted forced expiratory volume in 1 second (ppFEV1) from 
baseline through Week 24 
7.3 
Secondary Endpoints 
 Absolute change in sweat chloride (SwCl) from baseline through Week 24 
 Safety and tolerability assessments based on adverse events (AEs), clinical laboratory values, 
ECGs, vital signs, and pulse oximetry  
8 
STUDY POPULATION 
Eligibility will be reviewed and documented by an appropriately qualified member of the 
investigator’s team before subjects receive study drug on Day -28. 
Subjects who meet all of the inclusion criteria and none of the exclusion criteria will be eligible. 
8.1 
Inclusion Criteria 
1. Subject (or his or her legally appointed and authorized representative) will sign and date an 
informed consent form (ICF), and, when appropriate, an assent form. 
2. Willing and able to comply with scheduled visits, treatment plan, study restrictions, 
laboratory tests, contraceptive guidelines, and other study procedures. 
3. Age 12 years or older, on the date of informed consent. 

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4. Confirmed diagnosis of CF as determined by the investigator. 
5. Subject has the F/F genotype. Note: If the screening CFTR genotype result is not received 
before Day -28, a previous CFTR genotype laboratory report may be used to establish 
eligibility to enter the Run-in Period. Subjects who have been enrolled and whose screening 
genotype is not confirmed to be F/F must be discontinued from the study (Section 9.9). 
6. Forced expiratory volume in 1 second (FEV1) value ≥40% and ≤90% of predicted mean for 
age, sex, and height (equations of the Global Lung Function Initiative [GLI])11 at the 
Screening Visit. Spirometry measurements must meet American Thoracic Society/European 
Respiratory Society criteria12 for acceptability and repeatability. 
7. Stable CF disease as judged by the investigator. 
8. Willing to remain on a stable CF treatment regimen (defined in Section 9.5) through 
completion of study participation. 
8.2 
Exclusion Criteria 
1. History of any illness or any clinical condition that, in the opinion of the investigator, might 
confound the results of the study or pose an additional risk in administering study drug(s) to 
the subject. This includes, but is not limited to, the following: 
 Clinically significant cirrhosis with or without portal hypertension. 
 Solid organ or hematological transplantation. 
 Alcohol or drug abuse in the past year, including, but not limited to, cannabis, cocaine, 
and opiates, as deemed by the investigator. 
 Cancer, except for squamous cell skin cancer, basal cell skin cancer, and Stage 0 cervical 
carcinoma in situ (all 3 having occurred more than 5 years before screening with no 
recurrence for the last 5 years). 
2. Any of the following abnormal laboratory values at screening: 
 Hemoglobin <10 g/dL 
 Total bilirubin ≥2 × upper limit of normal (ULN) 
 Aspartate transaminase (AST), alanine transaminase (ALT), gamma-glutamyl transferase 
(GGT), or alkaline phosphatase (ALP) ≥3 × ULN 
 Abnormal renal function defined as glomerular filtration rate ≤50 mL/min/1.73 m2 
(calculated by the Modification of Diet in Renal Disease Study Equation)13, 14 for subjects 
≥18 years of age and ≤45 mL/min/1.73 m2 (calculated by the Counahan-Barratt 
equation)15 for subjects aged 12 to 17 years (inclusive) 
3. An acute upper or lower respiratory infection, pulmonary exacerbation(s) (PEx), or changes 
in therapy (including antibiotics) for sinopulmonary disease within 28 days before the first 
dose of TEZ/IVA in the Run-in Period (Day -28).  
4. Lung infection with organisms associated with a more rapid decline in pulmonary status 
(including, but not limited to, Burkholderia cenocepacia, Burkholderia dolosa, and 
Mycobacterium abscessus). For subjects who have had a history of a positive culture, the 

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investigator will apply the following criteria to establish whether the subject is free of 
infection with such organisms:  
 The subject has not had a respiratory tract culture positive for these organisms within the 
12 months before the date of informed consent. 
 The subject has had at least 2 respiratory tract cultures negative for such organisms 
within the 12 months before the date of informed consent, with the first and last of these 
separated by at least 3 months, and the most recent 1 within the 6 months before the date 
of informed consent. 
5. An acute illness not related to CF (e.g., gastroenteritis) within 14 days before the first dose of 
TEZ/IVA in the Run-in Period (Day -28). 
6. Ongoing or prior participation in a study of an investigational treatment other than a Vertex 
CFTR modulator within 28 days or 5 terminal half-lives (whichever is longer) before 
screening. The duration of the elapsed time may be longer if required by local regulations. 
7. Use of prohibited medications as defined in Table 9-2, within the specified window before 
the first dose of TEZ/IVA in the Run-in Period (Day -28). 
8. Pregnant or nursing females. All female subjects must have a negative pregnancy test at 
Screening/Day -56 (serum test) and TEZ/IVA Run-in Period/Day -28 (urine test).  
9. The subject or a close relative of the subject is the investigator or a subinvestigator, research 
assistant, pharmacist, study coordinator, or other staff directly involved with the conduct of 
the study at that site. However, an adult (aged 18 years or older) who is a relative of a study 
staff member may be enrolled in the study provided that 
• 
the adult lives independently of and does not reside with the study staff member, and 
• 
the adult participates in the study at a site other than the site at which the family member 
is employed. 
9 
STUDY IMPLEMENTATION 
9.1 
Study Design 
This is a Phase 3, randomized, double-blind, active-controlled, parallel-group, multicenter study 
(Figure 9-1).  

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Figure 9-1 
Schematic of the Study Design 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
IVA: ivacaftor; N: number of subjects; TEZ: tezacaftor  
Note: The Safety Follow-up Visit is not required for subjects who complete the Week 24 Visit and have enrolled in 
an open-label study within 28 days after the last dose of study drug.  
In the TEZ/IVA Run-in Period, all subjects will receive TEZ 100 mg once daily (qd)/IVA 
150 mg every 12 hours (q12h). After completing the TEZ/IVA Run-in Period, subjects will be 
randomized (1:1) to the TC group or TEZ/IVA group for the Treatment Period. Randomization 
will be stratified by ppFEV1 determined during the TEZ/IVA Run-in Period (Day -14 
assessment; <70 versus ≥70), age at the Screening Visit (<18 versus ≥18 years of age), and 
whether the subject is receiving CFTR modulator treatment at the Screening Visit (yes versus 
no). If the Day -14 ppFEV1 value is not valid or not available, the most recent available ppFEV1 
value will be used for stratification. 
The dosages for the Treatment Period are shown in Table 9-1.  
Table 9-1 
Treatment Period Groups and Dosages 
Treatment Group 
VX-445 Dosage 
TEZ Dosage 
IVA Dosage 
VX-445/TEZ/IVA 
200 mg qd 
100 mg qd 
150 mg q12h 
TEZ/IVA 
0 mg qd 
100 mg qd 
150 mg q12h 
IVA: ivacaftor; q12h: every 12 hours; qd: once daily; TEZ: tezacaftor  
Note: Study drug administration is described in Section 9.6. 
 
Study visits and assessments to be conducted are shown in Table 3-1 and Table 3-2. All visits 
will occur within the windows specified. 
9.1.1 
Screening 
The Screening Period will occur within 28 days before the first dose of study drug in the 
TEZ/IVA Run-in Period. 
VX-445/TEZ/IVA Group        
 
N = 79 
TEZ/IVA Group 
 
 
N = 79 
Treatment Period 
TEZ/IVA 
Run-in  
Period 
Screening 
Period 
Safety 
Follow-up 
Day -56  
to Day -29 
Day -28  
to Day -1 
Randomization 
24 Weeks  
(Day 1 to Week 24) 
Open-label Study 
28 days 

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Screening assessments will be used to confirm that subjects meet the eligibility criteria. The 
investigator (or an appropriate authorized designee) will obtain informed consent and assent, if 
applicable, from each subject before any study procedure takes place. 
9.1.1.1 
Repetition of Screening Assessment(s) 
Screening assessments may be repeated once to establish study eligibility. If repeat values of the 
individual assessment(s) are within the eligibility criteria and completed within the screening 
window, then the subject is eligible for the study. 
9.1.1.2 
Rescreening 
Subjects may be rescreened once. If a subject is rescreened, all screening assessments will be 
repeated, except for:  
 CFTR genotyping 
 Follicle-stimulating hormone (FSH) level (if serum FSH level was in the postmenopausal 
range as determined by the laboratory performing the test during prior screening) 
 Ophthalmologic examination (if performed within 3 months of the date of informed consent, 
for subjects <18 years of age) 
If a subject is rescreened, a new screening window will begin when the first rescreening 
assessment has been initiated. 
9.1.1.3 
Extension of Screening Period Window 
A subject may have the Screening Period window extended by 2 weeks for the following 
reasons: 
 Repetition of the Screening Period assessments (Section 9.1.1.1) 
 Unexpected operational or logistic delays, or to meet the eligibility criteria 
 Scheduling of ophthalmologic examination (for subjects <18 years of age on the date of 
informed consent, Section 11.5.6) 
9.1.2 
Tezacaftor/Ivacaftor Run-in Period 
The TEZ/IVA Run-in Period has a 4-week duration and is designed to establish a reliable 
on-treatment (TEZ/IVA) baseline for the Treatment Period. The first dose of open-label 
TEZ/IVA will be administered at the Day -28 Visit. The last dose of open-label TEZ/IVA will be 
administered in the evening on Day -1 (1 day before the Day 1 Visit).  
The Day -14 spirometry assessment will be used for stratification of randomization to the 
Treatment Period (Section 9.2). 
Subjects who prematurely discontinue study drug treatment during the TEZ/IVA Run-in Period 
will not be randomized or participate in the Treatment Period (Section 9.1.5.1). 
9.1.3 
Treatment Period 
The Treatment Period will be randomized, double-blind, and active-controlled. It will last 
approximately 24 weeks (Day 1 to Week 24). Study drug administration details are provided in 
Section 9.6. 

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Randomization will occur before the first dose of study drug during the Treatment Period and 
may occur on either Day -1 or Day 1. Randomization and stratification details are provided in 
Section 9.2. 
To enter the Treatment Period, subjects must have stable CF disease (as judged by the 
investigator) and have remained on a stable CF treatment regimen during the TEZ/IVA Run-in 
Period. If these conditions are not met (for example, if the subject has an acute upper or lower 
respiratory infection, PEx, or changes in therapy [including antibiotics] for sinopulmonary 
disease within 28 days before the Day 1 Visit [first dose of study drug in the Treatment Period]), 
subjects may be rescreened once (Section 9.1.1.2) and re-enter the TEZ/IVA Run-in Period on 
Day -28. 
Subjects who prematurely discontinue study drug treatment during the Treatment Period will 
remain in the study from the time of discontinuation of study drug treatment through the last 
scheduled study visit and complete the assessments for all study visits, as described in 
Section 9.1.5.2. 
9.1.4 
Follow-up 
The Safety Follow-up Visit will occur approximately 28 (± 7) days after the last dose of study 
drug for subjects who complete study drug dosing and for subjects who prematurely discontinue 
study drug dosing, as described in Section 9.1.5. 
An open-label roll-over study will be available for subjects who complete the Week 24 Visit and 
are eligible. The Safety Follow-up Visit is not required for subjects who complete the Week 24 
Visit and enroll in an open-label roll-over study within 28 days after the last dose of study drug. 
9.1.5 
Early Termination of Treatment 
If a subject prematurely discontinues study drug treatment, an Early Termination of Treatment 
(ETT) Visit should be scheduled as soon as possible after the decision to discontinue treatment. 
Subjects who prematurely discontinue treatment will also be required to complete the Safety 
Follow-up Visit, approximately 28 days after their last dose of study drug. The assessments 
performed at the Safety Follow-up Visit are listed in Table 3-2. 
If the ETT Visit occurs 3 weeks or later following the last dose of study drug, then the ETT Visit 
will replace the Safety Follow-up Visit, and a separate Safety Follow-up Visit will not be 
required. 
If a subject withdraws from the study and also withdraws consent or assent, no further 
assessments will be performed. Vertex may retain and continue to use any data and samples 
collected before such withdrawal of consent or assent. 
9.1.5.1 
Discontinuation During the Run-in Period 
Subjects who prematurely discontinue study drug treatment during the TEZ/IVA Run-in Period 
will not be randomized or participate in the Treatment Period. These subjects will complete an 
ETT Visit and Safety Follow-up Visit (as applicable; see Section 9.1.5). The Safety Follow-up 
Visit will be their last visit in the study. 
9.1.5.2 
Discontinuation During the Treatment Period 
Subjects who prematurely discontinue study drug treatment during the Treatment Period will 
continue to complete all scheduled study visits following completion of the ETT Visit, as 

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detailed in Table 3-2. These subjects will complete an ETT Visit and Safety Follow-up Visit (as 
applicable; see Section 9.1.5).  
9.1.6 
Lost to Follow-up 
A subject will be considered lost to follow-up if both of the following occur: 
 The subject misses 2 consecutive study visits (telephone contact and/or clinic visit) and is 
subsequently unable to be contacted by telephone (3 documented attempts by telephone 
within 2 weeks following the second missed visit). 
 The subject does not respond within 2 weeks to a registered letter sent after the 3 attempted 
telephone contacts. 
9.1.7 
Completion of Study Participation 
Completion of study participation for each individual subject is defined as one of the following: 
 For subjects who complete the Treatment Period and enter an open-label study within 
28 days of the Week 24 Visit: the Week 24 Visit 
 For subjects who complete the Treatment Period and do not enter an open-label study within 
28 days of the Week 24 Visit: the Safety Follow-up Visit 
 For subjects who prematurely discontinue study drug treatment during the Treatment Period 
but do not withdraw consent (and assent, as applicable): The latest of the Week 24 Visit, ETT 
Visit, or Safety Follow-up Visit (if required) 
 For subjects who prematurely discontinue study drug treatment during the TEZ/IVA Run-in 
Period but do not withdraw consent (and assent, as applicable): the ETT or Safety Follow-up 
Visit (if required) 
 For subjects who withdraw consent or assent: date of withdrawal of consent or assent, 
whichever is earlier (Section 9.9) 
If subjects are lost to follow-up (Section 9.1.6), the date of completion of study participation will 
be defined as the date of the last contact.  
The end of study is defined in Section 13.2.8. 
9.2 
Method of Assigning Subjects to Treatment Groups 
Subjects will be randomized (1:1) to the VX-445/TEZ/IVA or TEZ/IVA group. Randomization 
will be stratified by ppFEV1 determined during the TEZ/IVA Run-in Period (Day -14 
assessment; <70 versus ≥70), age at the Screening Visit (<18 versus ≥18 years of age), and 
whether the subject is receiving CFTR modulator treatment at the Screening Visit (yes versus 
no). If the Day -14 ppFEV1 value is not valid or not available, the most recent available ppFEV1 
value will be used for stratification. 
An interactive web response system (IWRS) will be used to assign subjects to treatment. The 
randomization code list will be produced by Vertex Biometrics or a qualified randomization 
vendor. 

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9.3 
Rationale for Study Elements 
9.3.1 
Study Design 
A randomized, double-blind, controlled study design was selected to assess the effects of 
VX-445/TEZ/IVA while avoiding observer bias. TEZ/IVA is considered an appropriate active 
control since TEZ/IVA (Symdeko/Symkevi) is approved to treat CF in this patient population. 
A 4-week TEZ/IVA Run-in Period was incorporated into this study to establish a reliable 
on-treatment (TEZ/IVA) baseline for comparison during the Treatment Period. 
The study will have a 24-week duration to allow for the collection of controlled efficacy and 
safety data.  
The extent of response to CFTR modulator treatment may depend on the subject’s ppFEV1 value 
(an index of disease severity) before the start of randomized study drug dosing. Some subjects in 
this study may be receiving treatment with LUM/IVA or TEZ/IVA at screening, while some 
subjects may not be receiving treatment with CFTR modulators. Therefore, randomization will 
be stratified by previous CFTR modulator use and ppFEV1 value determined during the 
TEZ/IVA Run-in Period after at least 13 days of treatment with TEZ/IVA (Day -14 assessment). 
Randomization will also be stratified by age at screening. This will ensure a balanced evaluation 
of adult and adolescent subjects.  
9.3.2 
Study Population 
CF patients with the F/F genotype have continuing unmet needs despite the availability of CFTR 
modulators, and are expected to respond to a TC regimen of VX-445/TEZ/IVA based on results 
from Phase 2 and Phase 3 studies in this population. 
The VX-445 Phases 2 and 3 clinical safety and efficacy data support the enrollment of subjects 
≥12 and <18 years of age in this study. 
9.3.3 
Study Drug Dose 
VX-445 Dosage 
A VX-445 dose of 200 mg qd will be administered. This is the dosing regimen that was 
evaluated in Phase 3 studies of VX-445/TEZ/IVA. 
TEZ/IVA Dosage 
TEZ will be administered as 100 mg qd and IVA will be administered as 150 mg q12h. This is 
the approved dosing regimen for Symdeko/Symkevi. 
9.3.4 
Rationale for Study Assessments 
SwCl, spirometry, and CFQ-R endpoints are widely accepted and generally recognized as 
reliable, accurate, and relevant to the study of individuals with CF and were evaluated in 
previous registration studies of CFTR modulators. 
All safety assessments are standard measurements for clinical studies in drug development. 

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9.4 
Study Restrictions 
9.4.1 
Prohibited Medications 
Table 9-2 lists prohibited medications. A non-exhaustive list of study prohibitions and cautions 
for medication will be provided in the Study Reference Manual. 
Table 9-2 
Prohibited Medications 
Medication 
Timing of Restriction 
Rationale 
Start of Restriction 
End of 
Restriction 
Moderate and strong 
CYP3A inducers 
None allowed 
within 14 days 
before the first dose 
of the study drug on 
Day -28 
None allowed 
through 
completion of 
study 
participation 
VX-445, TEZ, and IVA are metabolized 
extensively via CYP3A4. Therefore, use of 
moderate and strong inducers of CYP3A and 
moderate and strong inhibitors of CYP3A, which 
have the potential to alter the exposure of 
VX-445, TEZ, or IVA, will be prohibited. 
 
Moderate and strong 
CYP3A inhibitors 
(except 
ciprofloxacin)a 
None allowed 
within 14 days 
before the first dose 
of the study drug on 
Day -28 
None allowed 
through 
completion of 
study 
participation 
Non-Vertex CFTR 
modulators 
(investigational or 
approved) 
None allowed 
within 28 days or 
5 terminal half-lives 
(whichever is 
longer) before 
screening  
None allowed 
through 
completion of 
study 
participation  
These agents may confound the results of this 
study. 
Vertex CFTR 
modulators 
(investigational or 
approved), except 
for study drugs 
None allowed from 
the first dose of 
study drug on 
Day -28 
None allowed 
until after the last 
dose of study 
drug 
 
These agents may confound the results of this 
study. 
CYP: cytochrome P450; IVA: ivacaftor; TEZ: tezacaftor 
a 
Ciprofloxacin is not a moderate CYP3A inhibitor on the basis of results of a drug-drug interaction study 
conducted with IVA, a sensitive CYP3A substrate (Kalydeco [ivacaftor] US Package Insert). 
9.5 
Prior and Concomitant Medications 
Information regarding prior and concomitant medications, including CF medications, other 
medications, and herbal and naturopathic remedies, will be collected from each subject’s source 
documentation for medications taken within 56 days before the Screening Visit through 
completion of study participation, as defined in Section 9.1.7. 
For subjects who are screened, but are not subsequently randomized into the Treatment Period, 
details of prior medication will be documented only in the subjects’ source documents. 
 Subjects should remain on a stable treatment regimen for their CF from 28 days before the 
TEZ/IVA Run-in Period/Day -28 through completion of study participation. Stable treatment 
regimen is defined as the current treatment regimen for CF that subjects have been following 
for at least 28 days before the TEZ/IVA Run-in Period/Day -28. Subjects may remain on 
Vertex CFTR modulators (investigational or approved) during the Screening Period and may 
transition directly to the TEZ/IVA Run-in/Day -28 without a washout (Table 9-2). Subjects 

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should not initiate long-term treatment with new medication from 28 days before the 
TEZ/IVA Run-in Period/Day -28 through completion of study participation. Guidelines for 
stable treatment regimens for CF are as follows:  
o Subjects who are taking inhaled tobramycin or other chronically inhaled antibiotics 
should remain on that regimen throughout the study. 
o Subjects who cycle onto and off of an inhaled antibiotic should continue on their prior 
schedule. The timing of the first dose of study drug on the Day 1 Visit should be 
synchronized as closely as possible (e.g., not more than ± 3 days) to the first day in 
the cycle onto the inhaled antibiotic. 
o Subjects who alternate between 2 different inhaled antibiotics should remain on the 
same cycling schedule during the study. The timing of the first dose of study drug on 
the Day 1 Visit should be synchronized as closely as possible (e.g., not more than 
± 3 days) to the first day in the cycle onto 1 of the inhaled antibiotics. 
 Subjects may receive doses of prednisone or prednisolone of up to 10 mg/day chronically, or 
up to 60 mg daily for up to 5 days. 
 VX-445 may inhibit OATP1B1 and OATP1B3, which may increase the exposure of 
medicinal products that are substrates for these transporters. Substrates such as statins, 
glyburide, nateglinide, and repaglinide should be used with caution.  
 IVA is a weak inhibitor of P-glycoprotein (P-gp). Administration of IVA may increase 
systemic exposure of medicinal products that are sensitive substrates of P-gp, which may 
increase or prolong their therapeutic effect and adverse reactions. Digoxin or other substrates 
of P-gp with a narrow therapeutic index, such as cyclosporine, everolimus, sirolimus, and 
tacrolimus, should be used with caution and appropriate monitoring.  
 IVA may inhibit CYP2C9; therefore during coadministration with warfarin, additional 
monitoring of the international normalized ratio is recommended. Other medicinal products 
that are CYP2C9 substrates for which exposure may be increased include glimepiride and 
glipizide; these should be used with caution. 
 Information about bronchodilator use during the study will be collected and documented. 
Subjects who are using a bronchodilator must have their spirometry assessments performed 
according to the guidelines provided in Section 11.4.2. 
9.6 
Administration 
9.6.1 
Dosing 
Study drug will be administered orally. All subjects will receive the same number of tablets each 
day to maintain the blind. Additional information is provided in the Pharmacy Manual. 
Study drug should be administered with a fat-containing meal or snack, such as a standard “CF” 
meal or snack or a standard meal. 
1. It is recommended that the dose be taken within 30 minutes of the start of the meal or snack. 
2. Study drug will be administered as fixed-dose combination (FDC) tablet(s) 
(e.g., 2 VX-445/TEZ/IVA or matching placebo tablets; 1 TEZ/IVA or matching placebo 

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tablet) in the morning and as 1 IVA tablet in the evening. For each subject, doses of study 
drugs should be taken at approximately the same time (± 2 hours) each day. 
3. On days of scheduled visits, the morning dose of study drug will be administered at the site 
after predose assessments have been completed. A meal or snack will be provided by the site 
for the morning dose of study drug. 
4. If a subject’s scheduled visit is to occur in the afternoon, the following guidelines must be 
used:  
 If the dose in the clinic will be within 6 hours of the subject’s scheduled morning dose, 
the subject should withhold their morning dose of study drug and the morning dose will 
be administered in the clinic. 
 If the dose in the clinic will be more than 6 hours after the subject’s scheduled morning 
dose, the subject should take the morning dose of study drug at home.  
5. Subjects will be instructed to bring all used and unused materials associated with the study 
drug to the site; study drug will be dispensed at each visit, as appropriate.  
9.6.2 
Missed Doses 
If 6 hours or less have passed since the missed morning or evening dose, the subject should take 
the missed dose as soon as possible and continue on the original schedule. 
Morning dose: If more than 6 hours have passed since the missed morning dose, the subject 
should take the missed dose as soon as possible and should not take the evening dose. 
Evening dose: If more than 6 hours have passed since the missed evening dose, the subject 
should not take the missed dose. The next scheduled morning dose should be taken at the usual 
time. 
Morning and evening doses should not be taken at the same time. 
9.7 
Dose Modification for Toxicity 
No dose modifications for toxicity are allowed. Treatment may be interrupted; if any 
unacceptable toxicity arises, individual subjects will discontinue dosing. 
9.8 
Study Drug Interruption and Stopping Rules 
In subjects who have interrupted study drug for >72 hours for any reason, the investigator should 
resume study drug only after a thorough investigation of the cause for interruption. The 
investigator should evaluate the subject’s clinical stability and only resume drug after the subject 
is clinically stable and there is no comorbidity or condition that, in the opinion of the 
investigator, might confound the results of the study or pose an additional risk in administering 
study drug to the subject. 
The medical monitor should be notified of an interruption of study drug that lasts >72 hours for 
any reason and of the resumption of study drug after such interruption. The medical monitor 
should be notified of any plan to discontinue study drug. 
9.8.1 
Liver Function Tests 
The central laboratory will notify the medical monitor of instances of ALT or AST >3 × ULN in 
association with total bilirubin >2 × ULN that are derived from centrally submitted samples. 

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Subjects with new treatment-emergent ALT or AST elevations of >3 × ULN, with or without 
total bilirubin >2 × ULN, must be followed closely, including confirmatory testing performed by 
the central laboratory within 48 to 72 hours of the initial finding and subsequent close 
monitoring of ALT, AST, and bilirubin levels, as clinically indicated. 
If a subject cannot return to the site for central laboratory confirmatory testing, a local laboratory 
may be used. Local laboratory results must be reported immediately to the medical monitor, and 
the subject must have the tests repeated and sent to the central laboratory as soon as possible 
(ideally within 48 to 72 hours). 
Study drug administration must be interrupted immediately (before confirmatory testing) if any 
of the following criteria are met: 
 ALT or AST >8 × ULN 
 ALT or AST >5 × ULN for more than 2 weeks 
 ALT or AST >3 × ULN, in association with total bilirubin >2 × ULN and/or clinical jaundice 
A thorough investigation of potential causes should be conducted, and the subject should be 
followed closely for clinical progression. 
Study drug administration must be discontinued if the following criterion is met: 
 Subsequent ALT or AST values confirm the initial elevation that satisfied the interruption 
rule (above), and no convincing alternative etiology (e.g., acetaminophen use, viral hepatitis, 
alcohol ingestion) is identified, regardless of whether transaminase levels have improved 
All subjects in whom treatment is discontinued for elevated transaminases (and bilirubin, as 
applicable) should have these levels monitored closely until levels normalize or return to 
baseline. 
If an alternative, reversible cause of transaminase elevation with or without increased bilirubin or 
clinical jaundice has been identified, study drug administration may be resumed once 
transaminases return to baseline or are ≤2 × ULN, whichever is higher. Regardless of the 
duration of interruption, the medical monitor should be notified before resumption of study drug. 
Upon resumption of study drug, transaminases and bilirubin should be assessed weekly for 
4 weeks. If a protocol-defined transaminase elevation interruption threshold recurs within 
4 weeks of rechallenge with the study drug (with confirmation of the initial elevation by repeat 
testing within 48 to 72 hours), then the study drug must be permanently discontinued, regardless 
of the presumed etiology.  
9.8.2 
Rash 
Individuals who develop a generalized rash will be monitored closely. Study drug dosing should 
be interrupted if a subject develops a generalized rash of Grade 3 or higher, or a rash that is 
considered a serious adverse event (SAE). The investigator will notify the medical monitor of 
any rash that results in interruption of study drug, is Grade 3 or higher (Section 13.1.1.4), or is an 
SAE. Investigators should consider additional evaluation including laboratory testing (e.g., 
complete blood count with differential, liver function tests), photographs of the rash, and 
dermatology consultation. The investigator may consider resumption of study drug if considered 
clinically appropriate.  

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9.9 
Removal of Subjects 
Subjects may withdraw from the study at any time at their own request. Subjects may be 
withdrawn from study drug treatment at any time at the discretion of the investigator or Vertex 
for safety, behavior, noncompliance with study procedures, or administrative reasons. If a subject 
has been withdrawn from study drug treatment, the subject will continue to be followed, 
provided that the subject has not withdrawn consent (and assent, as applicable). 
In addition, a subject must be discontinued from study drug treatment if the subject meets any of 
the following criteria: 
 Has a screening CFTR genotype that does not confirm study eligibility if a previous CFTR 
genotype laboratory report was used to establish eligibility. These subjects must be 
discontinued from the study (Section 8.1) 
 Meets any of the stopping (discontinuation) criteria (Section 9.8) 
 Becomes pregnant (Section 11.5.7.2) 
Subjects who discontinue study drug treatment should return for study assessments, as noted in 
Section 9.1.5.2. 
If a subject does not return for a scheduled visit, reasonable effort will be made to contact the 
subject. In any circumstance, reasonable effort will be made to document subject outcome. The 
investigator will inquire about the reason for withdrawal, request that the subject return all 
unused investigational product(s), request that the subject return for an ETT Visit and Safety 
Follow-up Visit, if applicable (see Section 9.1.5), and follow up with the subject regarding any 
unresolved AEs. 
If the subject withdraws consent or assent for the study, no further assessments will be 
performed. Vertex may retain and continue using the study data and samples after the study is 
over, and may use the samples and information in the development of the study compound, and 
for other drugs and diagnostics, in publications and presentations, and for education purposes. If 
the subject withdraws from the study, the study data and samples collected will remain part of 
the study. A subject will not be able to request the withdrawal of his/her information from the 
study data. A subject may request destruction of the samples collected from him/her during the 
study as long as those samples can be identified as his/her samples. 
9.10 
Replacement of Subjects 
Subjects who withdraw or are withdrawn before the first dose of randomized study drug on 
Day 1 of the Treatment Period may be replaced. 
Subjects who withdraw or are withdrawn for nonsafety reasons during the study drug treatment 
periods may be replaced at Vertex’s discretion. 
10 
STUDY DRUG INFORMATION AND MANAGEMENT 
During the TEZ/IVA Run-in Period, study drug refers to TEZ/IVA and IVA.  
During the Treatment Period, study drug refers to VX-445/TEZ/IVA and matching placebo, 
TEZ/IVA and matching placebo, and IVA.  

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10.1 
Preparation and Dispensing 
Study drug may be dispensed only under the supervision of the investigator or an authorized 
designee and only for administration to the study subjects. 
10.2 
Packaging and Labeling 
Study drug tablets will be supplied in blister cards by Vertex. Study drug labeling will be in 
compliance with applicable local and national regulations. Additional details regarding 
packaging, labeling, and dispensing for study drug will be in the Pharmacy Manual. 
10.3 
Study Drug Supply, Storage, and Handling 
VX-445/TEZ/IVA will be supplied as FDC film-coated tablets containing 100 mg VX-445, 
50 mg TEZ, and 75 mg IVA. Matching VX-445/TEZ/IVA placebo tablets will be of similar size 
and appearance and contain 0 mg VX-445, 0 mg TEZ, and 0 mg IVA (Table 10-1). 
TEZ/IVA will be supplied as FDC film-coated tablets containing 100 mg TEZ and 150 mg IVA. 
A matching TEZ/IVA placebo tablet will be of similar size and appearance and contain 0 mg 
TEZ and 0 mg IVA (Table 10-1). 
IVA will be supplied as a film-coated tablet containing 150 mg IVA (Table 10-1). 
Blister cards must be stored under conditions noted in the Pharmacy Manual. The investigator, or 
an authorized designee (e.g., a licensed pharmacist), will ensure that all investigational product is 
stored in a secured area, under recommended storage conditions, and in accordance with 
applicable regulatory requirements. To ensure adequate records, all study drugs will be 
accounted for via the drug accountability forms as instructed by Vertex. 
Table 10-1 
Study Drug: Strength/Dosing Form/Route 
Drug Name, Dosing Form, Route 
Strength 
VX-445/TEZ/IVA, FDC tablet, oral 
 
VX-445 
100 mg 
TEZ 
50 mg 
IVA 
75 mg 
VX-445/TEZ/IVA-matching placebo, tablet, oral 
0 mg 
TEZ/IVA, FDC tablet, oral 
 
TEZ 
100 mg 
IVA 
150 mg 
TEZ/IVA-matching placebo, tablet, oral 
0 mg 
IVA, tablet, oral 
150 mg 
FDC: fixed-dose combination; IVA: ivacaftor; TEZ: tezacaftor 
10.4 
Drug Accountability 
The pharmacist or designated study site staff will maintain information regarding the dates and 
amounts of (1) study drug received; (2) study drug dispensed to the subjects; and (3) study drug 
returned by the subjects. Subjects will be instructed to return all used and unused materials 
associated with the study drug to the site. These materials will be retained at the site according to 
instructions provided by Vertex or its designee. The study monitor will review study drug 
records and inventory throughout the study. 

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If a site uses a site-specific drug accountability system and/or process, including processes 
associated with the destruction of returned materials, the process must be documented and 
approved by Vertex. The study monitor must review the drug accountability documentation on a 
regular basis. The study monitor will promptly communicate to Vertex any discrepancies he/she 
is unable to resolve with the site. 
10.5 
Disposal, Return, or Retention of Unused Drug 
The study site staff or pharmacy personnel will retain all materials returned by the subjects until 
the study monitor has performed drug accountability. The investigator will ensure that the 
materials are destroyed in compliance with applicable environmental regulations, institutional 
policy, and any special instructions provided by Vertex. Destruction will be adequately 
documented. 
10.6 
Compliance 
To ensure treatment compliance, the investigator or designee will supervise all study drug dosing 
that occurs at the site. At each visit, site personnel will review that the subject is compliant with 
study drug dosing and remind the subject of study drug dosing requirements. Compliance will 
also be assessed by ongoing study drug count. 
If a subject demonstrates continued noncompliance of study drug dosing despite educational 
efforts, the investigator should consider discontinuing the subject from the study. 
10.7 
Blinding and Unblinding 
This will be a double-blind study. 
10.7.1 
Blinding  
All subjects (and their parents/caregivers/companions), site personnel (including the investigator, 
the site monitor, and the study team), and members of the Vertex study team will be blinded to 
the treatment codes. 
Individuals who may be unblinded include only the following: 
 Any site personnel for whom this information is important to ensure the safety of the subject 
in the event of a life-threatening medical emergency 
 Any site personnel for whom this information is important to ensure the safety of the subject 
and her fetus in the event of a pregnancy 
 Vertex Global Patient Safety (GPS) and Regulatory Affairs personnel to satisfy SAE 
processing and reporting regulations 
 Vendor preparing the final (production) randomization list 
 Vertex IWRS Manager 
 Vertex Clinical Supply Chain 

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A limited Vertex team may be unblinded if an interim analysis (IA) is performed. Members of 
the limited Vertex unblinded team will not be involved in or influence the conduct of the 
remaining part of the study to protect the integrity of the study (Section 12.3.5.1). 
Access to Spirometry and SwCl Results: 
During the conduct of the study, the Vertex study team will not have access to the spirometry or 
SwCl results after the first dose of study drug in the Treatment Period.  
Shortly before any planned efficacy analysis is conducted, the spirometry and SwCl data will be 
reviewed for data cleaning purposes by a biostatistician who does not have access to the 
treatment codes. 
Individual SwCl test results will not be disclosed to the study sites with the exception of the 
screening values. Subjects and their parents/caregivers/companions should not be informed of 
study-related spirometry results until Vertex has determined that the study has completed 
(i.e., clinical study report [CSR] finalization), regardless of whether the subject has prematurely 
discontinued treatment.  
10.7.2 
Unblinding 
At the initiation of the study, study site personnel will be instructed on the method for breaking 
the blind. The unblinding method will be either manual or electronic. 
Unblinding of Individual Subject Treatment Assignments by Investigator for Medical 
Emergencies or Urgent Clinical Situations 
Unblinding of the individual subject’s treatment by the investigator will be limited to medical 
emergencies or urgent clinical situations in which knowledge of the subject’s study treatment is 
necessary for clinical management. In such cases, investigators will use their best judgment as to 
whether to unblind without first attempting to contact the medical monitor to discuss unblinding. 
If investigators deem it unnecessary to unblind immediately, they will first attempt to contact the 
medical monitor to discuss unblinding. If investigators have tried but are unable to reach the 
medical monitor, they will use their best judgment, based on the nature and urgency of the 
clinical situation, and may proceed with unblinding. 
Contact information for the medical monitor (or appropriate backup) will be in a separate 
document. 
If a subject’s treatment assignment has been unblinded for a medical emergency or urgent 
clinical situation, the medical monitor will be notified within 24 hours of the unblinding event. 
The reason and the date of the unblinding will be documented clearly in the subject’s study file. 
Information about the treatment assignment obtained from the unblinding will be maintained in a 
secure location with controlled access and will not be shared with Vertex, the contract research 
organization, or any site personnel (other than the physician treating the subject). In addition, the 
investigator will consider whether the clinical event that prompted unblinding will be considered 
an SAE, according to the regulatory definitions or criteria for SAEs, and if so, submit an SAE 
report to Vertex GPS or designee, per Section 13.1.2. 

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Unblinding of Individual Subject Treatment Assignments by Vertex GPS or Designee for 
SAEs or Safety Concerns 
Vertex GPS or designee will also unblind any SAE reports in compliance with regulatory 
reporting requirements. In addition, Vertex may, for matters relating to safety, unblind individual 
subjects at any time.  
Unblinding: Interim Analysis 
A limited Vertex team may be unblinded if an IA is performed. Members of the limited Vertex 
unblinded team will not be involved in or influence the conduct of the remaining part of the 
study to protect the integrity of the study (Section 12.3.5.1). Regardless of the outcome of the IA, 
subjects (and their parents/caregivers/companions), site personnel (including the investigator, the 
site monitor, and the study team), and members of the Vertex study team will remain blinded 
until the final database lock. 
11 
ASSESSMENTS 
11.1 
Timing of Assessments 
The timing of assessments is shown in Table 3-1 and Table 3-2. 
11.2 
Subject and Disease Characteristics 
Subject and disease characteristics include the following: demographics, medical history, height, 
and weight. 
Medical history will be elicited from each subject and extracted from medical records during 
screening. Based on the medical history, the subject will be assessed for any disqualifying 
medical conditions as specified in the inclusion and exclusion criteria. The medical history will 
include a complete review of systems, medical and surgical histories, and any allergies. 
11.3 
Pharmacodynamics: Sweat Chloride 
SwCl samples will be collected with an approved collection device. Each collection will occur 
before study drug dosing (Section 9.6.1). At each time point, 2 samples will be collected, 1 from 
each arm (left and right). Sweat samples will be sent to a central laboratory for testing and 
interpretation of results. Specific instructions for the collection, handling, processing, and 
shipping of SwCl samples to the central laboratory will be provided separately. 
See Section 10.7.1 for information about access to SwCl results. 
11.4 
Efficacy 
11.4.1 
Cystic Fibrosis Questionnaire-Revised 
The questionnaires provide information about demographics; general quality of life, school, 
work, or daily activities; and symptom difficulties (pertaining to CF). 
Subjects will be asked to complete the CFQ-R in their native language, if validated translations 
are available.16, 17 If there is no validated translation available in the subject’s native language, 
the subject will not complete the questionnaire. Copies of the CFQ-R used will be provided in 
the Study Reference Manual. Validated translations of the CFQ-R, if available, will be provided 
for participating centers in non-English-speaking countries.18, 19 

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The CFQ-R will be completed before any other assessments (except signing of ICF) are 
performed at that visit.  
Subjects who are 12 and 13 years of age at the date of informed consent will complete the 
CFQ-R Child version themselves, and their parents/caregivers will complete the CFQ-R Parent 
version, at all visits, regardless of whether the subject subsequently turns 14 years of age during 
the study. Subjects 14 years of age and older at the date of informed consent will complete the 
Adolescent/Adult version of the questionnaire themselves at all visits. 
11.4.2 
Spirometry 
Spirometry will be performed according to the American Thoracic Society Guidelines/European 
Respiratory Society Guidelines12 and according to the additional guidelines that follow. 
Pre-bronchodilator spirometry is defined as spirometry testing performed for subjects who have 
• 
withheld their short-acting bronchodilators (e.g., albuterol) or anticholinergic 
(e.g., ipratropium bromide [Atrovent®]) for more than 4 hours before the spirometry 
assessment; 
• 
withheld their long-acting bronchodilator (e.g., salmeterol) for more than 12 hours before the 
spirometry assessment; and 
• 
withheld their once-daily, long-acting bronchodilator (e.g., tiotropium bromide [Spiriva®]) 
for more than 24 hours before the spirometry assessment. 
During the Screening Period, spirometry assessments may be performed pre- or 
post-bronchodilator. At all other visits, all spirometry assessments should be performed 
pre-bronchodilator. During the Treatment Period, spirometry assessments must be performed 
before study drug dosing (Section 9.6.1) at approximately the same time at each visit. In the 
event that a subject forgets to withhold bronchodilator(s), spirometry should be performed 
according to the following: 
• 
If a subject’s Day 1 spirometry assessment is pre-bronchodilator but, on a subsequent visit, 
the subject forgets to withhold bronchodilator use, a post-bronchodilator spirometry 
assessment will be obtained for that visit only, and the visit will not be rescheduled. 
• 
If, on Day 1, the subject forgets to withhold his/her dose of bronchodilator, spirometry 
should be performed post-bronchodilator, and all subsequent spirometric measurements 
(according to the schedule of assessments in Table 3-2) should be performed 
post-bronchodilator. 
• 
Each spirometry assessment will be recorded in the source documents as pre- or 
post-bronchodilator. 
All sites will be provided with spirometers to be used for all study assessments. Spirometry data 
will be transmitted to a centralized spirometry service for quality review. The investigator’s 
assessment of the spirometry results will be used for the screening assessment and determination 
of eligibility. 
See Section 10.7.1 for information about access to spirometry results. 
The measured spirometric values listed below will be converted to percent predicted values using 
the standard equations of GLI.11  

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• 
FEV1 (L) 
• 
Forced vital capacity (FVC) (L) 
• 
FEV1/FVC (ratio) 
• 
Forced expiratory flow, midexpiratory phase (FEF25%-75%) (L/s) 
11.4.3 
Height and Weight 
Height and weight will be measured with shoes off. Following screening, height will be collected 
only for subjects ≤21 years of age on the date of informed consent. 
11.5 
Safety 
Safety evaluations will include AEs, clinical laboratory assessments, and clinical evaluation of 
vital signs, ECGs, physical examinations (PEs), and pulse oximetry. 
For subjects <18 years of age on the date of informed consent, ophthalmological examinations 
will also be performed at screening (if not done within preceding 3 months) and at Week 24 (or 
ETT Visit or Safety Follow-up Visit). 
11.5.1 
Adverse Events 
All AEs will be assessed, documented, and reported in accordance with ICH GCP guidelines. 
Section 13.1 outlines the definitions, collection periods, criteria, and procedures for 
documenting, grading, and reporting AEs. A separate document that details AE case report form 
(CRF) completion guidelines for investigators as well as training will be provided. 
11.5.2 
Clinical Laboratory Assessments 
Blood and urine samples will be analyzed at a central laboratory, with the exception of the urine 
pregnancy tests. As described below, urine pregnancy tests will either be analyzed by the site or 
at home using a home kit. On Day 1, blood samples will be collected before the first dose of the 
study drug. 
Laboratory test results that are abnormal and considered clinically significant will be reported as 
AEs. 
The safety laboratory test panels are shown in Table 11-1. 

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Table 11-1 
Safety Laboratory Test Panels 
Serum Chemistry 
Hematology 
Urinalysisa 
Glucose 
Blood urea nitrogenb 
Creatinine 
Sodium 
Potassium 
Calcium 
Chloride 
Magnesium 
Bicarbonate 
Inorganic phosphate  
Total and direct bilirubin 
Alkaline phosphatase 
Aspartate transaminase  
Alanine transaminase 
Amylase 
Lipase 
Gamma-glutamyl transferase 
Protein 
Albumin 
Creatine kinase 
Total cholesterol 
Lactate dehydrogenase  
Hemoglobin 
Erythrocytes 
Mean corpuscular volume 
Platelets 
Reticulocytes  
Leukocytes 
Differential (absolute and percent): 
Eosinophils 
Basophils 
Neutrophils 
Lymphocytes  
Monocytes 
Coagulation Studies 
Activated partial thromboplastin time  
Prothrombin time 
Prothrombin time International 
Normalized Ratio 
 
Leukocyte esterase 
Nitrite 
Urobilinogen  
Urine protein  
pH 
Urine blood 
Specific gravity  
Urine ketones  
Urine bilirubin  
Urine glucose  
Note: Haptoglobin may be analyzed if judged to be clinically appropriate by the investigator. 
a 
If urinalysis results are positive for leukocyte esterase, nitrite, protein, or blood, microscopic examination of 
urine will be performed, and results will be provided for leukocytes, erythrocytes, crystals, bacteria, and casts. 
b 
If blood urea nitrogen cannot be collected, urea may be substituted. 
Pregnancy (β-human chorionic gonadotropin) Tests for female subjects: All female subjects must 
have a serum pregnancy test at screening. Serum pregnancy tests will be performed at the study 
site and analyzed at the central laboratory. Urine pregnancy tests will either be performed and 
analyzed at the site or, when there is no clinic visit scheduled, at home by using a home kit 
provided by the site. Results will be reported to the site by telephone. The urine pregnancy test 
on Day 1 must be negative before the first dose of study drug. Additional pregnancy tests may be 
required according to local regulations and/or requirements. 
FSH: Blood samples for FSH will be measured as needed for any suspected postmenopausal 
female with at least 12 months of continuous spontaneous amenorrhea. Serum FSH levels must 
be in the postmenopausal range as determined by the laboratory performing the test.  
CFTR Genotype (Screening Period Only): CFTR genotyping will be performed for all subjects. 
If the screening CFTR genotype result is not received before randomization, a previous CFTR 
genotype laboratory report may be used to establish eligibility. Subjects who have been 
randomized and whose screening genotype does not confirm study eligibility must be 
discontinued from the study (Section 9.9). 
Additional Evaluations: Additional clinical laboratory evaluations will be performed at other 
times if judged to be clinically appropriate.  

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For the purposes of study conduct and unless noted otherwise, only laboratory tests done in the 
central laboratory may be used. Local laboratories may be used at the discretion of the local 
investigator for management of urgent medical issues. If a local laboratory test value is found to 
be abnormal and clinically significant, it will be verified by the central laboratory as soon as 
possible after the investigator becomes aware of the abnormal result. If it is not possible to send a 
timely specimen to the central laboratory (e.g., the subject was hospitalized elsewhere), the 
investigator may base the assessment of an AE on the local laboratory value. 
11.5.3 
Physical Examinations and Vital Signs 
A PE of all body systems and vital signs assessments will be performed at screening and select 
study visits (see Table 3-1 and Table 3-2). At other visits, symptom-directed PEs and 
symptom-directed vital sign assessments will occur at any time if deemed necessary by the 
investigator or healthcare provider. 
A complete PE includes a review of the following systems: head, neck, and thyroid; eyes, ears, 
nose, and throat (EENT); respiratory; cardiovascular; lymph nodes; abdomen; skin; 
musculoskeletal; and neurological. Breast, anorectal, and genital examinations will be performed 
when medically indicated. After screening, any clinically significant abnormal findings in PEs 
will be reported as AEs. 
Vital signs include blood pressure (systolic and diastolic), temperature, pulse rate, and 
respiration rate. These will be assessed before dosing and following at least a 5-minute rest. A 
consistent methodology should be used for repeat measurements of these parameters at a clinical 
site. 
11.5.4 
Pulse Oximetry 
Pulse oximetry is a noninvasive measure of oxygen delivery to the tissues and has been 
correlated with clinical status and lung function. Arterial oxygen saturation by pulse oximetry 
will be assessed following at least a 5-minute rest and before study drug dosing. At visits when 
study drug is taken at the site, pulse oximetry will be collected before study drug dosing 
(Section 9.6.1). 
11.5.5 
Electrocardiograms 
Standard 12-lead ECGs will be performed using a machine with printout according to the 
schedule of assessments (Table 3-1 and Table 3-2). Additional standard 12-lead ECGs will be 
performed at any other time if clinically indicated. Subjects will be instructed to rest for at least 
5 minutes before having an ECG performed. 
The ECG traces will be manually read at the study site. A printout of the ECG traces will be 
made for safety review by the investigator and maintained with source documentation. Clinically 
significant ECG abnormalities occurring during the study through completion of study 
participation will be recorded as AEs.  
To ensure the safety of the subjects, a qualified individual at the study site will make 
comparisons to baseline measurements. If the QTcF is increased by >60 msec from the baseline 
or an absolute QTcF value is ≥500 msec for any scheduled ECG, 2 additional ECGs will be 
performed approximately 2 to 4 minutes apart to confirm the original measurement. If either of 
the QTcF values from these repeated ECGs remains above the threshold value (>60 msec from 
baseline or ≥500 msec), a single ECG will be repeated at least hourly until QTcF values from 

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2 successive ECGs fall below the threshold value that triggered the repeat measurement. Further 
details pertaining to ECGs will be provided to sites in the ECG Manual. 
11.5.6 
Ophthalmologic Examination 
Ophthalmologic examinations will be conducted only for subjects who are <18 years of age on 
the date of informed consent. The examination does not need to be completed if there is 
documentation of bilateral lens removal for the subject. 
All examinations will be conducted by a licensed ophthalmologist or optometrist and will 
include: 
• 
measurement of best-corrected distance visual acuity of each eye; and 
• 
pharmacologically-dilated examination of the lens with a slit lamp 
The screening examination does not need to be conducted if there is documentation of an 
examination meeting the protocol requirements that was conducted within 3 months before the 
date of informed consent. 
In addition to the screening ophthalmologic examination, subjects who are <18 years of age on 
the date of informed consent and who have completed at least 12 weeks of study drug treatment 
will have a single ophthalmologic examination at either the ETT or Week 24 Visit (whichever 
comes first), except for those subjects who have withdrawn consent or assent. This examination 
should be completed within 4 weeks before the Week 24 Visit, unless the subject prematurely 
discontinues study drug, in which case this examination should occur by the Safety Follow-up 
Visit (or ETT Visit for subjects who do not complete a Safety Follow-up Visit), as described in 
Table 3-2. 
Any clinically significant abnormal findings will be reported as AEs. 
11.5.7 
Contraception and Pregnancy 
The effects of VX-445 monotherapy or in combination with TEZ/IVA on conception, pregnancy, 
and lactation in humans are not known. VX-445, TEZ, and IVA did not show genotoxic potential 
in a standard battery of in vitro (Ames test, chromosomal aberration, or micronucleus in cultured 
mammalian cells) and in vivo (rodent micronucleus) studies. Reproductive toxicology studies of 
VX-445, TEZ, and IVA have not shown teratogenicity in rats and rabbits. 
11.5.7.1 
Contraception 
Contraception requirement for a couple is waived for the following: 
• 
True abstinence for the subject, when this is in line with the preferred and usual lifestyle of 
the subject. Periodic abstinence (e.g., calendar, ovulation, symptothermal, postovulation 
methods) and withdrawal are not acceptable methods of contraception. True abstinence must 
be practiced from the Screening Visit through 90 days after the last dose of study drug. 
• 
If the male is infertile (e.g., bilateral orchiectomy). If a male subject is assumed to have 
complete bilateral absence of the vas deferens, infertility must be documented before the first 
dose of study drug (e.g., examination of a semen specimen or by demonstration of the 
absence of the vas deferens by ultrasound). 
• 
If the female is of non-childbearing potential. To be considered of non-childbearing potential, 
the female must meet at least 1 of the following criteria: 

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o Postmenopausal: Amenorrheic for at least 12 consecutive months and a serum FSH 
level within the laboratory’s reference range for postmenopausal females 
o Documented hysterectomy or bilateral oophorectomy/salpingo-oophorectomy 
Note: All other females (including females with tubal ligations and pre-menarchal females) 
will be considered to be of childbearing potential. 
• 
Same-sex relationships 
For subjects for whom the contraception requirement is not waived, study participation 
requires a commitment from the subject that at least 1 acceptable method of contraception is 
used as a couple. Methods of contraception must be in successful use from signing of consent, 
approximately 28 days before the first dose of study drug (unless otherwise noted), and until 
90 days following the last dose of study drug. Additional contraception requirements may need 
to be followed according to local regulations and/or requirements. Acceptable methods of 
contraception are listed in Table 11-2. 
Table 11-2 
Acceptable Methods of Contraception 
 
Male Subjects and Their 
Female (Non-study) 
Partners 
Female Subjects and 
Their Male (Non-study) 
Partners 
Vasectomy performed at least 6 months previously, with 
a documented negative postvasectomy semen analysis for 
sperm 
Yes 
Yes 
Bilateral tubal occlusion (e.g., ligation) performed at least 
6 months previously 
Yes 
Yes 
Male or female condom with or without spermicidea 
Yes 
Yes 
Female barrier contraception (such as diaphragm, cervical 
cap, or sponge) with spermicide 
Yes 
Yes 
Continuous use of an intrauterine device for at least 
90 days before the first dose of study drug 
 
 
 Hormone-releasing 
Yes 
Yes 
 Non-hormone releasing 
Yes 
Yes 
Oral, implanted, injected, or vaginal hormonal 
contraceptives, if successfully used for at least 60 days 
before the first dose of study drug 
Yes 
 
Yes 
a 
A female condom cannot be used with a male condom due to risk of tearing.  
 
Additional notes: 
• 
If over the course of the study, the subject meets the criteria for waiving the contraception 
requirements, the subject does not need to follow the contraceptive methods listed in 
Table 11-2.  
• 
If, over the course of the study, the subject’s status changes and the subject does not meet the 
criteria for waiving the contraception requirements, the subject must begin following the 
contraceptive methods listed in Table 11-2. 
• 
Male subjects must not donate sperm during the period starting from the first dose of study 
drug until 90 days after the last dose of study drug. 

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• 
Female subjects should not nurse a child during the period starting from the first dose of 
study drug until 90 days after the last dose of study drug. 
• 
For male subjects with a female partner of childbearing potential, the couple should not plan 
to become pregnant during the study or within 90 days after the last dose of study drug, with 
the exception of couples who plan to become pregnant by artificial insemination using sperm 
banked by the male subject before the first dose of study drug or sperm from another source. 
11.5.7.2 
Pregnancy 
Subjects will be counseled to inform the investigator of any pregnancy that occurs during study 
treatment and for 90 days after the last dose of study drug. 
If a female subject becomes pregnant during study participation, study drug will be permanently 
discontinued immediately. The investigator will notify the medical monitor and Vertex GPS 
within 24 hours of the site’s knowledge of the subject’s (or partner’s) pregnancy using the 
Pregnancy Information Collection Form. Male subjects with female partners who become 
pregnant during the study must use a male condom to avoid exposure of a potential embryo or 
fetus to study drug via the seminal fluid. 
If confirmed to be on active drug, the subject or partner will be followed until the end of the 
pregnancy and the infant will be followed for 1 year after the birth, provided informed consent 
(and assent, as applicable) is obtained. A separate ICF will be provided to explain these 
follow-up activities. Pregnancy itself does not constitute an AE. 
12 
STATISTICAL AND ANALYTICAL PLANS 
This section presents a summary of the planned analyses for this protocol. Statistical analysis 
details will be provided in the statistical analysis plan (SAP), which will be finalized before the 
clinical data lock for the study and treatment unblinding. 
12.1 
Sample Size and Power 
Up to approximately 158 subjects will be enrolled and randomized (1:1) to the 
VX-445/TEZ/IVA group or the TEZ/IVA group. Information regarding the powering of primary 
and key secondary endpoints is provided below. 
Power for Primary Efficacy Endpoint 
The primary efficacy endpoint is the absolute change in CFQ-R respiratory domain score from 
baseline through Week 24. The primary null hypothesis to be tested is that the mean absolute 
change in CFQ-R respiratory domain score from baseline is the same for the 2 treatment groups, 
VX-445/TEZ/IVA and TEZ/IVA. The null hypothesis will be tested at a 2-sided significance 
level of 0.05.  
Assuming a within-group SD of 18 and a treatment difference of 10 between VX-445/TEZ/IVA 
and TEZ/IVA, a sample size of 71 subjects completing the Treatment Period in each group for a 
total of 142 subjects will have approximately 90% power for the CFQ-R respiratory domain 
score hypothesis testing, based on a 2-sample t-test at a significance level of 0.05 (2-sided). 
Assuming a 10% dropout rate, up to approximately 158 subjects will be enrolled.  

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Power for Key Secondary Endpoint 
The key secondary endpoint is the absolute change in ppFEV1 from baseline through Week 24. 
Assuming a within-group SD of 7 percentage points and a treatment difference of 5 between 
VX-445/TEZ/IVA and TEZ/IVA, a sample size of 71 subjects completing the Treatment Period 
in each group for a total of 142 subjects will have approximately 98% power for the ppFEV1 
hypothesis testing, based on a 2-sample t-test at a significant level of 0.05 (2-sided). Assuming a 
10% dropout rate, approximately 158 subjects will be enrolled.  
All power calculations were based on EAST software Version 6.4. 
12.2 
Analysis Sets 
The following analysis sets are defined: All Subjects Set, Full Analysis Set (FAS), and Safety 
Set. Additional analysis sets related to the Run-in Period will be defined in the SAP, as 
appropriate. 
The All Subjects Set will include all subjects who were randomized or received at least 1 dose 
of study drug. This analysis set will be used for all individual subject data listings and disposition 
summary tables, unless otherwise specified.  
The FAS will include all randomized subjects who carry the intended CFTR allele mutation and 
receive at least 1 dose of study drug in the Treatment Period. The FAS will be used to summarize 
subject demographics and baseline characteristics, and for all efficacy analyses in which subjects 
will be analyzed according to their randomized treatment group, unless otherwise specified.  
The Safety Set for the Treatment Period will include all subjects who receive at least 1 dose of 
study drug in the Treatment Period. This safety set will be used for all safety analyses in which 
subjects will be analyzed according to the treatment they receive, unless otherwise specified. 
The Safety Set for the Run-in Period will include all subjects who received at least 1 dose of 
study drug in the Run-in Period.  
12.3 
Statistical Analysis 
12.3.1 
General Considerations 
Continuous variables will be summarized using the following descriptive summary statistics: 
the number of subjects (n), mean, SD, median, minimum value (min), and maximum value 
(max).  
Categorical variables will be summarized using counts and percentages.  
The baseline value, unless otherwise specified, will be defined as the most recent non-missing 
measurement (scheduled or unscheduled) collected before the first dose of study drug in the 
Treatment Period (i.e., the Day 1 Visit). For ECG, baseline will be defined as the most recent 
pretreatment measurement (or the average of triplicate measurements, if the most recent 
pretreatment measurement is obtained in triplicate) before the first dose of study drug in the 
Treatment Period (i.e., the Day 1 Visit). 
Absolute change from baseline will be calculated as post-baseline value – baseline value. 
The Treatment-emergent (TE) Period for the Run-in Period will be from the first dose of 
study drug in the Run-in Period to (1) the first dose of study drug in the Treatment Period for 
subjects who complete the Run-in Period and continue to the Treatment Period, or (2) 28 days 

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after the last dose date of study drug in the Run-in Period for subjects who do not continue to the 
Treatment Period (e.g., subjects who do not meet the conditions to enter the Treatment Period). 
The TE Period for the Treatment Period will include the time from the first dose date of study 
drug in the Treatment Period (VX-445/TEZ/IVA or placebo + TEZ/IVA) to 28 days after the last 
dose of the study drug or to the completion of study participation date (as defined in 
Section 9.1.7), whichever occurs first. 
12.3.2 
Background Characteristics 
12.3.2.1 
Subject Disposition 
The number and percentage of subjects in each disposition category (e.g., randomized, included 
in the FAS, included in the Safety Set, completed Treatment Period, completed study, 
prematurely discontinued treatment or study with a breakdown of the reasons for 
discontinuation, and entered an open-label study) will be summarized overall and by treatment 
group. 
An additional subject disposition summary related to the TEZ/IVA Run-in Period will be defined 
in the SAP, as appropriate. 
12.3.2.2 
Demographics and Baseline Characteristics 
Demographic, medical history, and baseline characteristics will be summarized using descriptive 
summary statistics. 
The following demographics and baseline characteristics will be summarized overall and by 
treatment group for the FAS, and will include (but are not limited to): sex, race, age, baseline 
weight, baseline height, baseline body mass index, baseline CFQ-R, baseline ppFEV1, and 
baseline SwCl. 
Medical history will be summarized by MedDRA System Organ Class (SOC) and Preferred 
Term (PT) for the FAS.  
12.3.2.3 
Prior and Concomitant Medications 
Medications will be coded using the World Health Organization Drug-Dictionary and 
categorized as follows: 
 Prior medication: any medication that was administered during the 56 days before the first 
dose of study drug in the Treatment Period but not in the Run-in Period. For subjects who 
discontinue during the Run-in Period and whose first dose of study drug in the Treatment 
Period is not available, prior medication will be any medication that was administered during 
the 56 days before the last dose of study drug in the Run-in Period but before the first dose in 
the Run-in Period 
 Concomitant medication during the Run-in Period: medication continued or newly 
received during the TE Period for the Run-in Period  
 Concomitant medication during the Treatment Period: medication continued or newly 
received during the TE Period for the Treatment Period  
 Post-treatment medication: medication continued or newly received after: 

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o the TE Period for the Run-in Period if the subject did not receive study drug in the 
Treatment Period  
o the TE Period for the Treatment Period for subjects who received study drug in the 
Treatment Period 
A given medication may be classified as a prior medication, a concomitant medication, or a 
post-treatment medication; both prior and concomitant; both concomitant and post-treatment; or 
prior, concomitant, and post-treatment. If a medication has a missing or partially missing 
start/end date or time and if it cannot be determined whether it was taken before the first dose of 
study drug, concomitantly during the TE Period, or after the TE Period, it will be considered in 
all 3 categories of prior, concomitant, and post-treatment medication. 
Prior medications and concomitant medications will be summarized descriptively by Preferred 
Name based on the FAS. Post-treatment medications will be provided separately in an individual 
subject data listing. 
12.3.2.4 
Study Drug Exposure and Compliance 
Study drug exposure and compliance will be summarized for the Treatment Period only. 
Study drug exposure will be summarized overall and by treatment group, based on the Safety Set 
in terms of the duration of treatment a subject received (in days), defined as the last day – the 
first day of study drug plus 1, regardless of study drug interruption. 
Study drug compliance will be summarized overall and by treatment group based on the FAS, 
and will be calculated as: 100 × [1- (total number of days of study drug interruption) / (duration 
of study drug exposure in days)]. A study drug interruption on a given day is defined as an 
interruption of any study drug on that day. 
12.3.2.5 
Important Protocol Deviations 
An important protocol deviation (IPD) is a deviation that may significantly affect the 
completeness, accuracy, or reliability of the study data or that may significantly affect a subject’s 
rights, safety, or well-being. The rules for identifying an IPD will be described in the SAP. 
All IPDs will be provided in an individual subject data listing and summarized, as appropriate. 
12.3.3 
Efficacy and Pharmacodynamic Analyses 
The primary objective of the study is the evaluation of the efficacy of VX-445/TEZ/IVA. The 
analysis in this section will be based on the FAS, unless otherwise specified. 
12.3.3.1 
Analysis of Primary Endpoint 
The primary efficacy endpoint is the absolute change in CFQ-R respiratory domain score 
from baseline through Week 24. The analysis of this endpoint will be performed using a 
mixed-effects model for repeated measures (MMRM) with absolute change from baseline in 
CFQ-R respiratory domain score at each post-baseline visit as the dependent variable. The model 
will include treatment group, visit, and treatment-by-visit interaction as fixed effects, and will be 
adjusted for selected covariates as appropriate. Details will be described in the SAP. The model 
will be estimated using restricted maximum likelihood. Denominator degrees of freedom for the 
F test for fixed effects will be estimated using the Kenward-Roger approximation. An 
unstructured covariance structure will be used to model the within-subject errors. If the model 

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estimation does not converge, a compound symmetry covariance structure will be used instead. 
Conditional on the observed data and covariates, missing data will be assumed to be missing at 
random; consequently, no imputation of missing data will be performed. 
The primary result obtained from the model will be the estimated treatment difference through 
Week 24 (defined as the average of Weeks 4, 8, 16, 24). The least squares (LS) mean estimate 
with a 2-sided 95% CI and a 2-sided P value will be provided. The treatment difference at each 
post-baseline visit, obtained from the model, will also be provided. 
Additional 
 or subgroup analyses if appropriate will be described 
in the SAP. 
12.3.3.2 
Analysis of Key Secondary Endpoint 
 Absolute change in ppFEV1 from baseline through Week 24 
The analysis of this endpoint will be based on an MMRM model similar to the CFQ-R endpoint 
above, with absolute change from baseline in ppFEV1 at each post-baseline visit as the 
dependent variable.  
The primary result obtained from the model will be the estimated treatment difference through 
Week 24 (defined as the average of Weeks 4, 8, 16, 24). Data obtained from the Day 15, Week 4, 
Week 8, Week 16, and Week 24 Visits will be included in the model. The Day 15 Visit will not 
be included in the estimation of the average treatment effect through Week 24. The LS mean 
estimate with a 2-sided 95% CI and a 2-sided P value will be provided. The treatment difference 
at each post-baseline visit, obtained from the model, will also be provided. 
12.3.3.3 
Analysis of Secondary Endpoint 
 Absolute change in SwCl from baseline through Week 24 
The analysis of this endpoint will be based on an MMRM model similar to the analysis of the 
primary endpoints above, with absolute change from baseline in SwCl at each post-baseline visit 
as the dependent variable. Data obtained from Week 4, Week 8, and Week 24 Visits will be 
included in the model and all of these visits will be included in the estimation of the average 
treatment effect through Week 24. The treatment difference at each post-baseline visit, obtained 
from the model will also be provided. 
12.3.3.4 
Multiplicity Adjustment 
A hierarchical fixed-sequence testing procedure will be used to control the overall family-wise 
type I error at a 2-sided alpha of 0.05 for the testing of the primary endpoint and key secondary 
endpoints. The testing order is as follows: 
1. Primary endpoint: Absolute change in CFQ-R respiratory domain score from baseline 
through Week 24 
2. Key secondary endpoint: Absolute change in ppFEV1 from baseline through Week 24 
For a test at any step to be considered statistically significant within the testing hierarchy, it must 
be statistically significant, and all previous tests (if any) within the hierarchy must be statistically 
significant. In other words, the key secondary endpoint (ppFEV1) will only be tested if the 
primary endpoint is statistically significant. 

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12.3.4 
Safety Analysis 
All safety analyses will be based on data from the TE Period for all subjects in the Safety Set. 
The overall safety profile of study drug will be assessed based on the following safety and 
tolerability endpoints: 
 Treatment-emergent adverse events (TEAEs) 
 Clinical laboratory values (i.e., hematology, serum chemistry, coagulation, and urinalysis) 
 ECGs 
 Vital signs 
 Pulse oximetry 
All safety data from the TE Period will be summarized by treatment group, unless otherwise 
specified. 
All safety data will be presented in individual subject data listings, including safety data from the 
Run-in Period. 
12.3.4.1 
Adverse Events 
For analysis purposes, AEs will be classified as pretreatment AEs, TEAEs during the Run-in 
Period, TEAEs during the Treatment Period, or post-treatment AEs, defined as follows:  
 Pretreatment AE: any AE that occurred before the first dose date of study drug (TEZ/IVA) 
in the Run-in Period 
 TEAE during the Run-in Period: any AE that worsened (either in severity or seriousness) 
or that was newly developed at or after the first dose date of study drug (TEZ/IVA) through 
the end of the TE Period for the Run-in Period 
 TEAE during the Treatment Period: any AE that worsened (either in severity or 
seriousness) or that was newly developed at or after the first dose date of study drug (TC or 
placebo + TEZ/IVA) in the Treatment Period through the end of the TE Period for the 
Treatment Period 
 Post-treatment AE: any AE that worsened (either in severity or seriousness) or that was 
newly developed after:  
o the TE Period for the Run-in Period if the subject did not receive treatment in the 
Treatment Period 
o the TE Period for the Treatment Period if the subject received treatment in the Treatment 
Period 
For AEs with missing or partial start dates, if there is no clear evidence that the AEs started 
before or after study drug treatment, then the AEs will be classified as TEAEs corresponding to 
the Treatment Period.  
Unless otherwise specified, TEAE refers to TEAE during the Treatment Period. 
AE summary tables will be presented by treatment group, and will include the following: 
 Overview of TEAEs 

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 TEAEs 
 Related TEAEs 
 TEAEs by maximum severity 
 Grade 3/4 TEAEs 
 Serious TEAEs 
 Related serious TEAEs 
 AE of special interest (details will be described in SAP) 
 TEAEs leading to treatment discontinuation 
 TEAEs leading to treatment interruption 
Summaries will be presented by MedDRA SOC and PT using frequency counts and percentages 
(i.e., number and percentage of subjects with an event). When summarizing the number and 
percentage of subjects with an event, subjects with multiple occurrences of the same AE or a 
continuing AE will be counted once, only the maximum severity level will be presented in the 
severity summaries, and the strongest relationship level in the relationship summaries.  
Listings containing individual subject level AE data will be provided separately for: 
 Serious TEAEs 
 TEAEs leading to treatment discontinuation 
 TEAEs leading to treatment interruption 
 TEAEs leading to death 
In addition, all AEs, including pre- and post-treatment AEs, will be presented in individual 
subject data listings. 
12.3.4.2 
Clinical Laboratory Assessments 
For the treatment-emergent laboratory measurements, the observed values and change from 
baseline values of the continuous hematology, serum chemistry, and coagulation results will be 
summarized in SI units by treatment group at each visit. 
The number and percentage of subjects with at least 1 threshold analysis event during the 
TE Period will be summarized by treatment group. The threshold analysis criterion shift from 
baseline will also be summarized for select laboratory parameters. The threshold analysis criteria 
and the parameter selection criteria will be provided in the SAP. 
Results of urinalysis and pregnancy tests will be listed in individual subject data listings only. In 
addition, a listing containing individual subject hematology, chemistry, and coagulation values 
will be provided. This listing will include data from scheduled and unscheduled visits. 
12.3.4.3 
Electrocardiogram 
For the treatment-emergent ECG measurements, a summary of observed values and change from 
baseline values will be provided by treatment group, at each visit and time point, as applicable, 
for the following ECG interval measurements (in msec): RR, PR, QT, and QT corrected for heart 
rate (QTcF), QRS duration, and HR (beats per minute). 

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The number and percentage of subjects with at least 1 threshold analysis event during the 
TE Period will be summarized by treatment group. The threshold analysis criteria will be 
provided in the SAP. 
Additional ECG analyses may be described in the SAP. 
12.3.4.4 
Vital Signs 
For the treatment-emergent vital signs measurements, the observed values and change from 
baseline values will be summarized by treatment group at each visit. The following vital signs 
parameters will be summarized: systolic and diastolic blood pressure (mm Hg), body 
temperature (C), pulse rate (beats per minute), and respiratory rate (breaths per minute). 
The number and percentage of subjects with at least 1 threshold analysis event during the 
TE Period will be summarized by treatment group. The threshold analysis criteria will be 
provided in the SAP. 
Additional vital signs analyses may be described in the SAP. 
12.3.4.5 
Pulse Oximetry 
For the treatment-emergent pulse oximetry measurements, a summary of observed values and 
change from baseline values will be provided by treatment group, at each visit for the percent of 
oxygen saturation by pulse oximetry. 
The number and percentage of subjects with shift changes from baseline (normal/missing and 
low according to the reference range) to the lowest percent of oxygen saturation during the 
TE Period will be summarized by treatment group. 
12.3.4.6 
Physical Examination 
PE findings will be presented in an individual subject data listing only. 
12.3.5 
Interim and IDMC Analyses 
12.3.5.1 
Interim Analysis 
An IA may be performed when approximately 70% subjects complete the Week 24 Visit. To 
control the family-wise type 1 error rate, O’Brien-Fleming20 group sequential boundaries will be 
applied. Specifically, if the number of subjects included in the IA is 108, the null hypotheses will 
be tested at a 2-sided significance level of 0.014 at the IA and 0.046 at final analysis. The actual 
boundaries at the IA and final analysis will be calculated based on the number of actual subjects 
included in the IA.  
The Vertex Biometrics team will assign an internal biostatistician independent of the study team 
or a designated independent third-party vendor to perform the IA. The assigned independent 
statistician/vendor will not be involved in or influence the conduct of the study.  
12.3.5.2 
IDMC Analysis 
Not applicable.  

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13 
PROCEDURAL, ETHICAL, REGULATORY, AND ADMINISTRATIVE 
CONSIDERATIONS 
13.1 
Adverse Event and Serious Adverse Event Documentation, Severity 
Grading, and Reporting 
13.1.1 
Adverse Events 
13.1.1.1 
Definition of an Adverse Event 
An AE is defined as any untoward medical occurrence in a subject during the study; the event 
does not necessarily have a causal relationship with the treatment. This includes any newly 
occurring event or worsening of a pre-existing condition (e.g., increase in its severity or 
frequency) after the ICF is signed.  
An AE is considered serious if it meets the definition in Section 13.1.2.1.  
13.1.1.2 
Clinically Significant Assessments 
Study assessments including laboratory tests, ECGs, PEs, and vital signs will be assessed and 
those deemed to have clinically significant worsening from baseline will be documented as an 
AE. When possible, a clinical diagnosis for the study assessment will be provided, rather than the 
abnormal test result alone (e.g., urinary tract infection, anemia). In the absence of a diagnosis, 
the abnormal study assessment itself will be listed as the AE (e.g., bacteria in urine or decreased 
hemoglobin). 
An abnormal study assessment is considered clinically significant if the subject has 1 or more of 
the following: 
• 
Concomitant signs or symptoms related to the abnormal study assessment 
• 
Further diagnostic testing or medical/surgical intervention 
• 
A change in the dose of study drug or discontinuation from the study 
Repeat testing to determine whether the result is abnormal, in the absence of any of the above 
criteria, does not necessarily meet clinically significant criteria. The determination of whether the 
study assessment results are clinically significant will be made by the investigator. 
A laboratory value that is Grade 4 will not automatically be an SAE. A Grade 4 laboratory value 
will be an SAE if the subject’s clinical status indicates a life-threatening AE. 
13.1.1.3 
Documentation of Adverse Events 
All AEs will be collected from the time the ICF is signed until the subject completes study 
participation, as defined in Section 9.1.7 
All subjects will be queried, using nonleading questions, about the occurrence of AEs at each 
study visit. When possible, a constellation of signs and/or symptoms will be identified as 
1 overall event or diagnosis. All AEs for enrolled subjects will be recorded in the CRF and 
source document. AEs for subjects who are screened but not subsequently enrolled will be 
recorded only in the subject’s source documents. The following data will be documented for 
each AE: 
• 
Description of the event 

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• 
Classification of “serious” or “nonserious” 
• 
Date of first occurrence and date of resolution (if applicable) 
• 
Severity  
• 
Causal relationship to study drug(s)  
• 
Action taken  
• 
Outcome  
• 
Concomitant medication or other treatment given 
13.1.1.4 
Adverse Event Severity 
The investigator will determine and record the severity of all serious and nonserious AEs. The 
guidance available at the following website will be consulted: Common Terminology Criteria for 
Adverse Events (CTCAE), Version 5.0, Cancer Therapy Evaluation Program, 
http://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm (Accessed 
February 2019). AEs of CTCAE Grades 4 and 5 will be documented as “life-threatening.” When 
considering the severity of an AE in a pediatric subject, the investigator will consider that 
reference ranges for pediatric clinical laboratory parameters may differ from those in the 
CTCAE. The severity of an AE described by a term that does not appear in the CTCAE will be 
determined according to the definitions in Table 13-1. 
Table 13-1 
Grading of AE Severity  
Classification 
Definition 
Mild (Grade 1) 
Mild level of discomfort and does not interfere with regular activities 
Moderate (Grade 2) 
Moderate level of discomfort and significantly interferes with regular activities 
Severe (Grade 3) 
Significant level of discomfort and prevents regular activities 
Life-threatening (Grade 4) 
Any adverse drug event that places the subject, in the view of the investigator, at 
immediate risk of death  
AE: adverse event 
13.1.1.5 
Adverse Event Causality 
Every effort will be made by the investigator to assess the relationship of the AE, if any, to the 
study drug(s). Causality will be classified using the categories in Table 13-2. 
Table 13-2 
Classifications for AE Causality 
Classification 
Definition 
Related 
There is an association between the event and the administration of investigational 
study drug, a plausible mechanism for the event to be related to the investigational 
study drug and causes other than the investigational study drug have been ruled out, 
and/or the event reappeared on re-exposure to the investigational study drug. 
Possibly related 
There is an association between the event and the administration of the 
investigational study drug and there is a plausible mechanism for the event to be 
related to investigational study drug, but there may also be alternative etiology, such 
as characteristics of the subject’s clinical status or underlying disease. 
Unlikely related 
The event is unlikely to be related to the investigational study drug and likely to be 
related to factors other than investigational study drug.  

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Table 13-2 
Classifications for AE Causality 
Classification 
Definition 
Not related 
The event is related to an etiology other than the investigational study drug (the 
alternative etiology will be documented in the subject’s medical record). 
AE: adverse event 
13.1.1.6 
Study Drug Action Taken 
The investigator will classify the study drug action taken with regard to the AE. The action taken 
will be classified according to the categories in Table 13-3.  
Table 13-3 
Classifications for Study Drug Action Taken With Regard to an AE 
Classification 
Definition 
Dose not changed 
Study drug dose not changed in response to an AE 
Dose reduced 
Study drug dose reduced in response to an AE 
Drug interrupted 
Study drug administration interrupted in response to an AE  
Drug withdrawn 
Study drug administration permanently discontinued in response to an AE 
Not applicable 
Action taken regarding study drug administration does not apply.  
“Not applicable” will be used in circumstances such as when the investigational 
treatment had been completed before the AE began and no opportunity to decide 
whether to continue, interrupt, or withdraw treatment is possible. 
AE: adverse event 
13.1.1.7 
Adverse Event Outcome 
An AE will be followed until the investigator has determined and provided the final outcome. 
The outcome will be classified according to the categories in Table 13-4. 
Table 13-4 
Classifications for Outcome of an AE 
Classification 
Definition 
Recovered/resolved 
Resolution of an AE with no residual signs or symptoms 
Recovered/resolved with 
sequelae 
Resolution of an AE with residual signs or symptoms 
Not recovered/not 
resolved (continuing) 
Either incomplete improvement or no improvement of an AE, such that it remains 
ongoing 
Fatal 
Outcome of an AE is death. “Fatal” will be used when death is at least possibly 
related to the AE. 
Unknown 
Outcome of an AE is not known (e.g., a subject lost to follow up) 
AE: adverse event 
13.1.1.8 
Treatment Given 
The investigator ensures adequate medical care is provided to subjects for any AEs, including 
clinically significant laboratory values related to study drug. In addition, the investigator will 
describe whether any treatment was given for the AE. “Yes” is used if any treatment was given 
in response to an AE, and may include treatments such as other medications, surgery, or physical 
therapy. “No” indicates the absence of any kind of treatment for an AE. 

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13.1.2 
Serious Adverse Events 
13.1.2.1 
Definition of a Serious Adverse Event 
An SAE is any AE that meets any of the following outcomes: 
• 
Fatal (death, regardless of cause, that occurs during participation in the study or occurs after 
participation and is suspected of being a delayed toxicity due to administration of the study 
drug) 
• 
Life-threatening, such that the subject was at immediate risk of death from the reaction as it 
occurred  
• 
Inpatient hospitalization or prolongation of hospitalization 
• 
Persistent or significant disability/incapacity (disability is defined as a substantial disruption 
of a person’s ability to conduct normal life functions) 
• 
Congenital anomaly or birth defect 
• 
Important medical event that, based upon appropriate medical judgment, may jeopardize the 
subject or may require medical or surgical intervention to prevent 1 of the outcomes listed 
above (e.g., an allergic bronchospasm requiring intensive treatment in an emergency room or 
at home)  
If a subject has a hospitalization or procedure (e.g., surgery) for an event or condition that 
occurred before the subject signed the ICF, and the hospitalization or procedure was planned 
before the subject signed the ICF, the hospitalization or procedure will not be considered to 
indicate an SAE, unless an AE caused the hospitalization or procedure to be rescheduled sooner 
or to be prolonged relative to what was planned. In addition, hospitalizations clearly not 
associated with an AE (e.g., social hospitalization for purposes of respite care) will not be 
considered to indicate an SAE. 
Clarification will be made between the terms “serious” and “severe” because they are not 
synonymous. The term “severe” is often used to describe the intensity (severity) of a specific 
event, as in mild, moderate, or severe myocardial infarction. The event itself, however, may be 
of relatively minor medical significance, such as a severe headache. This is not the same as 
“serious”, which is based on subject/event outcome or action described above, and is usually 
associated with events that pose a threat to a subject’s life or functioning. Seriousness, not 
severity, serves as a guide for defining expedited regulatory reporting obligations.  
13.1.2.2 
Reporting and Documentation of Serious Adverse Events 
All SAEs that occur after obtaining informed consent and assent (where applicable) through the 
completion of study participation, regardless of causality, will be reported by the investigator to 
Vertex GPS within 24 hours of identification. In addition, all SAEs that occur after the 
completion of study participation and are considered related to study drug(s) will be reported to 
Vertex GPS within 24 hours of identification.  
For SAEs that occur after obtaining informed consent and assent (where applicable) through the 
completion of study participation, the SAE Form will be completed for new/initial events as well 
as to report follow-up information on previously reported events. Investigators are asked to 
report follow-up information as soon as it becomes available to ensure timely reporting to health 
authorities.  

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Please send completed SAE Forms to Vertex GPS via: 
Email: 
 (preferred choice) 
Fax: 
  
For technical issues related to submitting the form, contact telephone: 
 
SAEs that occur after the completion of study participation and are considered related to study 
drug(s) will be recorded on the Vertex Clinical Trial Safety Information Collection Form 
(hereafter referred to as the “SAE Form”) using a recognized medical term or diagnosis that 
accurately reflects the event. SAEs will be assessed by the investigator for relationship to the 
investigational study drug(s) and possible etiologies. On the SAE Form, relationship to study 
drug(s) will be assessed only as related (includes possibly related) or not related (includes 
unlikely related), and severity assessment will not be required. For the purposes of study 
analysis, if the event has not resolved at the end of the study reporting period, it will be 
documented as ongoing. For purposes of regulatory safety monitoring, the investigator is 
required to follow the event to resolution and report the outcome to Vertex using the SAE Form. 
13.1.2.3 
Expedited Reporting and Investigator Safety Letters 
Vertex, as study sponsor, is responsible for reporting suspected, unexpected, serious adverse 
reactions (SUSARs) involving the study drug(s) to all regulatory authorities, IECs, and 
participating investigators in accordance with ICH Guidelines and/or local regulatory 
requirements, as applicable. In addition, Vertex, or authorized designee, will be responsible for 
the submission of safety letters to central IECs.  
It is the responsibility of the investigator or designee to promptly notify the local IRB/ IEC of all 
unexpected serious adverse drug reactions involving risk to human subjects. 
13.2 
Administrative Requirements 
13.2.1 
Ethical Considerations 
The study will be conducted in accordance with the current ICH GCP Guidelines, which are 
consistent with the ethical principles founded in the Declaration of Helsinki, and in accordance 
with local applicable laws and regulations. The IRB/IEC will review all appropriate study 
documentation to safeguard the rights, safety, and well-being of the subjects. The study will be 
conducted only at sites where IRB/IEC approval has been obtained. The protocol, Investigator’s 
Brochure, sample ICF, advertisements (if applicable), written information given to the subjects 
(including diary cards), safety updates, annual progress reports, and any revisions to these 
documents will be provided to the IRB/IEC by the investigator or Vertex, as allowable by local 
applicable laws and regulations. 
13.2.2 
Subject Information and Informed Consent 
After the study has been fully explained, written informed consent will be obtained from the 
subject or legal representative or guardian (if applicable), and assent will be obtained from the 
subject (if applicable), before study participation. The method of obtaining and documenting the 
informed consent and assent (if applicable) and the contents of the consent will comply with 
ICH GCP and all applicable laws and regulations and will be subject to approval by Vertex or its 
designee. 

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13.2.3 
Investigator Compliance 
No modifications to the protocol will be made without the approval of both the investigator and 
Vertex. Changes that significantly affect the safety of the subjects, the scope of the investigation, 
or the scientific quality of the study (i.e., efficacy assessments) will require IRB/IEC notification 
before implementation, except where the modification is necessary to eliminate an apparent 
immediate hazard to human subjects. Vertex will submit all protocol modifications to the 
required regulatory authorities. 
When circumstances require an immediate departure from procedures set forth in the protocol, 
the investigator will contact Vertex to discuss the planned course of action. If possible, contact 
will be made before the implementation of any changes. Any departures from the protocol will 
be fully documented in the source documentation and in a protocol deviation log.  
13.2.4 
Access to Records 
The investigator will make the office and/or hospital records of subjects enrolled in this study 
available for inspection by Vertex or its representative at the time of each monitoring visit and 
for audits. The records will also be available for direct inspection, verification, and copying, as 
required by applicable laws and regulations, by officials of the regulatory health authorities 
(FDA and others). The investigator will comply with applicable privacy and security laws for use 
and disclosure of information related to the research set forth in this protocol.  
13.2.5 
Subject Privacy 
To maintain subject confidentiality and to comply with applicable data protection and privacy 
laws and regulations, all data provided to Vertex, study reports, and communications relating to 
the study will identify subjects by assigned subject numbers, and access to subject names linked 
to such numbers will be limited to the site and the study physician and will not be disclosed to 
Vertex. As required by applicable laws and regulations in the countries in which the study is 
being conducted, the investigator will allow Vertex and/or its representatives access to all 
pertinent medical records to allow for the verification of data gathered and the review of the data 
collection process. The FDA and regulatory authorities in other jurisdictions, including the 
IRB/IEC, may also request access to all study records, including source documentation, for 
inspection. 
13.2.6 
Record Retention 
The investigator will maintain all study records according to ICH GCP Guidelines and/or 
applicable local regulatory requirement(s), whichever is longest, as described in the Clinical 
Trial Agreement. If the investigator withdraws from the responsibility of keeping the study 
records, custody will be transferred to a person willing to accept the responsibility and Vertex 
will be notified. 
13.2.7 
Study Termination 
At any time, Vertex may terminate this study in its entirety or may terminate this study at any 
particular site. In addition, for reasonable cause, either the investigators or their IRBs/IECs may 
terminate the study at their center. 
Conditions that may lead to reasonable cause and warrant termination include, but are not limited 
to: 

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• 
Subject or investigator noncompliance 
• 
Unsatisfactory subject enrollment 
• 
Lack of adherence to protocol procedures 
• 
Lack of evaluable and/or complete data 
• 
Potentially unacceptable risk to study subjects 
• 
Decision to modify drug development plan 
• 
Decision by the FDA or other regulatory authority 
Written notification that includes the reason for the clinical study termination is required. 
13.2.8 
End of Study 
The end of study is defined as the last scheduled visit (or scheduled contact) of the last subject. 
13.3 
Data Quality Assurance 
Vertex or its designated representative will conduct a study site visit to verify the qualifications 
of each investigator, inspect clinical study site facilities, and inform the investigator of 
responsibilities and procedures for ensuring adequate and correct study documentation. Vertex 
will provide, or assess and approve, any electronic data capture (EDC) tools. 
The investigator is required to prepare and maintain adequate and accurate case histories 
designed to record all observations and other data pertinent to the study for each subject. Data 
collected during the study, including results from screening, will be recorded in a data capture 
system for each enrolled subject. Each subject’s set of captured data records, once complete, will 
be signed and dated by the investigator. 
13.4 
Monitoring 
Monitoring and auditing procedures developed or approved by Vertex will be followed to 
comply with GCP Guidelines. On-site checking of the data captured for the study/SAE Forms for 
completeness and clarity, and clarification of administrative matters will be performed. 
The study will be monitored by Vertex or its designee. Monitoring will be done by personal 
visits from a representative of Vertex or designee (study site monitor), who will review the data 
captured for the study/SAE Forms and source documents. The study site monitor will ensure that 
the investigation is conducted according to the protocol design and regulatory requirements. 
13.5 
Electronic Data Capture 
Sites will use an EDC tool to record data for each enrolled subject.  
It is the investigator’s responsibility to ensure the accuracy, completeness, clarity, and timeliness 
of the data reported. The investigator is required to prepare and maintain adequate and accurate 
case histories designed to record all observations and other data pertinent to the study for each 
subject, including the dates and details of study procedures, AEs, other observations, and subject 
status.  
The audit trail entry will show the user’s identification information and the date and time of any 
correction. The investigator will provide formal approval of all data reported to Vertex, including 

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any changes made, to endorse the final submitted data for the subjects for whom the investigator 
is responsible.  
13.6 
Confidentiality and Disclosure 
Any and all scientific, commercial, and technical information disclosed by Vertex in this 
protocol or elsewhere will be considered the confidential and proprietary property of Vertex. The 
investigator shall hold such information in confidence and shall not disclose the information to 
any third party except to such of the investigator's employees and staff as have been made aware 
that the information is confidential and who are bound to treat it as such and to whom disclosure 
is necessary to evaluate that information. The investigator shall not use such information for any 
purpose other than determining mutual interest in performing the study and, if the parties decide 
to proceed with the study, for the purpose of conducting the study. 
The investigator understands that the information developed from this clinical study will be used 
by Vertex in connection with the development of the study drug and other drugs and diagnostics, 
and therefore may be disclosed as required to other clinical investigators, business partners and 
associates, the FDA, and other government agencies. The investigator also understands that, to 
allow for the use of the information derived from the clinical study, the investigator has the 
obligation to provide Vertex with complete test results and all data developed in the study. 
13.7 
Publications and Clinical Study Report 
13.7.1 
Publication of Study Results 
Vertex is committed to reporting the design and results of all clinical studies in a complete, 
accurate, balanced, transparent, and timely manner, consistent with Good Publication Practices 
(GPP3).21  
Publication Planning: Vertex staff along with the lead principal investigators, the steering 
committee, and/or the publication committee will work together to develop a publication plan.  
Authorship: Authorship of publications will be determined based on the Recommendations for 
Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, which 
states that authorship should be based on the following 4 criteria22: 
1. Substantial contributions to conception and design, acquisition of data, or analysis and 
interpretation of data;  
2. Drafting of the article or revising it critically for important intellectual content;  
3. Final approval of the version to be published; and 
4. Agreement to be accountable for all aspects of the work in ensuring that questions related 
to the accuracy or integrity of any part of the work are appropriately investigated and 
resolved. 
All authors must meet conditions 1, 2, 3, and 4. All persons designated as authors should qualify 
for authorship, and all those who qualify should be listed. Contributions such as medical writing, 
enrollment of subjects, acquisition of funding, collection of data, or general supervision of the 
research group, alone, do not justify authorship.  
Contributors: Contributors who meet fewer than all 4 of International Committee of Medical 
Journal Editors (ICMJE) criteria for authorship will not be listed as authors, but their 

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contribution will be acknowledged and specified either as a group (e.g., “study investigators”) or 
individually (e.g., “served as scientific advisor”).  
Publication Review: As required by a separate clinical study agreement, Vertex must have the 
opportunity to review all publications, including any manuscripts, abstracts, oral/slide 
presentations, and book chapters regarding this study before submission to congresses or journals 
for consideration.  
13.7.2 
Clinical Study Report  
A CSR, written in accordance with the ICH E3 Guideline, will be submitted in accordance with 
local regulations. 

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14 
REFERENCES 
 
1 
Cystic Fibrosis Foundation. What is cystic fibrosis? Available at: 
https://www.cff.org/What-is-CF/About-Cystic-Fibrosis/. Accessed 22 March 2018. 
2 
Cystic Fibrosis Foundation. Patient Registry: 2017 Annual Data Report. Bethesda, MD: 
Cystic Fibrosis Foundation; 2018. 
3 
European Cystic Fibrosis Society. 2016 ECFS Patient Registry Annual Data Report. 
Karup, Denmark: European Cystic Fibrosis Society; 2018. 
4 
United States Department of Health and Human Services. Food and Drug Administration. 
Office of Orphan Products Development. Developing Products for Rare Diseases & 
Conditions. Available at: 
http://www.fda.gov/ForIndustry/DevelopingProductsforRareDiseasesConditions/default.
htm. Accessed 19 September 2016. 
5 
European Medicines Agency [Internet]. Committee for Orphan Medicinal Products 
(COMP). Available at: https://www.ema.europa.eu/en/committees/committee-orphan-
medicinal-products-comp. Accessed 07 December 2018. 
6 
Rommens J, Iannuzzi M, Kerem B, Drumm M, Melmer G, Dean M, et al. Identification 
of the cystic fibrosis gene: chromosome walking and jumping. Science. 
1989;245(4922):1059-65. 
7 
Kreindler JL. Cystic fibrosis: exploiting its genetic basis in the hunt for new therapies. 
Pharmacol Ther. 2010;125(2):219-29. 
8 
Sheppard MN, Nicholson AG. The pathology of cystic fibrosis. Curr Diagn Pathol. 
2002;8(1):50-59. 
9 
Flume PA, VanDevanter DR. State of progress in treating cystic fibrosis respiratory 
disease. BMC Med. 2012;10(1):88. 
10 
CFTR2.org. Clinical and functional translation of CFTR. The Clinical and Functional 
TRanslation of CFTR (CFTR2), US Cystic Fibrosis Foundation, Johns Hopkins 
University, the Hospital for Sick Children. Available at: http://www.cftr2.org. Accessed 
09 January 2018. 
11 
Quanjer PH, Stanojevic S, Cole TJ, Baur X, Hall GL, Culver BH, et al. Multi-ethnic 
reference values for spirometry for the 3–95-yr age range: the global lung function 2012 
equations. Eur Respir J. 2012;40(6):1324-43. 
12 
Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. 
Standardisation of spirometry. Eur Respir J. 2005;26(2):319-38. 
13 
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to 
estimate glomerular filtration rate from serum creatinine: a new prediction equation. 
Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130(6):461-
70. 
14 
Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, et al. Using 
standardized serum creatinine values in the modification of diet in renal disease study 
equation for estimating glomerular filtration rate. Ann Intern Med. 2006;145(4):247-54. 
15 
Counahan R, Chantler C, Ghazali S, Kirkwood B, Rose F, Barratt TM. Estimation of 
glomerular filtration rate from plasma creatinine concentration in children. Arch Dis 
Child. 1976;51(11):875-78. 

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16 
Goss CH, Quittner AL. Patient-reported outcomes in cystic fibrosis. Proc Am Thorac 
Soc. 2007;4(4):378-86. 
17 
Quittner AL, Buu A, Messer MA, Modi AC, Watrous M. Development and validation of 
the Cystic Fibrosis Questionnaire in the United States. Chest. 2005;128(4):2347-54. 
18 
Henry B, Aussage P, Grosskopf C, Goehrs JM. Development of the Cystic Fibrosis 
Questionnaire (CFQ) for assessing quality of life in pediatric and adult patients. Qual Life 
Res. 2003;12(1):63-76. 
19 
Wenninger K, Aussage P, Wahn U, Staab D, German Cystic Fibrosis Questionnaire study 
group. The revised German Cystic Fibrosis Questionnaire: validation of a disease-
specific health-related quality of life instrument. Qual Life Res. 2003;12(1):77-85. 
20 
O'Brien PC, Fleming TR. A Multiple Testing Procedure for Clinical Trials. Biometrics. 
1979;35(3):549-56. 
21 
Battisti WP, Wager E, Baltzer L, Bridges D, Cairns A, Carswell CI, et al. Good 
Publication Practice for Communicating Company-Sponsored Medical Research: GPP3. 
Ann Intern Med. 2015;163(6):461-4. 
22 
(ICMJE). ICoMJE. Recommendations for conduct, reporting, editing, and publication of 
scholarly work in medical journals. [Internet]. Available from: Accessed April 9,. 
 

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15 
PROTOCOL SIGNATURE PAGES 
15.1 
Sponsor Signature Page 
Protocol#: 
VX18-445-109 I Version#: 
1.0 
J Version Date: 
30 May 2019 
Study Title: A Phase 3b, Randomized, Double-blind, Controlled Study Evaluating the Efficacy 
and Safety ofVX-445/Tezacaftor/Ivacaftor in Cystic Fibrosis Subjects, Homozygous for 
F508del 
This Clinical Study Protocol has been reviewed and approved by the sponsor. 
Vertex Pharmaceuticals Incorporated 
 

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15.2 
Investigator Signature Page 
Protocol #:  
VX18-445-109 Version #: 
1.0 
Version Date: 
30 May 2019 
Study Title: A Phase 3b, Randomized, Double-blind, Controlled Study Evaluating the Efficacy 
and Safety of VX-445/Tezacaftor/Ivacaftor in Cystic Fibrosis Subjects, Homozygous for 
F508del 
 
 
I have read Protocol VX18-445-109, Version 1.0, and agree to conduct the study according to its 
terms. I understand that all information concerning VX-445, tezacaftor, and ivacaftor and this 
protocol supplied to me by Vertex Pharmaceuticals Incorporated (Vertex) is confidential. 
 
 
Printed Name 
 
 
Signature 
 
Date