A Phase 1, Randomized, Open-Label, Crossover Study to Evaluate the Bioequivalence of Single Oral Dose of TAK-438ASA Tablet and Single Oral Dose of TAK-438 Tablet Plus Aspirin Enteric-Coated Tablet (Study 1) and the Food Effect of Single Oral Dose of TAK-438ASA Tablet (Study 2) in Healthy Adult Male Subjects
Phase: PHASE1
Conditions: Healthy Volunteers
Sponsor: Takeda

 
 
Title: A Phase 1, Randomized, Open-Label, Crossover Study to Evaluate the 
Bioequivalence of Single Oral Dose of TAK-438ASA Tablet and Single Oral 
Dose of TAK-438 Tablet Plus Aspirin Enteric-Coated Tablet (Study 1) and the 
Food Effect of Single Oral Dose of TAK-438ASA Tablet (Study 2) in Healthy 
Adult Male Subjects 
 
NCT Number: NCT03456960 
Protocol Approve Date: 09-February-2018 
 
Certain information within this protocol has been redacted (ie, specific content is masked 
irreversibly from view with a black/blue bar) to protect either personally identifiable 
information or company confidential information. 
 
This may include, but is not limited to, redaction of the following: 
 
Named persons or organizations associated with the study. 
 
Patient identifiers within the text, tables, or figures or in by-patient data listings. 
 
Proprietary information, such as scales or coding systems, which are considered 
confidential information under prior agreements with license holder. 
 
Other information as needed to protect confidentiality of Takeda or partners, 
personal information, or to otherwise protect the integrity of the clinical study. 
 
If needed, certain appendices that contain a large volume of personally identifiable 
information or company confidential information may be removed in their entirety if it 
is considered that they do not add substantially to the interpretation of the data (eg, 
appendix of investigator’s curriculum vitae). 
 
Note; This document was translated into English as the language on original version 
was Japanese. 

CONFIDENTIAL
TAKEDA PHARMACEUTICALS
PROTOCOL
A Phase 1, Randomized, Open-Label, Crossover Study to Evaluate the Bioequivalence of 
Single Oral Dose of TAK-438ASA tablet and Single Oral Dose of TAK-438 tablet plus
Aspirin Enteric-Coated tablet (Study 1) and the Food Effect of Single Oral Dose of 
TAK-438ASA tablet (Study 2) in Healthy Adult Male Subjects
A Phase 1 Bioequivalence and Food Effect Study of TAK-438ASA tablet
Study Identifier:
TAK-438ASA-1001
Compound:
TAK-438ASA
Date:
9 February 2018
Version/Amendment 
Number:
Amendment 1
CONFIDENTIAL PROPERTY OF TAKEDA
This document is a confidential communication of Takeda. Acceptance of this document constitutes the agreement by 
the recipient that no information contained herein will be published or disclosed without written authorization from 
Takeda except to the extent necessary to obtain informed consent from those persons to whom the drug may be 
administered. Furthermore, the information is only meant for review and compliance by the recipient, his or her staff, 
and applicable institutional review committee and regulatory agencies to enable conduct of the study.

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TABLE OF CONTENTS
1.0
STUDY SUMMARY ......................................................................................................6
2.0
STUDY SCHEMATIC..................................................................................................11
3.0
SCHEDULE OF STUDY PROCEDURES (STUDIES 1 AND 2)..................................12
4.0
INTRODUCTION.........................................................................................................14
4.1
Background .............................................................................................................14
4.2
Rationale for the Proposed Study.............................................................................15
4.3
Benefit/Risk Profile .................................................................................................15
5.0
TRIAL OBJECTIVES AND ENDPOINTS ...................................................................17
5.1
Hypothesis...............................................................................................................17
5.2
Trial Objectives .......................................................................................................17
5.2.1
Trial Primary Objective......................................................................................17
5.2.2
Trial Secondary Objective..................................................................................17
5.3
Endpoints.................................................................................................................17
5.3.1
Primary Endpoint...............................................................................................17
5.3.2
Secondary Endpoints..........................................................................................17
5.3.3
Safety Endpoints................................................................................................18
6.0
TRIAL DESIGN AND DESCRIPTION ........................................................................19
6.1
Trial Design.............................................................................................................19
6.2
Procedures for Proceeding to the Pivotal Study........................................................20
6.3
Rationale for Trial Design, Dose, and Endpoints......................................................21
6.3.1
Rationale of Trial Design ...................................................................................21
6.3.2
Rationale for Dose .............................................................................................22
6.3.3
Rationale for Washout Period.............................................................................22
6.3.4
Rationale for Endpoints......................................................................................22
6.3.5
Critical Procedures Based on Trial Objectives: Timing of Procedures ................22
6.4
Trial Beginning and End/Completion.......................................................................23
6.4.1
Definition of Beginning of the Trial ...................................................................23
6.4.2
Definition of End of the Trial.............................................................................23
6.4.3
Definition of Trial Discontinuation ....................................................................23
6.4.4
Criteria for Premature Termination or Suspension of the Trial............................23
6.4.5
Criteria for Premature Termination or Suspension of the Site.............................24
7.0
SELECTION AND DISCONTINUATION/WITHDRAWAL OF SUBJECTS..............25
7.1
Inclusion Criteria .....................................................................................................25
7.2
Exclusion Criteria ....................................................................................................25

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7.3
Excluded Medications, Supplements, Dietary Products............................................27
7.4
Diet, Fluid, Activity.................................................................................................28
7.4.1
Diet and Fluid ....................................................................................................28
7.4.2
Activity..............................................................................................................29
7.5
Documentation of Subjects Failure ..........................................................................29
7.6
Criteria for Discontinuation or Withdrawal of a Subject...........................................30
7.7
Procedures for Discontinuation or Withdrawal of a Subject......................................31
7.8
Subject Replacement................................................................................................31
8.0
CLINICAL STUDY MATERIAL MANAGEMENT.....................................................32
8.1
Clinical Study Drug .................................................................................................32
8.1.1
Clinical Study Drug Labeling.............................................................................32
8.1.2
Clinical Study Drug Inventory and Storage ........................................................33
8.1.3
Randomization Code Creation and Storage ........................................................33
8.1.4
Accountability and Destruction of Sponsor-Supplied Drugs...............................33
9.0
STUDY PROCEDURES...............................................................................................34
9.1
Administrative Procedures.......................................................................................34
9.1.1
Informed Consent Procedure..............................................................................34
9.1.2
Inclusion and Exclusion .....................................................................................34
9.1.3
Medical History/Demography ............................................................................34
9.1.4
Concomitant Medications...................................................................................35
9.2
Clinical Procedures and Assessments.......................................................................35
9.2.1
Full Physical Exam ............................................................................................35
9.2.2
Height and Weight .............................................................................................35
9.2.3
BMI ...................................................................................................................35
9.2.4
Vital Signs .........................................................................................................35
9.2.5
12-Lead ECG.....................................................................................................36
9.2.6
Study Drug Administration ................................................................................36
9.2.7
AE Monitoring...................................................................................................36
9.2.8
Laboratory Procedures and Assessments ............................................................36
9.3
PK Samples .............................................................................................................38
9.3.1
PK Measurements..............................................................................................39
9.3.2
Confinement ......................................................................................................41
10.0
ADVERSE EVENTS ....................................................................................................42
10.1
Definitions and Elements of AEs .............................................................................42
10.1.1 SAEs..................................................................................................................44

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10.1.2 Special Interest AEs...........................................................................................45
10.2
AE Procedures.........................................................................................................46
10.2.1 Assigning Severity/Intensity of AEs...................................................................46
10.2.2 Assigning Causality of AEs................................................................................46
10.2.3 Assigning Causality of AEs to Study Procedures................................................47
10.2.4 Start Date...........................................................................................................47
10.2.5 End Date............................................................................................................47
10.2.6 Pattern of Adverse Event (Frequency)................................................................47
10.2.7 Action Taken With Study Treatment..................................................................47
10.2.8 Outcome ............................................................................................................48
10.2.9 Collection and Reporting of AEs, SAEs, Special Interest AEs, and Abnormal 
LFTs ..................................................................................................................48
10.2.10
Safety Reporting to Investigators, IRBs, and Regulatory Authorities ............50
11.0
STATISTICAL METHODS..........................................................................................51
11.1
Statistical and Analytical Plans ................................................................................51
11.1.1 Analysis Sets......................................................................................................51
11.1.2 Analysis of Demography and Other Baseline Characteristics .............................51
11.1.3 PK Analysis .......................................................................................................51
11.1.4 Safety Analysis ..................................................................................................53
11.2
Interim Analysis and Criteria for Early Termination ................................................54
11.3
Determination of Sample Size..................................................................................54
12.0
QUALITY CONTROL AND QUALITY ASSURANCE...............................................56
12.1
Study-Site Monitoring Visits ...................................................................................56
12.2
Protocol Deviations..................................................................................................56
12.3
Quality Assurance Audits and Regulatory Agency Inspections ................................56
13.0
ETHICAL ASPECTS OF THE STUDY........................................................................57
13.1
IRB Approval ..........................................................................................................57
13.2
Subject Information, Informed Consent, and Subject Authorization .........................57
13.3
Subject Confidentiality ............................................................................................58
13.4
Publication, Disclosure, and Clinical Trial Registration Policy.................................59
13.4.1 Publication and Disclosure.................................................................................59
13.4.2 Clinical Trial Registration..................................................................................59
13.4.3 Clinical Trial Results Disclosure ........................................................................59
13.5
Insurance and Compensation for Injury....................................................................59
14.0
ADMINISTRATIVE AND REFERENCE INFORMATION.........................................60
14.1
Administrative Information......................................................................................60

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14.1.1 Study Contact Information .................................................................................60
14.1.2 Investigator Agreement......................................................................................60
14.1.3 Study-Related Responsibilities...........................................................................60
14.1.4 List of Abbreviations .........................................................................................60
15.0
DATA HANDLING AND RECORDKEEPING............................................................61
15.1
eCRFs......................................................................................................................61
15.2
Record Retention .....................................................................................................61
16.0
REFERENCES..............................................................................................................63
17.0
APPENDICES...............................................................................................................64
LIST OF IN-TEXT TABLES
Table 6.a
Dose Levels and Dosing Schedules ....................................................................20
Table 7.a
Excluded Medications, Supplements, and Dietary Products................................28
Table 9.a
Primary Specimen Collections ...........................................................................39
Table 9.b
Collection of Blood Samples for PK Analysis ....................................................40
Table 9.c
Collection of Urine Samples for PK Analysis.....................................................41
Table 10.a
Takeda Medically Significant AE List................................................................45
LIST OF IN-TEXT FIGURES
Figure 2.a
Schematic of the Study Design (Studies 1 and 2, with 14-day Washout Period)..11
CCI

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1.0
STUDY SUMMARY
Name of Sponsor:
Takeda Pharmaceuticals Company Limited
Compound:
TAK-438ASA tablet
TAK-438 tablet
Aspirin enteric-coated tablet
Study Identifier: TAK-438ASA-1001
Phase: 1
Protocol Title: A Phase 1, Randomized, Open-Label, Crossover Study to Evaluate the Bioequivalence of Single Oral 
Dose of TAK-438ASA tablet and Single Oral Dose of TAK-438 tablet plus Aspirin Enteric-Coated tablet (Study 1) 
and the Food Effect of Single Oral Dose of TAK-438ASA tablet (Study 2) in Healthy Adult Male Subjects
Trial Design:
This study comprises a bioequivalence study (Study 1) and food effect study (Study 2).
Each of these studies includes Periods 1 and 2 in which subjects are scheduled for a confinement period of 4 days and 
3 nights, with a washout period of at least 14 days between the study drug administrations in Periods 1 and 2.
Study 1: Bioequivalence study
This study is an open-label 2×2 crossover study to investigate the bioequivalence of TAK-438ASA tablet with 
concomitant administration of TAK-438 tablet and aspirin enteric-coated tablet in a fasted (without breakfast) 
condition.
The study will consist of pilot and pivotal studies with the same design (inclusion/exclusion criteria, dose levels and
conditions, and schedules). The pilot study will be implemented in a total of 12 subjects per sequence to provide a 
basis for sample size calculation to verify the bioequivalence in the pivotal study. The pivotal study will be 
implemented in a maximum of 202 subjects per sequence. If bioequivalence is verified for TAK-438 free base 
(TAK-438F) and unchanged aspirin in the pilot study, the pivotal study will not be implemented. If bioequivalence is
verified only for TAK-438F or unchanged aspirin in the pilot study, the pivotal study will be implemented for testing 
the bioequivalence of only the compound for which bioequivalence has not been verified. If bioequivalence is not
verified in the pivotal study, implementation of an add-on subject study will be considered. Any evidence from the
pilot study suggesting difficulties in bioequivalence testing in the pivotal study may lead to the pivotal study not being 
implemented.
Study 2: Food effect study
This study will be an open-label 2×2 crossover food effect study for TAK-438ASA tablet.
Trial Primary Objective:
To evaluate the bioequivalence of a single-dose TAK-438ASA tablet to concomitant administration of a single-dose 
TAK-438 tablet 10 mg and aspirin enteric-coated tablet 100 mg in healthy Japanese adult male subjects (Study 1).
Secondary Objective:
To evaluate the food effect on pharmacokinetics (PK) following administration of TAK-438ASA tablet (Study 2).
Trial Subject Population: Healthy Japanese adult male subjects, aged 20 to 60 years, inclusive.
Planned Number of Subjects:
Study 1: Bioequivalence study
Pilot study: 12 per sequence, 24 in total
Pivotal study: Maximum of 202 per sequence, 404 in 
total
The number of subjects required for the pivotal study
will be calculated based on the results from the pilot
study.
Study 2: Food effect study
Planned Number of Sites:
1 site

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CONFIDENTIAL
6 per sequence, 12 in total
Whole study (Study 1+ Study 2):
Maximum of 440 in total
Dose Levels:
Study 1: One TAK-438ASA tablet (a fixed dose 
combination of TAK-438 10 mg and aspirin 100 mg) 
or one each of TAK-438 tablet 10 mg and aspirin 
enteric-coated tablet 100 mg, taken orally with 
150 mL of water in a fasted (without breakfast [after 
at least 10 hours of fasting]) condition.
Study 2: One TAK-438ASA tablet (a fixed dose 
combination of TAK-438 10 mg and aspirin 100 mg) 
taken orally with 150 mL of water in a fasted (without 
breakfast) condition or fed (30 minutes after starting
breakfast) condition.
Route of Administration:
Oral
Duration of Treatment:
Study 1: Single-dose administration (a fixed dose 
combination [TAK-438ASA tablet] or a free 
combination of single-agent tablets [TAK-438 tablet 
and aspirin enteric-coated tablet]) in Periods 1 and 2
Study 2: Single-dose administration (a fixed dose 
combination [TAK-438ASA tablet] in a fasted 
[without breakfast] condition or fed [30 minutes after 
starting breakfast] condition) in Periods 1 and 2
Planned Trial Duration:
From the day prior to study drug administration through
48 hours after administration in Periods 1 and 2
Main Criteria for Inclusion:
1.
The subject is a healthy Japanese adult male, aged 20 to 60 years, inclusive, at the time of informed consent.
2.
The subject weighs at least 50 kg and has a body mass index (BMI) from 18.5 to 25.0 kg/m2, inclusive at 
Screening.
Main Criteria for Exclusion:
1.
The subject has received any investigational compound within 16 weeks (112 days) prior to the start of study 
drug administration in Period 1.
2.
The subject has participated in a clinical study of TAK-438 or aspirin and received the study drug.
3.
The subject is an immediate family member of or a study site employee, or is in a dependent relationship with a 
study site employee who is involved in the conduct of this study (eg, spouse, parent, child, sibling) or may 
consent under duress.
4.
The subject has uncontrolled, clinically significant neurologic, cardiovascular, pulmonary, hepatic, renal, 
metabolic, gastrointestinal, urologic, or endocrine disease or other abnormality (other than the disease being 
studied), which may impact the ability of the subject to participate in the study or potentially confound its results.
5.
The subject has aspirin asthma (non-steroidal anti-inflammatory drug-induced bouts of asthma) or a history of 
aspirin asthma.
6.
The subject has hypersensitivity to any component of TAK-438 tablet, aspirin enteric-coated tablet or salicylic 
acid-containing drugs.
7.
The subject has a positive urine drug result for drugs of abuse at Screening.
8.
The subject has a history of drug or alcohol abuse within 2 years prior to the Screening visit or is unwilling to 
agree to abstain from alcohol and drugs throughout the study.

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9.
The subject requires any excluded medication, supplements, or food products.
10.
The subject has current or recent (within 6 months) gastrointestinal disease that would be expected to influence 
the absorption of drugs (ie, a history of malabsorption, esophageal reflux, peptic ulcer disease, erosive 
esophagitis), frequent (more than once per week) occurrence of heartburn, or any surgical intervention.
11.
The subject has a history of cancer, except basal cell carcinoma which has been in remission for at least 5 years 
prior to Day 1.
12.
The subject has a positive test result for hepatitis B virus surface antigen (HBsAg), hepatitis C virus (HCV) 
antibody, human immunodeficiency virus (HIV) antibody/antigen, or serological reactions for syphilis at 
Screening.
13.
The subject has poor peripheral venous access.
14.
The subject has undergone whole blood collection of at least 200 mL within 4 weeks (28 days) or at least 400 mL 
within 12 weeks (84 days) prior to the start of study drug administration in Period 1.
15.
The subject has undergone whole blood collection of at least 800 mL in total within 52 weeks (364 days) prior to 
the start of study drug administration in Period 1.
16.
The subject has undergone blood component collection within 2 weeks (14 days) prior to the start of study drug 
administration in Period 1.
17.
The subject has a Screening or Check-in (Day -1) electrocardiogram (ECG) that was abnormal (clinically 
significant).
18.
The subject has abnormal Screening laboratory values that suggest a clinically significant underlying disease or 
subject with the following laboratory abnormalities: alanine aminotransferase (ALT) or aspartate 
aminotransferase (AST) above the upper limits of normal (ULN).
19.
The subject who, in the opinion of the investigator or sub-investigator, is unlikely to comply with the protocol or 
is unsuitable for any other reason.
Main Criteria for Evaluation and Analyses:
The primary endpoint of the study is:
Study 1:
PK (plasma concentration)

AUClast and Cmax of TAK-438F.

AUClast and Cmax of unchanged aspirin.
The secondary endpoints of the study are:
Study 1:
PK (plasma concentration)

AUC∞, tmax, MRT∞,ev, and λz of TAK-438F.

AUC∞, tmax, MRT∞,ev, and λz of unchanged aspirin.
Study 2:
PK (plasma concentration)

AUC∞, AUCt, AUClast, Cmax, tmax and t1/2z of TAK-438F and its metabolites (M-I, M-II, M-III, and M-IV-Sul).

AUC∞, AUCt, AUClast, Cmax, tmax and t1/2z of unchanged aspirin and its metabolite (salicylic acid).
PK (urine concentration)

Aet, fe,t, and CLR of TAK-438F and its metabolites (M-I, M-II, M-III, and M-IV-Sul).

Aet, fe,t, and CLR of unchanged aspirin and its metabolites (salicylic acid and salicyluric acid).
Safety:
Study 1:

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
Treatment-emergent adverse events (TEAEs), clinical laboratory tests, vital signs, weight, and 12-lead ECG.
Study 2:

TEAEs, clinical laboratory tests, vital signs, weight, and 12-lead ECG.
Statistical Considerations:
PK:
The following analyses will be performed using the PK analysis set.
Analytical methods:
1)
Plasma concentrations
Study 1:
At each time point scheduled for blood sampling, descriptive statistics of plasma concentrations of TAK-438F 
and unchanged aspirin will be provided for each study medication (ie, TAK-438ASA tablet [as a fixed dose 
combination] or concomitant administration of TAK-438 tablet and aspirin enteric-coated tablet [as a free 
combination], the same hereinafter). Case plots and mean plots with standard deviations (SD) will be provided
for each study medication. Descriptive statistics of PK parameters will be provided for each study medication.
Additionally, descriptive statistics will be provided for AUClast and Cmax ratios (TAK-438ASA tablet [as a fixed 
dose combination]/concomitant administration of TAK-438 tablet and aspirin enteric-coated tablet [as a free 
combination]).
Testing for bioequivalence:
For log-transformed (natural log) AUClast and Cmax of TAK-438F and unchanged aspirin (ie, the primary 
endpoint of the study), the two-sided 90% confidence interval (CI) of the difference in the least square means
between the study medications (TAK-438ASA tablet [as a fixed dose combination] −concomitant 
administration of TAK-438 tablet and aspirin enteric-coated tablet [as a free combination]) will be provided
using the analysis of variance (ANOVA) model. The same analyses will be performed for AUC∞, tmax, MRT∞,ev, 
and λz (ie, the secondary endpoint of the study) to provide additional information.
Study 2:
At each time point scheduled for blood sampling, descriptive statistics will be provided for the plasma
concentrations of TAK-438F and its metabolites (M-I, M-II, M-III, and M-IV-Sul), and of unchanged aspirin and
its metabolite (salicylic acid) for each dosing condition of TAK-438ASA tablet (fasted [without breakfast]
condition or fed [30 minutes after starting breakfast] condition, the same hereinafter). Case plots and mean plots 
with SD will be provided for each dosing condition. Descriptive statistics of PK parameters will be provided for 
each dosing condition.
Testing of food effect:
For log-transformed (natural log) AUC∞, AUCt, AUClast, and Cmax of TAK-438F and unchanged aspirin, the 
two-sided 90% and 95% CI of the difference in the least square means between the dosing conditions of 
TAK-438ASA tablet (fed [30 minutes after starting breakfast] condition – fasted [without breakfast] condition) 
will be provided using the ANOVA model.
2)
Urinary concentrations (Study 2 only)
For Aet, fe,t and CLR of TAK-438F and its metabolites (M-I, M-II, M-III, and M-IV-Sul), and of unchanged 
aspirin and its metabolites (salicylic acid and salicyluric acid), descriptive statistics will be provided for each 
dosing condition.
Safety:
The following analyses will be performed using the safety analysis set.
Analytical methods:
1)
TEAEs
A TEAE is defined as an AE with a date of onset that occurs on or after the start of study drug administration. 
Frequency distribution of TEAEs will be provided for all TEAEs, drug-related TEAEs, TEAEs by intensity, 
drug-related TEAEs by intensity, and serious TEAEs for each study medication (in Study 1) or for each dosing 

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CONFIDENTIAL
condition (in Study 2). TEAEs will be coded using the Medical Dictionary for Regulatory Activities (MedDRA) 
dictionary and tabulated by system organ class (SOC) and preferred term (PT).
2)
Clinical laboratory tests, vital signs, weight, and 12-lead ECG
For continuous variables, descriptive statistics of observed values and changes from baseline will be provided for 
each evaluation point for each study medication (in Study 1) or for each dosing condition (in Study 2).
For categorical variables, shift tables showing the number of subjects in each category at baseline and each 
post-baseline scheduled evaluation point will be provided for each study medication (in Study 1) or for each 
dosing condition (in Study 2).
Sample Size Justification:
Study 1:
Planned number of subjects is 12 per sequence (total of 24 subjects) in the pilot study, and a maximum of 202 per 
sequence (total of 404 subjects) in the pivotal study. Statistical basis for the sample size is presented below.
Assuming a root mean square error of 0.20 for PK parameters in the pilot study, the power of two one-sided t-tests to 
verify the bioequivalence [H0: ln(μ)≤ln(θ1), ln(μ)≥ln(θ2); H1: ln(θ1)<ln(μ)<ln(θ2); where μ=μt/μs, μt is the mean for
TAK-438ASA tablet, μs is the mean for the concomitant administration of TAK-438 tablet and aspirin enteric-coated 
tablet, θ1=0.80, and θ2=1.25] at a one-sided significance level of 5% and μ=0.95 to 1.05 would be 89% to 96% with a
sample size of 12 subjects per sequence (total of 24 subjects).
In the case that the pivotal study will be implemented, the number of subjects will be recalculated based on the results 
from the pilot study. Assuming a maximal root mean square error of 0.57 for PK parameters in the pivotal study, 
which is based on the results from preceding studies of TAK-438 and the bioequivalence study of another combination 
tablet using the same aspirin enteric-coated tablet (AG-1749ASA/CPH-001), two one-sided t-tests with a one-sided 
significance level of 5% and μ=0.90 to 1.10 would need a maximum of 202 subjects per sequence (total of 404 
subjects) to provide 90% power to verify the bioequivalence.
Study 2:
Planned number of subjects is 6 per sequence (total of 12 subjects) to evaluate the PK and safety of TAK-438ASA. 
This sample size has not been determined by statistical considerations.

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2.0
STUDY SCHEMATIC
Figure 2.a
Schematic of the Study Design (Studies 1 and 2, with 14-day Washout Period)
Element
Screening
Period 1
Period 2
Study Day
-28 to -2
-1
1
2
3
15
16
17
18
Visit/
Confinement
Visit
Confinement
Confinement
Procedure
Informed consent
Screening tests
Check-in/Examinations
Examinations/Randomization 
Administration of study drug
for Period 1
Examinations
Examinations/Discharge
Washout
Check-in/Examinations
Administration of study drug
for Period 2//Examinations
Examinations
Examinations/Discharge

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3.0
SCHEDULE OF STUDY PROCEDURES (STUDIES 1 AND 2)
Screening
Day -28 to -2
Periods 1 and 2*
Early Termination
Study Day:
Day -1
Day 1
Predose Day 1
Day 2
Day 3
Basic Procedures
Informed consent
X
Inclusion/exclusion criteria
X
X
X
Medical history/Demography
X
Medication history/Concomitant 
medications
Clinical Procedures/Assessments (a)
Physical examination (b)
X
X
X
X
X
X
X
Height, BMI
X
Weight
X
X
X
X
Vital signs (b)
X
X
X
X
X
X
X
12-lead ECG (c)
X
X
X
X
X
Study drug administration 
X
AE monitoring
Clinical laboratory tests (a)
Hematology (d)
X
X
X
X
Chemistry (d)
X
X
X
X
Urinalysis (d)
X
X
X
X
Urine drug screen
X
HBsAg, anti-HCV, HIV 
antibody/antigen, and syphilis screen
X
PK Evaluations
Plasma sample for TAK-438 PK (e)
X
X
X
X
X (i)
Plasma sample for aspirin PK (f)
X
X
X
X (j)
Urine sample for TAK-438 PK (g)
X
X
X
X
Urine sample for aspirin PK (h)
X
X
X
Other
Confinement/Discharge (Visit)
Visit
Confinement
Discharge Confinement/Visit
Footnotes are on the following page.

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AE=adverse event, BMI=body mass index, ECG=electrocardiogram, HBsAg=hepatitis B virus surface antigen, 
HCV=hepatitis C virus, HIV=human immunodeficiency virus, PK=pharmacokinetics.
*A washout period of at least 14 days will be placed between the study drug administrations in Periods 1 and 2.
Eligibility regarding the inclusion/exclusion criteria will not be confirmed in Period 2.
(a) Clinical procedures/assessments and clinical laboratory tests will be allowed at any time unless otherwise 
specified.
(b) Physical examination and vital sign measurements will be performed at:
Day -1: 18 hours predose.
Days 1 to 3: predose, 2, 24 and 48 hours postdose.
(c) 12-lead ECG will be recorded at:
Day -1: 18 hours predose.
Day 1: 2 hours postdose.
Day 3: 48 hours postdose.
(d) Samples for clinical laboratory tests will be collected at:
Days 1 to 3: predose and 48 hours postdose.
(e) Plasma samples for TAK-438 PK evaluations will be collected at:
Days 1 to 3: predose, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, 16, 24, 36, and 48 hours postdose in Studies 1 and 2.
If bioequivalence is verified only for TAK-438 free base (TAK-438F) in the pilot study of Study 1, the samples 
will not be collected in the pivotal study of Study 1.
(f) Plasma samples for aspirin PK evaluations will be collected at:
Day 1: predose, 1, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 10, 11, and 12 hours postdose in Studies 1 
and 2.
Day 2:16 and 24 hours postdose, only in Study 2.
If bioequivalence is verified only for unchanged aspirin in the pilot study of Study 1, the samples will not be 
collected in the pivotal study of Study 1.
(g) Urine samples for TAK-438 PK evaluations will be collected only in Study 2 at:
Days 1 to 3: predose (spot urine), 0-4, 4-8, 8-12, 12-24, 24-36, and 36-48 hours postdose.
(h) Urine samples for aspirin PK evaluations will be collected only in Study 2 at:
Days 1 and 2: predose (spot urine), 0-4, 4-8, 8-12, and 12-24 hours postdose.
(i)
Plasma samples for TAK-438 PK evaluations should be collected only in the case of early termination within 48 
hours after the study drug administration.
(j)
Plasma samples for aspirin PK evaluations should be collected only in the case of early termination within 12
hours after the study drug administration in Study 1, and within 24 hours after the study drug administration in 
Study 2.

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4.0
INTRODUCTION
4.1
Background
Antiplatelet therapy with low-dose aspirin is being widely used in patients with a history of 
ischemic heart disease, ischemic cerebrovascular disease, or other conditions. However, even 
when used at a low dose, aspirin is potent enough to inhibit endogenous prostaglandin synthesis in 
the gastric mucosa, thereby disabling acid-resistance of the gastric mucosa, and causing gastric or 
duodenal ulcers, or low-dose aspirin induced ulcers.
Evidence-based Clinical Practice Guidelines for Peptic Ulcer 2015 (2nd edition) edited by the 
Japanese Society of Gastroenterology [1] recommend the use of proton pump inhibitors (PPIs) to 
prevent the recurrence of low-dose-aspirin-induced upper gastrointestinal tract ulcer.
Conventional PPIs including lansoprazole, rabeprazole, and esomeprazole are indicated for 
prophylaxis of recurrent gastric or duodenal ulcers during low-dose aspirin therapy. As for 
lansoprazole, Takelda® Combination Tablet received marketing approval in March 2014, which is 
a fixed dose combination of lansoprazole and low-dose aspirin designed to more reliably prevent
the recurrence of gastric or duodenal low-dose-aspirin-induced ulcers through its improved 
convenience of use.
TAK-438 (vonoprazan) is a novel class of PPIs, collectively referred to as potassium-competitive 
acid blockers (P-CAB), which was developed by Takeda Pharmaceutical Company Limited. 
TAK-438 inhibits H+, K+-ATPase in the final step of acid secretion from stomach parietal cells. 
Unlike conventional PPIs, TAK-438 inhibits H+, K+-ATPase competitively with potassium ions 
without activation by acid. Acid-stability and water-solubility of TAK-438 enable a smaller 
variability in time-of-onset of action compared with conventional PPIs without requiring 
pharmaceutical dosage form such as enteric-coated formulations. TAK-438 is predominantly 
metabolized by cytochrome P450 (CYP) 3A4, and the contribution of polymorphic CYP2C19 is 
considered to be limited. Whereas conventional PPIs require 3 to 5 days to exert their maximum 
acid-inhibitory effects, TAK-438 is expected to exhibit its maximum acid-inhibitory effects in a 
much shorter time than conventional PPIs do, and to exert potent and sustained acid-inhibitory 
effects, which warrant better treatment outcomes. Prophylaxis of the recurrence of gastric or 
duodenal ulcers by lansoprazole remains incomplete as indicated by a significant proportion of 
subjects with the recurrence under treatment with lansoprazole. TAK-438 was developed as a new 
acid suppressant potentially more effective than conventional PPIs, and received Japanese 
marketing approval as Takecab® Tablet in December 2014 for the indication of prophylaxis of 
recurrent gastric or duodenal ulcers during low-dose aspirin therapy.
The marketing approval of TAK-438 for this indication was based on the results of a double-blind 
active-controlled study comparing TAK-438 10 mg or 20 mg once daily versus lansoprazole 
15 mg administered once daily for 24 weeks in the patients with a history of gastric or duodenal 
ulcers who require low-dose aspirin therapy for prophylaxis of thromboembolism after ischemic 
heart disease, ischemic cerebrovascular disease, or other conditions. The recurrence rate of gastric 
or duodenal ulcers at Week 24 (ie, the primary endpoint of the study) was 0.5% in the TAK-438 
10 mg group, 1.5% in the TAK-438 20 mg group, and 2.8% in the lansoprazole group. Both 10 mg 

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and 20 mg doses of TAK-438 were demonstrated to be non-inferior to lansoprazole at a
non-inferiority margin of 8.7%; the difference between the TAK-438 10 mg group and 
lansoprazole group was -2.3% (95% confidence interval [CI], -4.743% to 0.124%), and that 
between the TAK-438 20 mg group and lansoprazole group was -1.3% (95% CI, -4.095% to 
1.523%). An open-label extension study was conducted in the subjects who completed this study
to compare TAK-438 10 mg or 20 mg versus lansoprazole in a maintenance treatment (a minimum 
of 28 weeks and a maximum of 80 weeks). The recurrence rate of gastric or duodenal ulcers at 
Week 104 was 0.5% in the TAK-438 10 mg group, 1.5% in the TAK-438 20 mg group, and 3.3% 
in the lansoprazole group. The incidence of gastric or duodenal bleeding lesions at Week 24 was 
0.0% in the TAK-438 10 mg group, 0.0% in the TAK-438 20 mg group, and 2.9% in the 
lansoprazole group. The differences between the TAK-438 treatments and lansoprazole treatment 
were significant: -2.9% (95% CI, -5.135% to -0.607%) between the TAK-438 10 mg group and 
lansoprazole group, and a similar difference between the TAK-438 20 mg group and lansoprazole 
group. The incidence of gastric or duodenal bleeding lesions remained significantly lower in both
TAK-438 groups than in the lansoprazole group until the last evaluation time point (Week 104).
These results provided the rationale for a fixed dose combination containing TAK-438 and 
low-dose aspirin, which potentially help prevent the recurrence of gastric or duodenal ulcers 
associated with the use of aspirin. Indeed, the proposed fixed dose combination was thought to 
meet one of the medical needs (ie, alleviation of adverse effects) that warrant filing of combination
medicinal products as specified in Points to be Considered in Filing of New Drug Application of 
Pharmaceuticals, Pharmaceutical and Food Safety Bureau (PFSB) Notification No. 1121-12 
issued on 21 November 2014. Furthermore, when judged in light of Appendix “Others” Q7 in 
Points to be Considered in Filing of New Drug Application of Pharmaceuticals, Particularly on 
the Q&A for Handling of Oral Combination Medicinal Products, PFSB Notification issued on 15 
March 2011, the proposed fixed dose combination containing TAK-438 and aspirin appeared to be 
worth developing as further scientific rationale has been provided in a prospective clinical study 
for combining TAK-438 and aspirin without compromising each other’s efficacy, as confirmed by 
the preceding studies including a drug-drug interaction study.
4.2
Rationale for the Proposed Study
To develop a fixed dose combination of TAK-438 10 mg and aspirin 100 mg (TAK-438ASA), this
study was planned to verify the bioequivalence of a single-dose TAK-438ASA tablet 
toconcomitant administration of a single-dose TAK-438 tablet and aspirin enteric-coated tablet 
(Study 1) as well as to evaluate the food effect on pharmacokinetics (PK) of TAK-438ASA 
(Study 2).
4.3
Benefit/Risk Profile
There will be no benefit to subjects in this study other than receiving physical examinations and 
obtaining information about their general health. Instead, patients with conditions including 
ischemic heart disease and cerebrovascular disease may benefit in the future from what can be 
learned in this study.

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Because both of the compounds contained in this fixed dose combination (TAK-438 and aspirin) 
have been already approved for marketing and their safety is established, the risk to subject is 
considered not to exceed the risk of receiving either compound.
For further information on TAK-438ASA, please refer to the Investigator’s Brochure.

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5.0
TRIAL OBJECTIVES AND ENDPOINTS
5.1
Hypothesis
This study was designed based on the following hypothesis:
Bioequivalence of a single-dose TAK-438ASA tablet to concomitant administration of a 
single-dose TAK-438 tablet and aspirin enteric-coated tablet (with the same single-agent doses as 
contained in TAK-438ASA tablet) is confirmed.
5.2
Trial Objectives
5.2.1
Trial Primary Objective
The primary objective of the study is to evaluate the bioequivalence of a single-dose 
TAK-438ASA tablet to concomitant administration of a single-dose TAK-438 tablet 10 mg and
aspirin enteric-coated tablet 100 mg in healthy Japanese adult male subjects (Study 1).
5.2.2
Trial Secondary Objective
The secondary objective of the study is to evaluate the food effect on PK following administration 
of TAK-438ASA tablet (Study 2).
5.3
Endpoints
5.3.1
Primary Endpoint
The primary endpoint of the study is:
Study 1:
PK (plasma concentration)

AUClast and Cmax of TAK-438F.

AUClast and Cmax of unchanged aspirin.
5.3.2
Secondary Endpoints
Secondary endpoints include:
Study 1:
PK (plasma concentration)

AUC∞, tmax, MRT∞,ev, and λz of TAK-438F.

AUC∞, tmax, MRT∞,ev, and λz of unchanged aspirin.
Study 2:
PK (plasma concentration)

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
AUC∞, AUCt, AUClast, Cmax, tmax and t1/2z of TAK-438F and its metabolites (M-I, M-II, M-III, 
and M-IV-Sul).

AUC∞, AUCt, AUClast, Cmax, tmax and t1/2z of unchanged aspirin and its metabolite (salicylic 
acid).
PK (urine concentration)

Aet, fe,t and CLR of TAK-438F and its metabolites (M-I, M-II, M-III, and M-IV-Sul).

Aet, fe,t and CLR of unchanged aspirin and its metabolites (salicylic acid and salicyluric acid).
5.3.3
Safety Endpoints
Safety endpoints will be assessed through the following parameters:
Treatment-emergent adverse events (TEAEs), clinical laboratory tests, vital signs, weight, and 
12-lead electrocardiogram (ECG).

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6.0
TRIAL DESIGN AND DESCRIPTION
6.1
Trial Design
This study comprises a bioequivalence study (Study 1) and food effect study (Study 2).
Each of these studies includes Periods 1 and 2 in which subjects are scheduled for a confinement 
period of 4 days and 3 nights, with a washout period of at least 14 days between the study drug
administrations in Periods 1 and 2.
Study 1: Bioequivalence study
This study is an open-label 2×2 crossover study to investigate the bioequivalence of 
TAK-438ASA tablet with concomitant administration of TAK-438 tablet and aspirin 
enteric-coated tablet in a fasted (without breakfast) condition.
The study will consist of pilot and pivotal studies with the same design (inclusion/exclusion 
criteria, dose levels and conditions, and schedules). The pilot study will be implemented in a total 
of 12 subjects per sequence to provide a basis for sample size calculation to verify the 
bioequivalence in the pivotal study. The pivotal study will be implemented in a maximum of 
202 subjects per sequence. If bioequivalence is verified for TAK-438 free base (TAK-438F) and 
unchanged aspirin in the pilot study, the pivotal study will not be implemented. If bioequivalence
is verified only for TAK-438F or unchanged aspirin in the pilot study, the pivotal study will be 
implemented for testing the bioequivalence of only the compound for which bioequivalence has 
not been verified. If bioequivalence is not verified in the pivotal study, implementation of an 
add-on subject study will be considered. Any evidence from the pilot study suggesting difficulties 
in bioequivalence testing in the pivotal study may lead to the pivotal study not being implemented.
Study 2: Food effect study
This study will be an open-label 2×2 crossover food effect study for TAK-438ASA tablet.
The planned dose levels and dosing schedules of TAK-438ASA to be evaluated are outlined in 
Table 6.a.

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Table 6.a
Dose Levels and Dosing Schedules
Study 1: Bioequivalence study
Pilot study
Sequence
Number 
of
Subjects
Period 1
Period 2
a
12
One TAK-438ASA tablet 
(a fixed dose combination containing 
TAK-438 10 mg and aspirin 100 mg)
One TAK-438 tablet 10 mg +
One aspirin enteric-coated tablet 100 mg
b
12
One TAK-438 tablet 10 mg +
One aspirin enteric-coated tablet 100 mg
One TAK-438ASA tablet 
(a fixed dose combination containing 
TAK-438 10 mg and aspirin 100 mg)
Dosing Condition
Fasted (without breakfast) condition
Pivotal Study
Sequence
Number 
of
Subjects*
Period 1
Period 2
a
Maximum 
of 202
One TAK-438ASA tablet 
(a fixed dose combination containing 
TAK-438 10 mg and aspirin 100 mg)
One TAK-438 tablet 10 mg +
One aspirin enteric-coated tablet 100 mg
b
Maximum 
of 202
One TAK-438 tablet 10 mg +
One aspirin enteric-coated tablet 100 mg
One TAK-438ASA tablet 
(a fixed dose combination containing 
TAK-438 10 mg and aspirin 100 mg)
Dosing Condition
Fasted (without breakfast) condition
*Number of subjects required for the pivotal study is to be calculated based on the results from pilot study.
Study 2: Food effect study
Sequence
Number 
of
Subjects
Period 1
Period 2
c
6
One TAK-438ASA tablet 
(a fixed dose combination containing 
TAK-438 10 mg and aspirin 100 mg) taken in a 
fasted (without breakfast) condition
One TAK-438ASA tablet 
(a fixed dose combination containing 
TAK-438 10 mg and aspirin 100 mg) taken in a 
fed (30 minutes after starting breakfast) condition
d
6
One TAK-438ASA tablet 
(a fixed dose combination containing 
TAK-438 10 mg and aspirin 100 mg) taken in a 
fed (30 minutes after starting breakfast) condition
One TAK-438ASA tablet 
(a fixed dose combination containing 
TAK-438 10 mg and aspirin 100 mg) taken in a 
fasted (without breakfast) condition
6.2
Procedures for Proceeding to the Pivotal Study
In Study 1, an interim analysis will be performed after the completion of the pilot study to 
determine whether the results may warrant further analysis in the pivotal study. On the basis of 
bioequivalence assessment in the pilot study, the Sponsor will decide, after discussion(s) with the 
medical experts, on whether to proceed to the pivotal study and promptly notify the investigator of 
the decision.

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In the case that the results from interim analysis satisfy the criteria of bioequivalence:
Study 1 will be completed without implementing the pivotal study.
In the case that the results from interim analysis do not meet the criteria of bioequivalence:
The pivotal study will be implemented after the number of subjects required to conclude the 
bioequivalence is calculated based on the results from the pilot study. If bioequivalence is verified
only for TAK-438F or unchanged aspirin in the pilot study, the pivotal study will be implemented 
for testing the bioequivalence of only the compound for which bioequivalence has not been 
verified. Any evidence from the pilot study suggesting difficulties in bioequivalence testing in the 
pivotal study may lead to the pivotal study not being implemented.
Criteria of bioequivalence:
In Study 1, the study drugs will be assessed for bioequivalence according to Partial Revision of the 
Guideline for Bioequivalence Studies of Generic Products, PFSB Notification No. 0229-10 issued 
on 29 February 2012 [2]. If any of the following criteria is satisfied, TAK-438ASA tablet and the 
concomitant administration of TAK-438 tablet and aspirin enteric-coated tablet will be concluded 
to be bioequivalent.

For both AUClast and Cmax of TAK-438F and unchanged aspirin, the two-sided 90% CI of the 
difference in the means of log-transformed (natural log) parameter between the study 
medications is between 0.8 and 1.25, inclusive.

For both AUClast and Cmax of TAK-438F and unchanged aspirin, the difference in the means of 
log-transformed (natural log) parameter between the study medications is between 0.90 and 
1.11, inclusive. Furthermore, the results of the elution test satisfy the requirements specified in 
Partial Revision of the Guideline for Bioequivalence Studies of Generic Products [2].
6.3
Rationale for Trial Design, Dose, and Endpoints
6.3.1
Rationale of Trial Design
To appropriately evaluate the PK and safety profile of TAK-438ASA tablet, both Studies 1 and 2 
are planned to enroll only healthy adult males with no disease.
Essentially based on Partial Revision of the Guideline for Bioequivalence Studies of Generic 
Products [2], both Studies 1 and 2 are planned to involve a 2×2 crossover design in which the 
subjects serve as their own controls to allow comparisons with a minimized effect of inter-subject 
variability. In this scheme, the subjects will be randomized to either of the two sequences with 
different dosing schedules to avoid potential bias. A 14-day washout period has been incorporated 
between the study drug administration in Periods 1 and 2 to minimize the carry-over effect of the 
study drug. Furthermore, as the primary objective of this study is to evaluate the PK profile of the 
study drug, which is an objective measure, an open-label design is considered appropriate.

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6.3.2
Rationale for Dose
The dose of TAK-438 in this study will be 10 mg, which is the approved dose for prophylaxis of 
recurrent gastric or duodenal ulcers during low-dose aspirin therapy. Aspirin enteric-coated tablet 
100 mg, commonly used as a low-dose aspirin in clinical settings, will be used in this study.
6.3.3
Rationale for Washout Period
Given that aspirin is known to act irreversibly on platelets, the washout period was determined to 
be 14 days, longer than the sum of the washout period recommended in Partial Revision of the 
Guideline for Bioequivalence Studies of Generic Products [2] (ie, 5 times the elimination half-life 
of the study drug) and the average lifespan of platelets (ie, 10 days).
Note: The elimination half-life of TAK-438F, M-I, M-II, M-III, and M-IV-Sul is 7.7, 9.1, 9.7, 7.5, 
and 5.8 hours, respectively, after a single-dose administration of TAK-438 20 mg under fasted 
conditions.
The elimination half-life of unchanged aspirin and salicylic acid is 0.44 and 2.03 hours,
respectively, after a single-dose administration of 
under fasted conditions
(refer to package insert for
).
6.3.4
Rationale for Endpoints
6.3.4.1
PK Endpoints
As Study 1 is intended to assess the bioequivalence in accordance with Partial Revision of the 
Guideline for Bioequivalence Studies of Generic Products [2], the endpoints are the PK
parameters of TAK-438F and unchanged aspirin.
As Study 2 is intended to evaluate the food effect on PK, the endpoints are the plasma 
concentrations of TAK-438F and its metabolites (M-I, M-II, M-III, and M-IV-Sul), unchanged 
aspirin and its metabolite (salicylic acid), as well as the urine concentrations of TAK-438F and its 
metabolites (M-I, M-II, M-III, and M-IV-Sul), unchanged aspirin and its metabolites (salicylic 
acid and salicyluric acid).
6.3.4.2
Safety Endpoints
Both Studies 1 and 2 will evaluate the safety of the study drugs based on the safety endpoints
conventionally used in clinical pharmacological studies, which include TEAEs, clinical laboratory 
tests, vital signs, weight, and 12-lead ECG.
6.3.5
Critical Procedures Based on Trial Objectives: Timing of Procedures
For this study, the collection of blood samples for PK evaluation is the critical procedure.
!
At any postdose time point, the blood samples for PK evaluation need to be collected as close 
to the exact nominal time point as possible.
CCI
CCI

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
All other procedures should be completed as close to the scheduled times as possible, either 
before or after them.

When other procedures are scheduled at the same time as PK sampling, the blood draw will 
take priority and other procedures will be performed within an acceptable time window (refer 
to Appendix B).

The order of priority can be changed with joint agreement of the investigator and the Sponsor.

Any unscheduled procedures required for urgently addressing a safety concern will take 
precedence over all routine scheduled procedures.
6.4
Trial Beginning and End/Completion
6.4.1
Definition of Beginning of the Trial
The entire study begins when the first subject signs the study’s informed consent form.
6.4.2
Definition of End of the Trial
The entire study ends when the last subject completes the last planned or follow-up visit (or the last
contact [eg, phone call] associated with a planned visit), discontinues the study, or becomes lost to 
follow-up (ie, the investigator is unable to contact the subject).
6.4.3
Definition of Trial Discontinuation
The study may be discontinued for any of the following nonsafety reasons:

Any finding (eg, PK, pharmacodynamics [PD], efficacy, biologic targets) from another 
nonclinical or clinical study using the study drug(s) may lead to the study discontinuation for a 
nonsafety reason.

Data from comparator(s), drug(s) of the same class, or methodology(ies) used in this study 
become available, possibly leading to the study discontinuation for a nonsafety reason.

The study may be discontinued because of a nonscientific and nonsafety reason, such as slow 
enrollment.
The study may be discontinued because of the following safety reasons:

The study may be terminated early when unanticipated safety concerns arise from clinical or 
preclinical studies using the study drug(s), comparator(s), drug(s) of the same class, or 
methodology(ies) used in this study.
6.4.4
Criteria for Premature Termination or Suspension of the Trial
6.4.4.1
Criteria for Premature Termination or Suspension of Trial
The study will be completed as planned unless 1 or more of the following criteria are met that 
require temporary suspension or early termination of the study.

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1. New information or other evaluation regarding the safety or efficacy of the study drug that 
indicates a change in the known risk/benefit profile for TAK-438ASA, such that the risk is no 
longer acceptable for subjects participating in the study.
2. Significant violation of Good Clinical Practice (GCP) that compromises the ability to achieve 
the primary study objectives or compromises subject safety.
3. Any subject experiences any of the Takeda Medically Significant List events (as outlined in 
Table 10.a).
4. Liver Function Test (LFT) abnormalities:
a. Any subject experiences alanine aminotransferase (ALT) and/or aspartate aminotransferase 
(AST) >5 × upper limit of normal (ULN) in the absence of a concomitant bilirubin increase.
b. Any subject experiences ALT and/or AST >3 ×ULN in the presence of a total bilirubin >2 
×ULN or an international normalized ratio (INR) >1.5 without findings of cholestasis or 
any other alternative etiology to explain the elevations (ie, Hy’s Law cases).
c. Any subject experiences ALT and/or AST >3 ×ULN with appearance of fatigue, nausea, 
vomiting, right upper quadrant pain or tenderness, fever, rash and/or eosinophilia (>5%).
6.4.4.2
Procedures for Premature Termination or Suspension of the Trial
In the event that the Sponsor, the institutional review board (IRB), or the regulatory authority 
elects to terminate or suspend the study or the participation of a study site, a study-specific 
procedure for early termination or suspension will be provided by the Sponsor; the procedure will 
be followed by the study site during the course of termination or study suspension.
6.4.5
Criteria for Premature Termination or Suspension of the Site
6.4.5.1
Criteria for Premature Termination or Suspension of the Site
The study site may be terminated prematurely or suspended if the site (including the investigator) 
is found in significant violation of GCP, protocol, or contractual agreement, is unable to ensure 
adequate performance of the study, or as otherwise permitted by the contractual agreement.
6.4.5.2
Procedures for Premature Termination or Suspension of the Site
In the event that the Sponsor, the IRB, or the regulatory authority elects to terminate or suspend the 
study or the participation of a study site, a study-specific procedure for early termination or 
suspension will be provided by the Sponsor; the procedure will be followed by the study site
during the course of termination or study suspension.

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7.0
SELECTION AND DISCONTINUATION/WITHDRAWAL OF SUBJECTS
7.1
Inclusion Criteria
Subject eligibility is determined according to the following criteria:
1. In the opinion of the investigator or sub-investigator, the subject is capable of understanding 
and complying with protocol requirements.
2. The subject signs and dates a written, informed consent form prior to the initiation of any study 
procedures.
3. The subject is a healthy Japanese adult male, aged 20 to 60 years, inclusive, at the time of 
informed consent.
4. The subject weighs at least 50 kg and has a body mass index (BMI) from 18.5 to 25.0 kg/m2, 
inclusive at Screening.
Justifications of the inclusion criteria
Criteria 1, 2, and 3:
These are selected as the standard criteria for the conduct of clinical pharmacological studies in 
healthy adults.
Criterion 4:
Since whole blood collections of 400 mL from individuals weighing less than 50 kg is harmful to 
their health, according to Enforcement Regulation on the Law for Securing a Stable Supply of Safe 
Blood Products, Ministry of Health and Welfare Ordinance No. 22 issued in 1956 [3], the lower 
weight limit is set to 50 kg. BMI of the subjects are to be within the range of the standard weight 
according to the Diagnostic Criteria for Obesity proposed by the Japan Society for the Study of 
Obesity [4].
7.2
Exclusion Criteria
Any subject who meets any of the following criteria will not qualify for entry into the study:
1. The subject has received any investigational compound within 16 weeks (112 days) prior to the 
start of study drug administration in Period 1.
2. The subject has participated in a clinical study of TAK-438 or aspirin and received the study
drug.
3. The subject is an immediate family member of or a study site employee, or is in a dependent 
relationship with a study site employee who is involved in the conduct of this study (eg, 
spouse, parent, child, sibling) or may consent under duress.
4. The subject has uncontrolled, clinically significant neurologic, cardiovascular, pulmonary, 
hepatic, renal, metabolic, gastrointestinal, urologic, or endocrine disease or other abnormality 
(other than the disease being studied), which may impact the ability of the subject to participate 
in the study or potentially confound its results.

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5. The subject has aspirin asthma (non-steroidal anti-inflammatory drug-induced bouts of 
asthma) or a history of aspirin asthma.
6. The subject has hypersensitivity to any component of TAK-438 tablet, aspirin enteric-coated 
tablet or salicylic acid-containing drugs.
7. The subject has a positive urine drug result for drugs of abuse at Screening.
8. The subject has a history of drug or alcohol abuse within 2 years prior to the Screening visit or 
is unwilling to agree to abstain from alcohol and drugs throughout the study.
9. The subject has taken any excluded medication, supplements, or food products during the time 
periods listed in Section 7.3.
10. The subject has current or recent (within 6 months) gastrointestinal disease that would be 
expected to influence the absorption of drugs (ie, a history of malabsorption, esophageal 
reflux, peptic ulcer disease, erosive esophagitis), frequent (more than once per week)
occurrence of heartburn, or any surgical intervention.
11. The subject has a history of cancer, except basal cell carcinoma which has been in remission 
for at least 5 years prior to Day 1.
12. The subject has a positive test result for hepatitis B virus surface antigen (HBsAg), hepatitis C 
virus (HCV) antibody, human immunodeficiency virus (HIV) antibody/antigen, or serological 
reactions for syphilis at Screening.
13. The subject has poor peripheral venous access.
14. The subject has undergone whole blood collection of at least 200 mL within 4 weeks (28 days) 
or at least 400 mL within 12 weeks (84 days) prior to the start of study drug administration in 
Period 1.
15. The subject has undergone whole blood collection of at least 800 mL in total within 52 weeks 
(364 days) prior to the start of study drug administration in Period 1.
16. The subject has undergone blood component collection within 2 weeks (14 days) prior to the 
start of study drug administration in Period 1.
17. The subject has a Screening or Check-in (Day -1) electrocardiogram (ECG) that was abnormal 
(clinically significant).
18. The subject has abnormal Screening laboratory values that suggest a clinically significant 
underlying disease or subject with the following laboratory abnormalities: ALT or AST above 
the ULN.
19. The subject who, in the opinion of the investigator or sub-investigator, is unlikely to comply 
with the protocol or is unsuitable for any other reason.
Justifications of the exclusion criteria
Criterion 1:

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This criterion is meant to ensure the safety of subjects by specifying a minimum interval that they 
are not affected by any previous clinical study, which is based on the General Considerations for 
Clinical Trials, Pharmaceutical Safety Bureau Notification No. 380, issued on 21 April 1998 [5].
Criteria 2, 3, 4, 7, 8, 11, 12, 13, and 19:
These are the standard criteria for clinical pharmacological studies in healthy adults and included 
in consideration of subjects’ safety.
Criteria 5, 6, 17, and 18:
These criteria are selected in consideration of subjects’ safety.
Criterion 9:
This is a standard criterion for clinical pharmacological studies in healthy adults and included in 
considerations of subjects’ safety and possible effects on PK evaluations.
Criterion 10:
This criterion is selected in considerations of subjects’ safety and possible effects on PK 
evaluations.
Criteria 14 to 16:
These criteria are in accordance with Enforcement Regulation on the Law for Securing a Stable 
Supply of Safe Blood Products, Ministry of Health and Welfare Ordinance No. 22, issued in 1956
[3].
7.3
Excluded Medications, Supplements, Dietary Products
Use of excluded agents (prescription or nonprescription) or dietary products is outlined in Table 
7.a.
Use of prohibited concomitant drugs will be allowed when the investigator or sub-investigator 
deem it necessary to do so for reasons including treatment of an AE.

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Table 7.a
Excluded Medications, Supplements, and Dietary Products
Throughout the study period, 
beginning from 28 days prior to
study drug administration (Day 1)
in Period 1
From 7 days prior to study drug 
administration (Day 1) to discharge 
in Periods 1 and 2
From 24 hours prior to study drug 
administration (Day 1) to Discharge
in Periods 1 and 2

Prescription medications

OTC medications

Neutraceuticals 
(St. John’s wort, ginseng, kava 
kava, ginkgo biloba, and 
melatonin)

Chinese herbals

Immunization/Vaccines

Nicotine-containing products

Vitamin supplements

Alcohol-containing products

Grapefruit/grapefruit juice

Caffeine-containing products
OTC=over-the-counter.
Subjects must be instructed not to take any medications including over-the-counter (OTC) 
products, without consulting with the investigator or sub-investigator.
7.4
Diet, Fluid, Activity
7.4.1
Diet and Fluid

Diet
Studies 1 and 2:
On the day before the visit for blood collection of laboratory tests (Screening visit), the subject 
must finish the dinner by 21:00, and must fast until blood collection in the next morning. For 
laboratory tests scheduled in the afternoon on a study visit, blood samples should be collected 
at least 10 hours after the last meal.
During confinement, the subjects are to take only served meals and are not allowed to take any 
other food. Meal menus will be the same for Periods 1 and 2.
Excessive eating or drinking should be avoided during the study period.
Study 1:
Dinner will be at approximately 19:00 on the day before study drug administration. The 
subjects must fast for at least 10 hours prior to and for 4 hours after dosing.
On the day of the study drug administration, the subjects must not have breakfast. The 
approximate time is 13:00 for lunch and 19:00 for dinner. If the lunch or dinner time conflicts 
with the laboratory test schedule, the subject must have lunch or dinner promptly after 
completion of the laboratory tests. On the next day of study drug administration, the 
approximate time is 9:30 for breakfast, 13:00 for lunch, and 19:00 for dinner. If the breakfast 
time conflicts with the laboratory test schedule, the subject must take breakfast promptly after 
completion of the laboratory tests.
Taking breakfast on Day 3 (the day of discharge) is optional.

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Study 2:
On the day of the study drug administration in a fasted condition without breakfast, the subject 
must fast for at least 10 hours prior to dosing. On the day of the study drug administration after 
breakfast, the subject must take breakfast at approximately 8:30, and take the study drug 
30 minutes after start of the breakfast.
In either dosing condition, the subject will continue to fast for an additional 4 hours after
dosing. On the day of the study drug administration, the approximate time is 13:00 for lunch 
and 19:00 for dinner. If the lunch or dinner time conflicts with the laboratory test schedule, the 
subject must take lunch or dinner promptly after completion of the laboratory tests. On the next 
day of study drug administration, the approximate time is 9:30 for breakfast, 13:00 for lunch,
and 19:00 for dinner. If the breakfast time conflicts with the laboratory test schedule, the 
subject must take breakfast promptly after completion of the laboratory tests.
Taking breakfast on Day 3 (the day of discharge) is optional.

Beverages
On the day of study drug administration, subjects must not drink any liquid from 1 hour prior to 
and 4 hours after dosing, with the exception of breakfast drinks and the water (150 mL) to take
the study drug.

Smoking
Smoking is not allowed during the study period, beginning from 28 days prior to the start of 
study drug administration (Day 1).
7.4.2
Activity
Supine position is not allowed for 4 hours after dosing, unless required for examinations, or for 
other reasons.
Excessive exercise is not allowed during the study period. Subjects should do 15 minutes of light 
exercise a day during the confinement.
Blood donations are not allowed for at least 12 weeks (84 days) after the final examination in this 
study. The investigator or sub-investigator will instruct the subjects on the prohibition of blood 
donations.
If a subject visits another medical institution during the study period, the investigator or 
sub-investigator should be informed of the visit in advance whenever possible, and should be 
reported the circumstances and therapy after visit. The investigator or sub-investigator should 
communicate that medical institution about the subject’s participation in the study.
7.5
Documentation of Subjects Failure
The investigator or sub-investigator must account for all subjects who sign informed consent. If a 
subject is withdrawn from the study before the first study drug administration in Period 1, the 
investigator or sub-investigator should complete the electronic case report form (eCRF).
Primary reasons for subject failure are to be recorded in the eCRF using the following categories:

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
Death.

AE.

Screen failure (failed inclusion criteria or did meet exclusion criteria) <specify reason>.

Protocol deviation.

Lost to follow-up.

Withdrawal by subject <specify reason>.

Study terminated by Sponsor.

Sample size sufficient.

Other <specify reason>.
Any subject identification number, once assigned to a subject, should not be reused if the assigned 
subject discontinues the study prior to study drug administration in Period 1. Nevertheless, if a
reserve subject is enrolled in the other sequence, the same subject identification number may be 
used.
7.6
Criteria for Discontinuation or Withdrawal of a Subject
Primary reasons for discontinuation or withdrawal of a subject from the study or study drug should 
be recorded in the eCRF using the following categories. For the subject who is withdrawn from the 
study before the first study drug administration in Period 1, refer to Section 7.5.
1. Death.
The subject died on study.
Note: If the subject dies on study, the event will be considered as serious adverse event (SAE). 
Refer to Section 10.2.9.3 for the reporting procedures.
2. AE.
The subject has experienced an AE that requires early termination because continued 
participation imposes an unacceptable risk to the subject’s health or the subject is unwilling to 
continue because of the AE.
In multidose studies, study drug should be discontinued immediately with appropriate clinical 
follow-up (including repeat laboratory tests, until the subject’s laboratory profile has returned 
to normal/baseline status, refer to Section 9.2.8), if the following circumstances occur at any 
time during study drug treatment:

LFT abnormalities.
-
ALT or AST >8×ULN, or
-
ALT or AST >5×ULN and persists for more than 2 weeks, or
-
ALT or AST >3×ULN in conjunction with elevated total bilirubin >2×ULN or INR 
>1.5, or

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-
ALT or AST >3×ULN with appearance of fatigue, nausea, vomiting, right upper 
quadrant pain or tenderness, fever, rash and/or eosinophilia (>5%).
3. Protocol deviation.
The discovery after the start of study drug administration in Period 1 that the subject failed to 
meet protocol entry criteria or did not adhere to protocol requirements, and continued 
participation poses an unacceptable risk to the subject’s health.
4. Lost to follow-up.
The subject did not return to the clinic and attempts to contact the subject were unsuccessful. 
Attempts to contact the subject must be documented in the subject’s source documentation.
5. Withdrawal by subject.
The subject wishes to withdraw from the study. The reason for withdrawal, if provided, should 
be recorded in the eCRF.
Note: All attempts should be made to determine the underlying reason for the withdrawal and, 
where possible, the primary underlying reason should be recorded (ie, withdrawal due to an 
AE should not be recorded in the “voluntary withdrawal” category).
6. Study terminated by the Sponsor.
The Sponsor terminates the study.
7. Other
Note: The specific reasons should be recorded in the “specify” field of the eCRF.
7.7
Procedures for Discontinuation or Withdrawal of a Subject
The investigator or sub-investigator may discontinue a subject’s study participation at any time 
during the study if the subject meets the study termination criteria described in Section 7.6. In 
addition, a subject may discontinue his participation without giving a reason at any time during the 
study. Should a subject’s participation be discontinued, the primary criterion for termination must 
be recorded by the investigator or sub-investigator. In addition, efforts should be made to perform 
all procedures scheduled for the Early Termination Visit.
7.8
Subject Replacement
In consideration of possible subject withdrawals for some reasons prior to the study drug 
administration in Period 1 after Screening, a certain number of individuals judged eligible at 
Screening are to be retained as standbys only for Period 1. Subject replacement is not allowed for 
dropouts after the start of study drug administration.

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8.0
CLINICAL STUDY MATERIAL MANAGEMENT
8.1
Clinical Study Drug
Dosage form:
Studies 1 and 2
1. TAK-438ASA tablet
Appearance: a white film-coated tablet
Content: vonoprazan 10 mg (13.36 mg as vonoprazan fumarate) and aspirin 100 mg per tablet
Generic name: To be determined
2. TAK-438 10 mg tablet (Takecab® Tablet 10 mg)
Appearance: a pale yellowish film-coated tablet
Content: vonoprazan 10 mg (13.36 mg as vonoprazan fumarate) per tablet
Chemical name:
1-[5-(2-Fluorophenyl)-1-(pyridine-3-ylsulfonyl)-1H-pyrrol-3-yl]-N-methylmethanamine 
monofumarate
Generic name: vonoprazan fumarate (JAN)
3. Aspirin 100 mg enteric-coated tablet (
)
Appearance: a white enteric-coated tablet (film-coated tablet)
Content: aspirin 100 mg per tablet
Chemical name: 2-Acetoxybenzoic acid
Generic name: aspirin (JAN)
Packaging:
TAK-438ASA tablets are to be supplied in amber glass bottles with desiccants which contains 
6 tablets of the study drug per bottle. TAK-438 10 mg tablets are to be supplied in commercially
available cartons, each of which contains 10 sheets of press through package (PTP), each sheet 
containing 10 tablets. Aspirin 100 mg enteric-coated tablets are also to be supplied in 
commercially available cartons, each of which contains 50 sheets of PTP, each sheet containing
10 tablets. Each carton containing either of the study drugs is to be labeled “study drug”.
Manufacturing:
TAK-438ASA tablet are manufactured by
TAK-438 10 mg tablets and aspirin 
100 mg enteric-coated tablets are to be supplied as commercially available Takecab® Tablet 10 mg 
and
, respectively.
8.1.1
Clinical Study Drug Labeling
Each carton of the study drugs must be labeled to indicate that the product is for clinical study, the 
study drug identification code, the amount, the Sponsor and its address, the manufacturing 
number, the method for storage, and the expiration date.
PPD
CCI
CCI

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8.1.2
Clinical Study Drug Inventory and Storage
All the study drugs are to be stored at room temperature (1°C to 30°C).
The study drugs must be kept in an appropriate, limited-access, secure place until it is used or 
returned to the Sponsor or designee for destruction. The study drugs must be stored under the 
conditions specified on the label until dispensing. A daily temperature log of the drug storage area 
must be maintained every working day.
8.1.3
Randomization Code Creation and Storage
The Sponsor-designated person responsible for randomization will prepare the randomization 
schedule and procedure prior to the start of the study. All randomization information will be stored 
in a secured area, accessible only by authorized personnel.
8.1.4
Accountability and Destruction of Sponsor-Supplied Drugs
The on-site pharmacist (the site designee) will receive a pharmacy manual created by the Sponsor, 
and follow the manual for storage and accountability of the Sponsor-supplied drug supplies. The
investigator will receive the manual from the Sponsor as well. The manual will provide 
instructions on ensuring appropriate receipt, handling, storage, accountability, and dispensation of 
the Sponsor-supplied drug. The manual will also describe procedures for the collection of unused 
medications from the subject and their return to the Sponsor, or the destruction of any unused 
supplies.
The on-site pharmacist (the site designee) will immediately return any unused study drugs in a 
sealed package to the Sponsor after the study is closed at the study site.

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9.0
STUDY PROCEDURES
The investigator or sub-investigator should collect data according to the procedures described in 
the following sections. For each procedure, subjects are to be assessed by the same investigator, 
sub-investigator or site designee whenever possible. The Schedule of Study Procedures is located 
in Section 3.0.
9.1
Administrative Procedures
9.1.1
Informed Consent Procedure
Informed consent must be obtained prior to the initiation of any study procedures. The 
requirements of informed consent are described in Section 13.2.
9.1.1.1
Assignment of Subject Identification Numbers
A unique subject identification number will be assigned to each subject at the time that informed 
consent is explained; this subject identification number will be used throughout the study.
9.1.1.2
Study Drug Assignment
The investigator or sub-investigator will assign the study drugs to subjects who are judged eligible 
based on the examinations prior to study drug administration (eg, screening and laboratory tests). 
For each study and sequence, the subjects will be assigned to the study drug in ascending order of 
their subject identification number according to the randomization schedule.
Subjects will be assigned to receive a 5-digit medication identification number in which 
ten-thousands digit represents the study type, thousands digit represents the sequence of the 
crossover study, and the remaining digits represents the sequential number within each sequence. 
The 5-digit number will be used by the study site to identify the PK samples, and will be the only 
subject identifier used on all PK sample collections. It should also be indicated on the PK sample
vials shipped to the bioanalytical laboratory, and will be used by the laboratory to report the 
subject data results instead of the subject identification number. It does not replace the last 3 digit 
numbers of the subject identification number. In case of subject replacement, the study drug with a 
medication identification number for the withdrawn subject will be used by the replacing subject.
The investigator or its designee will record the subject identification number in the eCRF.
9.1.2
Inclusion and Exclusion 
Each subject will be assessed according to the eligibility criteria provided in Section 7.0.
9.1.3
Medical History/Demography
Demographic information to be obtained will include date of birth, sex, race as described by the 
subject, height, weight, caffeine use, alcohol use, and smoking classification of the subject.
Medical history to be obtained will include determining whether the subject has any significant 
conditions or diseases that resolved within 1 year prior to the signing of informed consent. 

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Ongoing conditions will be considered concurrent medical conditions, which should include 
clinically significant laboratory, 12-lead ECG, or physical examination abnormalities noted at 
screening/baseline examination. Any concurrent medical conditions (ie, diagnoses) should be 
described. Medication history to be obtained will include any medication relevant to eligibility 
criteria and safety evaluations stopped at or within 4 weeks (28 days) prior to the signing of 
informed consent.
9.1.4
Concomitant Medications
Concomitant medication is any drug given in addition to the study drug. These may be prescribed 
by a physician or obtained by the subject over the counter. Concomitant medication is not provided 
by the Sponsor. Subjects will be asked whether they have taken any medication other than the 
study drug (used from the signing of informed consent through the end of the study), and all 
medication including vitamin supplements, OTC medications, and oral herbal preparations, must 
be recorded in the eCRF. Documentation will include generic medication names, route of 
administrations, start and end dates, and reasons for use.
9.2
Clinical Procedures and Assessments
9.2.1
Full Physical Exam
A physical examination will consist of the following body systems: (1) eyes; (2) ears, nose, throat; 
(3) cardiovascular system; (4) respiratory system; (5) gastrointestinal system; (6) dermatologic 
system; (7) extremities; (8) musculoskeletal system; (9) nervous system; (10) lymph nodes; and 
(11) other.
9.2.2
Height and Weight
Each subject should have his height and weight measured. Height will be recorded in centimeters 
without decimal places (rounding off the first decimal place). Weight will be collected in 
kilograms (kg) with the first decimal place (rounding off the second decimal place).
9.2.3
BMI
BMI should be derived as:
Metric: BMI=weight (kg)/height (m)2
The values should be calculated to the first decimal place (rounding off the second decimal place).
A subject's eligibility with respect to the BMI is determined based on the rounded off value. BMI 
will not be recorded in the eCRF.
9.2.4
Vital Signs
Vital signs will include body temperature (axilla measurement), respiratory rate, supine blood 
pressure (systolic and diastolic, after resting more than 5 minutes), and pulse (beats per minute).

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The same method (eg, the same and appropriately sized cuff, manual or automated) must be used 
for all measurements for each individual subject and should be the same for all subjects. All 
measurements will be recorded on the source documents and in the eCRF.
When vital signs are scheduled at the same time as blood draws, the blood draw will take priority 
and vital signs will be obtained within an acceptable time window (refer to Appendix B).
9.2.5
12-Lead ECG
A 12-lead ECG will be recorded. Subjects should be resting in a supine position for at least 
5 minutes before each ECG recording. The investigator or sub-investigator (or a qualified 
cardiologist at the study site) will interpret the ECG using one of the following categories: normal 
or abnormal. If an ECG is abnormal, the investigator or sub-investigator (or a qualified 
cardiologist at the study site) will judge clinical significance of the abnormality. The time that the 
ECG was performed will be recorded. The following parameters will be recorded on the eCRF 
from the subject’s ECG trace: heart rate, RR interval, PR interval, QT interval, QRS interval, and 
corrected QT interval using Fridericia’s formula (QTcF).
9.2.6
Study Drug Administration
Each subject will receive the study drug in Periods 1 and 2 as described below. The administration
conditions will be the same for the pilot and pivotal studies in Study 1.
Study 1: The subject will orally receive one TAK-438ASA tablet (a fixed dose combination of
TAK-438 10 mg and aspirin 100 mg) or one each of TAK-438 tablet 10 mg and aspirin 
enteric-coated tablet 100 mg with 150 mL of water in a fasted (without breakfast [after 
at least 10 hours of fasting]) condition.
Study 2: The subject will orally receive one TAK-438ASA tablet (a fixed dose combination of
TAK-438 10 mg and aspirin 100 mg) with 150 mL of water in a fasted (without 
breakfast) condition or fed (30 minutes after starting breakfast) condition.
9.2.7
AE Monitoring
AE monitoring will begin following the signing of informed consent. A complete description of 
AE procedures, including AE collection, is provided in Section 10.2.
9.2.8
Laboratory Procedures and Assessments
All samples will be collected in accordance with acceptable laboratory procedures. Laboratory 
samples will be taken following a minimum 10-hour fast on the days stipulated in the Schedule of 
Study Procedures (Section 3.0).

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9.2.8.1
Clinical Laboratory Tests
Hematology
Hematology will consist of the following tests:
RBC
WBC count with differential
(neutrophils, eosinophils, basophils, monocytes, lymphocytes)
Hemoglobin
Hematocrit
Platelets
Chemistry
Chemistry evaluations will consist of the following standard chemistry panel:
ALT
Albumin
ALP
AST
Total bilirubin
Total protein
Creatinine
BUN
Creatine kinase
GGT
Potassium
Sodium
Fasting glucose
Chloride
Urinalysis
Urinalysis will consist of the following tests:
pH
Specific gravity
Qualitative tests for protein
Qualitative tests for glucose

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Other
Tests performed at eligibility assessment:
Serum
Immunology tests:
HBsAg, HCV antibody, HIV antigen/antibody, serum test for 
syphilis
Urine
Urine drug tests:
phencyclidine, benzodiazepines, cocaine, antihypnotic agents, 
cannabinoids, opioids, barbiturates, and tricyclic antidepressants
HBsAg= hepatitis B virus surface antigen, HCV= hepatitis C virus, HIV= human immunodeficiency virus, RBC=red 
blood cells, WBC=white blood cells.
Note: The investigator or sub-investigator will report the results of immunology and urine drug screen directly to 
subjects. The Sponsor will confirm the overall test results (as “Positive” or “All negative”), rather than detailed results, 
for subjects (including reserve subjects) to be administered the study drug.
The local laboratory will perform laboratory tests for hematology, chemistry, and urinalysis. The 
results of laboratory tests will be returned to the investigator or sub-investigator, who is 
responsible for reviewing and filing these results.
If subjects experience an ALT or AST of >2 ×ULN, follow-up laboratory tests (at a minimum, 
serum alkaline phosphatase [ALP], ALT, AST, total bilirubin, gamma-glutamyl transferase 
[GGT], and INR) should be performed within a maximum of 7 days and preferably within 48 to 72 
hours after the abnormality was noted.
Refer to Sections 10.2.9.3 and 10.2.9.4 for the appropriate guidance on reporting abnormal LFTs
as SAEs or AESIs.
The investigator will maintain a copy of the reference ranges for the laboratory used.
9.3
PK Samples
Samples for PK analyses will be collected as specified in the Schedule of Study Procedures 
(Section 3.0). Please refer to the separately created procedure for information on the collection, 
processing, and shipment of samples to the central laboratory. The actual time of sample collection 
for PK analyses will be recorded on source documents and the eCRF.
Primary specimen collection parameters are provided in Table 9.a.

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Table 9.a
Primary Specimen Collections
Specimen Name
Primary 
Specimen
Description of Intended Use
Sample 
Collection
Plasma sample for TAK-438 PK
Plasma
PK analysis
Mandatory (a)
Urine sample for TAK-438 PK
Urine
PK analysis
Mandatory
(Study 2 only)
Plasma sample for aspirin PK
Plasma
PK analysis
Mandatory (b)
Urine sample for aspirin PK
Urine
PK analysis
Mandatory
(Study 2 only)
(a) If bioequivalence is verified only for TAK-438F in the pilot study of Study 1, the samples will not be collected in 
the pivotal study of Study 1.
(b) If bioequivalence is verified only for unchanged aspirin in the pilot study of Study 1, the samples will not be 
collected in the pivotal study of Study 1.
9.3.1
PK Measurements
The PK parameters of TAK-438F and its metabolites (M-I, M-II, M-III, and M-IV-Sul), 
unchanged aspirin and its metabolite (salicylic acid) will be determined from the 
concentration-time profiles for all evaluable subjects. Actual sampling times, rather than 
scheduled sampling times, will be used in all computations.
The following PK parameters will be calculated from plasma concentrations of TAK-438F and its
metabolites (M-I, M-II, M-III, and M-IV-Sul), unchanged aspirin and its metabolite (salicylic 
acid), unless otherwise specified:
Symbol/Term
Definition
Plasma
AUClast
Area under the concentration-time curve from time 0 to time of the last quantifiable concentration.
AUCt
Area under the concentration-time curve from time 0 to time t.
AUC∞
Area under the concentration-time curve from time 0 to infinity.
Cmax
Maximum observed concentration.
tmax
Time of first occurrence of Cmax.
t1/2z
Terminal disposition phase half-life.
λz
Terminal disposition phase rate constant.
MRT∞,ev
Mean residence time after extravascular administration from time 0 to infinity.
The following PK parameters will be calculated from urine concentrations of TAK-438F and its
metabolites (M-I, M-II, M-III, and M-IV-Sul), unchanged aspirin and its metabolites (salicylic 
acid and salicyluric acid), unless otherwise specified:

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Symbol/Term
Definition
Urine
Aet
Amount of drug excreted in urine from time 0 to time t.
fe,t
Fraction of administered dose of drug excreted in urine from time 0 to time t.
CLR
Renal clearance.
9.3.1.1
Plasma for PK Measurements
Blood samples for PK analyses of TAK-438 (one 4-mL sample per scheduled time) and those of 
aspirin (one 2-mL sample per scheduled time) will be collected in Vacutainers.
Blood samples for PK analyses of TAK-438 and aspirin will be collected according to the schedule 
described in Table 9.b.
Table 9.b
Collection of Blood Samples for PK Analysis
Study 1:
Analyte
Matrix
Study Day
Scheduled Time
TAK-438F (a)
Plasma
Days 1 to 3
Predose, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, 16, 24, 36, and 48 hours 
postdose
Unchanged aspirin (b)
Plasma
Day 1
Predose, 1, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 
10, 11, and 12 hours postdose
(a) If bioequivalence is verified only for TAK-438F in the pilot study, the samples will not be collected in the pivotal
study.
(b) If bioequivalence is verified only for unchanged aspirin in the pilot study, the samples will not be collected in the 
pivotal study.
Study 2:
Analyte
Matrix
Study Day
Scheduled Time
TAK-438F, M-I, M-II, 
M-III and M-IV-Sul
Plasma
Days 1 to 3
Predose, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, 16, 24, 36, and 48 hours 
postdose
Unchanged aspirin and 
salicylic acid
Plasma
Days 1 and 2 Predose, 1, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 
10, 11, 12, 16, and 24 hours postdose
If a subject is prematurely withdrawn from the study after the start of study drug administration, a 
blood sample at the time of early termination will be collected as follows.
In Study 1, blood sample for PK analysis of TAK-438 will be collected only if the subject is
withdrawn from the study within 48 hours after the start of study drug administration, while the 
blood sample for aspirin will be collected only if the subject is withdrawn from the study within 
12 hours after the start of study drug administration.
In Study 2, blood sample for PK analysis of TAK-438 will be collected only if the subject is 
withdrawn from the study within 48 hours after the start of study drug administration, while the 
blood sample for aspirin will be collected only if the subject is withdrawn from the study within 
24 hours after the start of study drug administration.

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9.3.1.2
Urine for PK Measurements (in Study 2 Only)
Urine samples for PK analysis of TAK-438 and aspirin will be collected and stored in 
polypropylene containers.
Urine samples for PK analyses of TAK-438 and aspirin will be collected according to the schedule 
described in Table 9.c.
Table 9.c
Collection of Urine Samples for PK Analysis
Analyte
Matrix
Study Day
Scheduled Time
TAK-438F, M-I, M-II, M-III 
and M-IV-Sul
Urine
Days 1 to 3
Predose (spot urine), 0-4, 4-8, 8-12, 12-24, 24-36, and 
36-48 hours postdose
Unchanged aspirin, salicylic 
acid, and salicyluric acid
Urine
Days 1 and 2
Predose (spot urine), 0-4, 4-8, 8-12, and 12-24 hours 
postdose
9.3.1.3
Analytical Methods Used for PK Samples
Plasma and urine concentrations of TAK-438F and its metabolites (M-I, M-II, M-III, and 
M-IV-Sul), and of unchanged aspirin and its metabolites (salicylic acid and salicyluric acid) will
be measured using liquid chromatography-tandem mass spectrometry (LC/MS/MS).
9.3.2
Confinement
In both Studies 1 and 2, each subject will be checked-in to the study site on Day -1 and hospitalized
until 48 hours postdose on Day 3. Subjects will undergo daily examinations, observations, and 
assessments as specified in the Schedule of Study Procedures in Section 3.0. Subjects will be 
discharged after being confirmed by physical examination and tests on Day 3 to have no 
significant abnormality in his health.

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10.0
ADVERSE EVENTS
10.1
Definitions and Elements of AEs
An AE is defined as any untoward medical occurrence in a clinical investigation subject who has 
signed informed consent to participate in a study; it does not necessarily have to have a causal 
relationship with the treatment or study participation.
An AE can therefore be any unfavorable and unintended sign (eg, a clinically significant abnormal 
laboratory finding), symptom, or disease temporally associated with the study participation, 
whether or not it is considered related to the drug or study procedure.
An untoward finding generally may:

Indicate a new diagnosis or unexpected worsening of a pre-existing condition. (Intermittent 
events for pre-existing conditions or underlying disease should not be considered AEs.)

Necessitate therapeutic intervention.

Require an invasive diagnostic procedure.

Require discontinuation or a change in dose of study drug or a concomitant medication.

Be considered unfavorable by the investigator or sub-investigator for any reason.
Diagnoses versus signs and symptoms:

Each event should be recorded to represent a single diagnosis. Accompanying signs (including 
abnormal laboratory values or ECG findings) or symptoms should NOT be recorded as 
additional AEs. If a diagnosis is unknown, sign(s) or symptom(s) should be recorded 
appropriately as an AE(s).
Laboratory values and ECG findings:

Changes in laboratory values or ECG parameters maybe considered AEs if they are judged to
be clinically significant by the investigator or sub-investigator (ie, if some action or 
intervention is required or if the investigator or sub-investigator judges the change to be 
beyond the range of normal physiologic fluctuation). A laboratory re-test and/or continued 
monitoring of an abnormal value are not considered an intervention. In addition, repeated or 
additional noninvasive testing for verification, evaluation or monitoring of an abnormality is 
not considered an intervention.

If abnormal laboratory values or ECG findings are the result of pathology for which there is an 
overall diagnosis (eg, increased creatinine in renal failure), the diagnosis only should be 
reported appropriately as an AE.
Pre-existing conditions:

A pre-existing condition (present at the time of signing of informed consent) is considered a 
concurrent medical condition and should NOT be recorded as an AE. A baseline evaluation 
(eg, laboratory test, ECG, X-ray, etc) should NOT be recorded as an AE unless related to a 

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study procedure. However, if the subject experiences a worsening or complication of such a 
concurrent medical condition, the worsening or complication should be recorded appropriately 
as an AE (worsening or complication occurs after informed consent is signed). Investigators or 
sub-investigators should ensure that the event term recorded captures the change in the 
condition (eg, “worsening of…”).

If a subject has a pre-existing episodic condition (eg, asthma, epilepsy), any occurrence of an 
episode should only be captured as an AE if the episodes become more frequent, serious, or 
severe in nature, that is, investigators or sub-investigators should ensure that the AE term 
recorded captures the change from baseline in the condition (eg, “worsening of…”).

If a subject has a degenerative concurrent condition (eg, cataracts, rheumatoid arthritis), 
worsening of the condition should only be captured as an AE if occurring to a greater extent to 
that which would be expected. Again, investigators or sub-investigators should ensure that the 
AE term recorded captures the change in the condition (eg, “worsening of…”).
Worsening of AEs:

If the subject experiences a worsening or complication of an AE after the first administration of 
study drug or after any change in study drug, the worsening or complication should be 
recorded as a new AE. Investigators or sub-investigators should ensure that the AE term 
recorded captures the change in the condition (eg, “worsening of…”).
Changes in severity of AEs:

If the subject experiences a change in the severity of an AE that is not associated with a change 
in study drug, the event should be captured once with the maximum severity recorded.
Preplanned surgeries or procedures:

Preplanned procedures (surgeries or therapies) that were scheduled prior to signing of 
informed consent are not considered AEs. However, if a preplanned procedure is performed 
early (eg, as an emergency) due to a worsening of the pre-existing condition, the worsening of 
the condition should be captured appropriately as an AE. Complications resulting from any 
planned surgery should be reported as AEs.
Elective surgeries or procedures:

Elective procedures performed where there is no change in the subject’s medical condition 
should not be recorded as AEs but should be documented in the subject’s source documents. 
Complications resulting from an elective surgery should be reported as AEs.
Overdose:

An overdose is defined as a known deliberate or accidental administration of investigational 
drug, to or by a study subject, at a dose above that which is assigned to that individual subject 
according to the study protocol. It is up to the investigator, sub-investigator, or the reporting 
physician to decide whether a dose is to be considered an overdose, in consultation with the 
Sponsor.

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
All cases of overdose (with or without associated AEs) will be documented on an Overdose 
page of the eCRF, in order to capture this important safety information consistently in the 
database. AEs associated with an overdose will be documented on AE page of the eCRF 
according to Section 10.0.

SAEs of overdose should be reported according to the procedure outlined in Section 10.2.9.

In the event of drug overdose, the subject should be treated symptomatically.
10.1.1 SAEs
An SAE is defined as any untoward medical occurrence that at any dose:
1. Results in DEATH.
2. Is LIFE THREATENING.

The term “life threatening” refers to an event in which the subject was at risk of death at the 
time of the event; it does not refer to an event that hypothetically might have caused death 
if it were more severe.
3. Requires inpatient HOSPITALIZATION or prolongation of existing hospitalization.
4. Results in persistent or significant DISABILITY/INCAPACITY.
5. Is a CONGENITAL ANOMALY/BIRTH DEFECT.
6. Is an IMPORTANT MEDICAL EVENT that satisfies any of the following:

May require intervention to prevent items 1 through 5 above.

May expose the subject to danger, even though the event is not immediately life 
threatening or fatal or does not result in hospitalization.

Includes any event or synonym described in the Takeda Medically Significant AE List 
(Table 10.a).

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Table 10.a
Takeda Medically Significant AE List 
Term
Acute respiratory failure/acute respiratory 
distress syndrome (ARDS)
Hepatic necrosis
Acute liver failure
Torsade de pointes/ventricular fibrillation/ 
ventricular tachycardia
Anaphylactic shock
Acute renal failure
Malignant hypertension
Pulmonary hypertension
Convulsive seizures (including convulsion and 
epilepsy)
Pulmonary fibrosis (including interstitial lung disease)
Agranulocytosis
Confirmed or suspected endotoxin shock
Aplastic anemia
Confirmed or suspected transmission of infectious agent by 
a medicinal product
Toxic epidermal necrolysis / oculomucocutaneous 
syndrome (Stevens-Johnson syndrome)
Neuroleptic malignant syndrome/malignant hyperthermia
Spontaneous abortion/stillbirth and fetal death
Note: Terms identified on the Medically Significant AE List represent the broad medical concepts to be considered as 
“Important Medical Events” satisfying SAE reporting requirements.
10.1.2 Special Interest AEs
A special interest AE (serious or non-serious) is an event of concern specific to the study drug. The 
special interest AEs in this study will be defined as liver dysfunction, gastrointestinal Clostridium 
difficile infection, and hypersensitivity.
The investigator and sub-investigator will monitor the subject for the occurrence of special interest 
AEs. An occurrence of any special interest AE should be reported according to the procedure 
described in Section 10.2.9.4. Such events may require further investigation to establish their
evaluation.
10.1.2.1 Liver Dysfunction
Liver dysfunction is defined as follows:

ALT or AST >2×ULN, or

Total bilirubin >2×ULN
A Liver Dysfunction Form must be completed with relevant detailed information on the subject, 
possible alternative etiologies (eg, acute viral hepatitis A or B or other acute liver disease or 
medical history/concurrent medical conditions), clinical course, and action taken for the event. 
Refer to Section 9.2.8.1 for the follow-up laboratory testing.
10.1.2.2 Gastrointestinal Clostridium difficile Infection
Gastrointestinal Clostridium difficile infection is defined as follows:

An AE with any of the following preferred terms (PT) of the Medical Dictionary for 
Regulatory Activities (MedDRA) Ver.20.1: Clostridial infection, Clostridium bacteraemia, 

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Clostridium colitis, Clostridium difficile colitis, Clostridium difficile infection, Clostridial 
sepsis, Clostridium test positive, Gastroenteritis clostridial, or pseudomembranous colitis.
A Gastrointestinal Clostridium difficile Infection Form must be completed with relevant detailed
information on the subject, possible alternative etiologies (eg, concomitant use of antibacterial 
agents or immunosuppressive agents, or medical history/concurrent medical conditions), the 
clinical course, and action taken for the event.
10.1.2.3 Hypersensitivity
A hypersensitivity-related AE is defined as follows.

An AE related to hypersensitivity (eg, anaphylactic reaction, angioedema, erythema 
multiforme, urticaria, or rash) that led to discontinuation of the study drug.
A Hypersensitivity Form must be completed with relevant detailed information on the subject, 
possible alternative etiologies, the clinical course, and action taken for the event.
The special interest AEs should be record as AEs in the eCRF. The completed eCRF along with all 
other required documentation should be submitted to the Sponsor.
10.2
AE Procedures
10.2.1 Assigning Severity/Intensity of AEs
The different categories of severity/intensity are:
Mild:
An AE that is usually transient and may require only minimal treatment or 
therapeutic intervention. The event does not generally interfere with usual 
activities of daily living.
Moderate:
An AE that is usually alleviated with additional specific therapeutic 
intervention. The event interferes with usual activities of daily living, causing 
discomfort but poses no significant or permanent risk of harm to the research 
participant.
Severe:
An AE that interrupts usual activities of daily living, or significantly affects 
clinical status, or may require intensive therapeutic intervention.
10.2.2 Assigning Causality of AEs
The causal relationship of each AE to study drug(s) will be assessed using the following 
categories:

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Related:
An AE that follows a reasonable temporal sequence from administration of a 
drug (including the course after withdrawal of the drug), or for which a causal 
relationship is at least a reasonable possibility, ie, the relationship cannot be 
ruled out, although factors other than the drug, such as underlying diseases, 
complications, concomitant drugs and concurrent treatments, may also be 
responsible.
Not Related:
An AE that does not follow a reasonable temporal sequence from administration 
of a drug and/or that can reasonably be explained by other factors, such as 
underlying diseases, complications, concomitant medications and concurrent 
treatments.
10.2.3 Assigning Causality of AEs to Study Procedures
The causal relationship of each AE to study procedures will be assessed.
The causality of an event should be assessed as Related if the investigator or sub-investigator 
considers that there is a reasonable possibility that the event is due to a study procedure. 
Otherwise, the causality should be assessed as Not Related.
10.2.4 Start Date
The start date of the AE is the date that the first signs/symptoms were noted by the subject,
investigator, or sub-investigator.
10.2.5 End Date
The end date of the AE is the date at which the subject recovered, the event resolved but with 
sequelae or the subject died.
10.2.6 Pattern of Adverse Event (Frequency)
Episodic AEs (eg, headache) or those which occur repeatedly over a period of consecutive days are 
“intermittent”. All other events are “continuous”.
10.2.7 Action Taken With Study Treatment

Drug withdrawn – a study drug is stopped due to the particular AE.

Dose not changed – the particular AE did not require changing the dose of study drug.

Unknown – only to be used if it has not been possible to determine what action has been taken.

Not applicable – a study drug was stopped for a reason other than the particular AE eg, the 
study has been terminated, the subject died, dosing with study drug had not yet started or 
dosing with study drug was already stopped before the onset of the AE.

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10.2.8 Outcome

Recovered/resolved – subject returned to first assessment status with respect to the AE.

Recovering/resolving – the intensity is lowered by one or more stages: the diagnosis has or 
signs/symptoms have almost disappeared; the abnormal laboratory value improved, but has 
not returned to the normal range or to the baseline value; the subject died from a cause other 
than the particular AE with the condition remaining “recovering/resolving.”

Not recovered/not resolved – there is no change in the diagnosis, signs or symptoms; the 
intensity of the diagnosis, signs/symptoms or laboratory value on the last day of the observed 
study period has become worse than when it started; is an irreversible congenital anomaly; the 
subject died from another cause with the particular AE state remaining “Not recovered/not 
resolved.”

Recovered/ Resolved with sequelae – the subject recovered from an acute AE but was left with 
permanent/significant impairment (eg, recovered from a cardiovascular accident but with 
some persisting paresis).

Fatal – an AE that is considered as the cause of death.

Unknown – the course of the AE cannot be followed up due to hospital change or residence 
change at the end of the subject’s participation in the study.
10.2.9 Collection and Reporting of AEs, SAEs, Special Interest AEs, and Abnormal LFTs
10.2.9.1 Collection Period
Collection of AEs (ie, AEs, SAEs, Special Interest AEs, and Abnormal LFTs) will commence at 
the time the subject signs the informed consent and continue until the end of examination at 
48 hours postdose in Period 2.
10.2.9.2 Reporting AEs
At each study visit, the investigator or sub-investigator will assess whether any subjective AEs 
have occurred. A neutral question, such as “How have you been feeling since your last visit?” may 
be asked. Subjects may report AEs occurring at any other time during the study.
Subjects experiencing an SAE prior to the first exposure to study drug must be monitored until the 
symptoms subside and any clinically relevant changes in laboratory values have returned to 
baseline or there is a satisfactory explanation for the change. Nonserious AEs that begin prior to 
the first exposure to study drug, related or unrelated to the study procedure, need not be 
followed-up for the purposes of the protocol.
All subjects experiencing AEs, whether considered associated with the use of the study drug or 
not, must be monitored until the symptoms subside and any clinically relevant changes in 
laboratory values have returned to baseline or until there is a satisfactory explanation for the 
changes observed. All AEs will be documented in the AE page of the eCRF, whether or not the 

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investigator concludes that the event is related to the drug treatment. The following information 
will be documented for each event:

Event term.

Start and end date and time.

Pattern of AE (frequency).

Severity/Intensity.

Investigator’s or sub-investigator’s opinion of the causal relationship between the event and 
administration of study drug(s).

Investigator’s or sub-investigator’s opinion of the causal relationship to study procedure(s), 
with a description of the suspected procedure.

Action taken with the study drug(s).

Outcome of event.

Seriousness.

Special Interest AEs.

Timing of occurrence (after administration of study drug[s]).
10.2.9.3 Reporting SAEs
When an SAE occurs through the AE collection period it should be reported according to the 
procedure outlined below:
An SAE should be reported by the investigator or sub-investigator to the Sponsor within 
1 business day of the first onset or notification of the SAE, along with any relevant information. 
The investigator should submit a detailed SAE Form to the Sponsor within 10 calendar days. The 
information should be completed as fully as possible but contain, at a minimum:

A short description of the event and the reason why the event is categorized as serious.

Subject identification number.

Investigator’s or sub-investigator’s name.

Name of the study drug(s).

Causality assessment.
Any SAE spontaneously reported to the investigator or sub-investigator following the AE 
collection period should be reported to the Sponsor if considered related to study participation.
SAE Follow-Up
If information is not available at the time of the first report becomes available at a later date, the 
investigator or sub-investigator should complete a follow-up SAE form copy or provide other 

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written documentation and promptly submit to the Sponsor. Copies of any relevant data from the 
hospital notes (eg, ECGs, laboratory tests, discharge summary, postmortem results) should be sent 
to the addressee, if requested.
All SAEs should be followed up until resolution or permanent outcome of the event.
10.2.9.4 Reporting Special Interest AEs
When a special interest AE (refer to Section 10.1.2) occurs through the AE collection period, it 
should be reported by the investigator or sub-investigator to the Sponsor within 1 business day of 
the first onset or notification of the event, along with any relevant information. The investigator 
should also submit a Special Interest AE Form to the Sponsor within 10 business days. 
Additionally, the investigator should submit the original copy of the Special Interest AE Form to 
the Sponsor.
The special interest AEs should be record as AEs in the eCRF.
10.2.9.5 Reporting of Abnormal LFTs
If a subject is noted to have ALT or AST >3 ×ULN and total bilirubin >2 ×ULN for which an 
alternative etiology has not been identified, the event should be recorded as an SAE and reported 
as per Section 10.2.9.3. The investigator or sub-investigator must report to the study monitor and 
evaluate relevant subject details and possible alternative etiologies, such as acute viral hepatitis A 
or B or other acute liver disease, or medical history/concurrent medical conditions. Follow-up 
laboratory tests as described in Section 9.2.8 must also be performed.
10.2.10Safety Reporting to Investigators, IRBs, and Regulatory Authorities
The Sponsor will be responsible for reporting all suspected unexpected serious adverse reactions 
(SUSARs) and any other applicable SAEs to regulatory authorities, investigators and IRBs, and 
the head of the study site. Relative to the first awareness of the event by/or further provision to the 
Sponsor or Sponsor’s designee, SUSARs will be submitted within 7 days for fatal and 
life-threatening events and 15 days for other serious events, unless otherwise required by national 
regulations. The Sponsor will also prepare an expedited report for other safety issues where these 
might materially alter the current benefit-risk assessment of an investigational medicinal product 
or that would be sufficient to consider changes in the investigational medicinal products 
administration or in the overall conduct of the trial. The study site also will forward a copy of all 
expedited reports to his or her IRB.

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11.0
STATISTICAL METHODS
11.1
Statistical and Analytical Plans
A statistical analysis plan (SAP) will be prepared and finalized prior to database lock. This 
document will provide further details regarding the definitions of analysis variables, and analysis 
methodologies to address all study objectives.
After the databases of the pilot study of Study 1 and Study 2 are locked for all the subjects’ data, 
statistical analysis will be performed on available data. In the case that the pivotal study is
implemented, statistical analysis will also be performed on data from the pivotal study after the
database of the pivotal study of Study 1 is locked for all of the subjects’ data.
11.1.1 Analysis Sets
In this study, two analysis sets are defined: the safety analysis set and PK analysis set. The 
definition of each analysis set will be described in the SAP.
The Sponsor will verify the validity of the definitions of the analysis sets and the rules for handling 
data in consultation with a medical expert, as needed. The Sponsor will address all remaining 
uncertainties not specified at planning, and will finalize the SAP prior to the database lock.
11.1.1.1 Safety Analysis Set
The safety analysis set will be defined as all subjects who received at least one dose of study drug.
11.1.1.2 PK Analysis Set
The PK analysis set will be defined as all subjects who received at least one dose of study drug, 
who had no major protocol deviation, and whose pharmacokinetic data are evaluable.
11.1.2 Analysis of Demography and Other Baseline Characteristics
Demographics and other baseline characteristics will be summarized using the safety analysis set 
and PK analysis set.
11.1.3 PK Analysis
11.1.3.1 PK Endpoints and Its Analytical Methods
The primary endpoint of the study is:
Study 1:
PK (plasma concentration)

AUClast and Cmax of TAK-438F.

AUClast and Cmax of unchanged aspirin.
The secondary endpoints of the study are:

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Study 1:
PK (plasma concentration)

AUC∞, tmax, MRT∞,ev, and λz of TAK-438F.

AUC∞, tmax, MRT∞,ev, and λz of unchanged aspirin.
Study 2:
PK (plasma concentration)

AUC∞, AUCt, AUClast, Cmax, tmax and t1/2z of TAK-438F and its metabolites (M-I, M-II, M-III, 
and M-IV-Sul).

AUC∞, AUCt, AUClast, Cmax, tmax and t1/2z of unchanged aspirin and its metabolite (salicylic 
acid).
PK (urine concentration)

Aet, fe,t and CLR of TAK-438F and its metabolites (M-I, M-II, M-III, and M-IV-Sul).

Aet, fe,t and CLR of unchanged aspirin and its metabolites (salicylic acid and salicyluric acid).
Analytical methods:
The following analyses will be performed using the PK analysis set.
1) Plasma concentrations
Study 1:
At each time point scheduled for blood sampling, descriptive statistics of plasma 
concentrations of TAK-438F and unchanged aspirin will be provided for each study 
medication (ie, TAK-438ASA tablet [as a fixed dose combination] or concomitant 
administration of TAK-438 tablet and aspirin enteric-coated tablet [as a free combination], the 
same hereinafter). Case plots and mean plots with standard deviations (SD) will be provided 
for each study medication. Descriptive statistics of PK parameters will be provided for each 
study medication. Additionally, descriptive statistics will be provided for AUClast and Cmax
ratios (TAK-438ASA tablet [as a fixed dose combination]/concomitant administration of 
TAK-438 tablet and aspirin enteric-coated tablet [as a free combination]).
Testing for bioequivalence:
For log-transformed (natural log) AUClast and Cmax of TAK-438F and unchanged aspirin (ie, 
the primary endpoint of the study), the two-sided 90% CI of the difference in the least square
means between the study medications (TAK-438ASA tablet [as a fixed dose combination] −
concomitant administration of TAK-438 tablet and aspirin enteric-coated tablet [as a free 
combination]) will be provided using the analysis of variance (ANOVA) model. The same 
analyses will be performed for untransformed AUClast and Cmax.
The same analyses will also be performed for AUC∞, tmax, MRT∞,ev, and λz (ie, the secondary 
endpoint of the study) to provide additional information.

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Study 2:
At each time point scheduled for blood sampling, descriptive statistics will be provided for the 
plasma concentrations of TAK-438F and its metabolites (M-I, M-II, M-III, and M-IV-Sul), and 
of unchanged aspirin and its metabolite (salicylic acid) for each dosing condition of 
TAK-438ASA tablet (fasted [without breakfast] condition or fed [30 minutes after starting
breakfast] condition, the same hereinafter). Case plots and mean plots with SD will be 
provided for each dosing condition. Descriptive statistics of PK parameters will be provided 
for each dosing condition.
Testing of food effect:
For log-transformed (natural log) AUC∞, AUCt, AUClast, and Cmax of TAK-438F and 
unchanged aspirin (ie, the secondary endpoint of the study), the two-sided 90% and 95% CI of 
the difference in the least square means between the dosing conditions of TAK-438ASA tablet 
(fed [30 minutes after starting breakfast] condition −fasted [without breakfast] condition) will 
be provided using the ANOVA model.
2) Urinary concentrations (Study 2 only)
For Aet, fe,t and CLR of TAK-438F and its metabolites (M-I, M-II, M-III, and M-IV-Sul), and 
of unchanged aspirin and its metabolites (salicylic acid and salicyluric acid) (ie, the secondary 
endpoint of the study), descriptive statistics will be provided for each dosing condition.
11.1.3.2 Methods of Data Conversion and Handling of Missing Data
For plasma concentrations and laboratory test results, values below the lower limit of 
quantification will be treated as zero. The details will be provided in the SAP.
11.1.4 Safety Analysis
11.1.4.1 Safety Endpoints and Analytical Methods
Safety endpoints will be the following: 
TEAEs, clinical laboratory tests, vital signs, weight, and 12-lead ECG.
Analytical methods:
The following analyses will be performed using the safety analysis set.
1) TEAEs
A TEAE is defined as an AE with a date of onset that occurs on or after the start of study drug
administration. The analyses of TEAEs will be conducted for the following. TEAEs will be 
coded using the MedDRA dictionary and tabulated by system organ class (SOC) and PT for 
each study medication (in Study 1) or for each dosing condition (in Study 2):

The frequency of all TEAEs

The frequency of drug-related TEAEs

The frequency of TEAEs by intensity

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
The frequency of drug-related TEAEs by intensity

The frequency of serious TEAEs
2) Clinical laboratory tests
For continuous variables, descriptive statistics of observed values and changes from baseline 
will be provided for each evaluation point for each study medication (in Study 1) or for each
dosing condition (in Study 2). Case plots of observed values will be provided for each study 
medication (in Study 1) or for each dosing condition (in Study 2).
For categorical variables, shift tables showing the number of subjects in each category at 
baseline and each post-baseline scheduled evaluation point will be provided for each study 
medication (in Study 1) or for each dosing condition (in Study 2).
3) Vital signs and weight
For continuous variables, descriptive statistics of observed values and changes from baseline 
will be provided for each evaluation point for each study medication (in Study 1) or for each 
dosing condition (in Study 2). Case plots of observed values will be provided for each study 
medication (in Study 1) or for each dosing condition (in Study 2).
4) Other safety parameters
12-lead ECG parameters will be summarized as follows:
For continuous variables, descriptive statistics of observed values and changes from baseline 
will be provided for each evaluation point for each study medication (in Study 1) or for each 
dosing condition (in Study 2). Case plots of observed values will be provided for each study 
medication (in Study 1) or for each dosing condition (in Study 2).
For categorical variables, shift tables showing the number of subjects in each category at 
baseline and each post-baseline scheduled evaluation point will be provided for each study 
medication (in Study 1) or for dosing condition (in Study 2).
11.2
Interim Analysis and Criteria for Early Termination
After the completion of the pilot study, an analysis will be performed on data obtained from the 
pilot study together with that from Study 2 to determine whether the results may warrant further 
analysis in the pivotal study. On the basis of bioequivalence evaluation in the pilot study, the 
Sponsor will determine entry into the pivotal study after discussion(s) with the medical experts, 
and will promptly notify the investigator. Refer to Section 6.2 for the procedures for proceeding to 
the pivotal study.
11.3
Determination of Sample Size
Study 1:
Planned number of subjects is 12 per sequence (total of 24 subjects) in the pilot study, and a 
maximum of 202 per sequence (total of 404 subjects) in the pivotal study. Statistical basis for the 
sample size is presented below.

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Assuming a root mean square error of 0.20 for PK parameters in the pilot study, the power of two 
one-sided t-tests to verify the bioequivalence [H0: ln(μ)≤ln(θ1), ln(μ)≥ln(θ2); H1: 
ln(θ1)<ln(μ)<ln(θ2); where μ=μt/μs, μt is the mean for TAK-438ASA tablet, μs is the mean for the 
concomitant administration of TAK-438 tablet and aspirin enteric-coated tablet, θ1=0.80, and 
θ2=1.25] at a one-sided significance level of 5% and μ=0.95 to 1.05 would be 89% to 96% with a 
sample size of 12 subjects per sequence (total of 24 subjects).
In the case that the pivotal study will be implemented, the number of subjects will be recalculated 
based on the results from the pilot study. Assuming a maximal root mean square error of 0.57 for 
PK parameters in the pivotal study, which is based on the results from preceding studies of 
TAK-438 and the bioequivalence study of another combination tablet using the same aspirin 
enteric-coated tablet (AG-1749ASA/CPH-001), two one-sided t-tests with a one-sided 
significance level of 5% and μ=0.90 to 1.10 would need a maximum of 202 subjects per sequence
(total of 404 subjects) to provide 90% power to verify the bioequivalence.
Study 2:
Planned number of subjects is 6 per sequence (total of 12 subjects) to evaluate the PK and safety of 
TAK-438ASA. This sample size has not been determined by statistical considerations.

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12.0
QUALITY CONTROL AND QUALITY ASSURANCE
12.1
Study-Site Monitoring Visits
Monitoring visits to the study site will be made periodically during the study to ensure that all 
aspects of the protocol are followed. Source documents will be reviewed for verification of data 
recorded on the eCRFs. Source documents are defined as original documents, data, and records. 
The investigator and study site guarantee access to source documents by the Sponsor or its 
designee (contract research organization [CRO]) and by the IRB.
All aspects of the study and its documentation will be subject to review by the Sponsor or the 
Sponsor’s designee, including but not limited to the Investigator’s Binder, trial drug, subject 
medical records, informed consent documentation, and review of eCRFs and associated source 
documents. It is important that the investigator and other study personnel are available during the 
monitoring visits and that sufficient time is devoted to the process.
12.2
Protocol Deviations
The investigator or sub-investigator can deviate and change from the protocol for any medically 
unavoidable reason, for example, to eliminate an immediate hazard to study subjects, without a 
prior written agreement with the Sponsor or a prior approval from IRB. In the event of a deviation 
or change, the investigator should notify the Sponsor and the head of the study site of the deviation 
or change as well as its reason in a written form, and then retain a copy of the written form. When 
necessary, the investigator may consult and agree with the Sponsor on a protocol amendment. If 
the protocol amendment is appropriate, the amendment proposal should be submitted to the head 
of the study site as soon as possible and an approval from IRB should be obtained.
The investigator or sub-investigator should document all protocol deviations.
12.3
Quality Assurance Audits and Regulatory Agency Inspections
The study site also may be subject to quality assurance audits by the Sponsor or designees. In this 
circumstance, the Sponsor-designated auditor will contact the site in advance to arrange an 
auditing visit. The auditor may ask to visit the facilities where laboratory samples are collected, 
where the medication is stored and prepared, and any other facility used during the study. In 
addition, there is the possibility that this study may be inspected by regulatory agencies, including 
those of foreign governments (eg, the Food and Drug Administration [FDA], the United Kingdom 
Medicines and Healthcare products Regulatory Agency [MHRA], the Pharmaceuticals and 
Medical Devices Agency of Japan [PMDA]). If the study site is contacted for an inspection by a 
regulatory body, the Sponsor should be notified immediately. The investigator and the head of the 
study site guarantees access for quality assurance auditors to all study documents as described in 
Section 12.1.

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13.0
ETHICAL ASPECTS OF THE STUDY
This study will be conducted with the highest respect for the individual participants (ie, subjects) 
according to the protocol, the ethical principles that have their origin in the Declaration of 
Helsinki, and the International Council for Harmonisation of Technical Requirements for 
Pharmaceuticals for Human Use (ICH) Harmonised Tripartite Guideline for GCP. Each 
investigator will conduct the study according to applicable local or regional regulatory 
requirements and align his or her conduct in accordance with the “Responsibilities of the 
Investigator” that are listed in Appendix A.
13.1
IRB Approval
IRBs must be constituted according to the applicable local requirements of each participating 
region. The Sponsor or designee will require documentation noting all names and titles of 
members who make up the respective IRB. If any member of the IRB has direct participation in 
this study, written notification regarding his or her abstinence from voting must also be obtained.
The Sponsor or designee will supply relevant documents for submission to the respective IRB for 
the protocol’s review and approval. This protocol, the Investigator’s Brochure, a copy of the 
informed consent form, and, if applicable, subject recruitment materials and/or advertisements and 
other documents required by all applicable laws and regulations, must be submitted to a central or 
local IRB for approval. The IRB’s written approval of the protocol and subject informed consent 
must be obtained and submitted to the Sponsor or designee before commencement of the study. 
The IRB approval must refer to the study by exact protocol title, number, and version date; identify 
versions of other documents (eg, informed consent form) reviewed; and state the approval date. 
The Sponsor will notify study site once the Sponsor has confirmed the adequacy of study site 
regulatory documentation. Until the site receives notification no protocol activities, including 
screening, may occur.
Study sites must adhere to all requirements stipulated by their respective IRB. This may include 
notification to the IRB regarding protocol amendments, updates to the informed consent form, 
recruitment materials intended for viewing by subjects, local safety reporting requirements, 
reports and updates regarding the ongoing review of the study at intervals specified by the 
respective IRB, and submission of the investigator’s final status report to IRB. All IRB approvals 
and relevant documentation for these items must be provided to the Sponsor or its designee.
Subject incentives should not exert undue influence for participation. Payments to subjects must 
be approved by the IRB and Sponsor.
13.2
Subject Information, Informed Consent, and Subject Authorization
Written consent documents will embody the elements of informed consent as described in the
Declaration of Helsinki and the ICH Guidelines for GCP and will be in accordance with all 
applicable laws and regulations. The informed consent form describes the planned and permitted 
uses, transfers, and disclosures of the subject’s personal and personal health information for 
purposes of conducting the study. The informed consent form further explains the nature of the 
study, its objectives, and potential risks and benefits, as well as the date informed consent is given. 

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The informed consent form will detail the requirements of the participant and the fact that he is 
free to withdraw at any time without giving a reason and without prejudice to his further medical 
care.
The investigator is responsible for the preparation, content, and IRB approval of the informed 
consent form. The informed consent form must be approved by both the IRB and the Sponsor prior 
to use.
The informed consent form must be written in a language fully comprehensible to the prospective 
subject. It is the responsibility of the investigator or sub-investigator to explain the detailed 
elements of the informed consent form to the subject. Information should be given in both oral and 
written form whenever possible and in the manner deemed appropriate by the IRB.
The subject must be given ample opportunity to: (1) inquire about details of the study, and (2) 
decide whether or not to participate in the study. If the subject determines he will participate in the 
study, then the informed consent form must be signed and dated by the subject at the time of 
consent and prior to the subject entering into the study. The subject should be instructed by the 
investigator or sub-investigator to sign using their legal names, not nicknames, using blue or black 
ballpoint ink. The investigator or sub-investigator must also sign and date the informed consent 
form prior to subject entering into the study.
Once signed, the original informed consent form will be stored in the investigator’s site file. The 
investigator or sub-investigator must document the date the subject signs the informed consent in 
the subject’s medical record. Copies of the signed informed consent form shall be given to the 
subject.
All revised informed consent forms must be reviewed and signed by relevant subjects in the same 
manner as the original informed consent. The date the revised consent was obtained should be 
recorded in the subject’s medical record, and the subject should receive a copy of the revised 
informed consent form.
13.3
Subject Confidentiality
The Sponsor and designees affirm and uphold the principle of the subject’s right to protection 
against invasion of privacy. Throughout this study, a subject’s source data will only be linked to 
the Sponsor’s clinical study database or documentation via a unique identification number. As 
permitted by all applicable laws and regulations, limited subject attributes, such as sex, age, or date 
of birth may be used to verify the subject and accuracy of the subject’s unique identification 
number.
To comply with ICH Guidelines for GCP and to verify compliance with this protocol, the Sponsor 
requires the investigator to permit its monitor or designee’s monitor, representatives from any 
regulatory authority (eg, FDA, MHRA, PMDA), the Sponsor’s designated auditors, and the 
appropriate IRBs to review the subject’s original medical records (source data or documents), 
including, but not limited to, laboratory test result reports, ECG reports, admission and discharge 
summaries for hospital admissions occurring during a subject’s study participation, and autopsy 

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reports. Access to a subject’s original medical records requires the specific authorization of the 
subject as part of the informed consent process (refer to Section 13.2).
Copies of any subject source documents that are provided to the Sponsor must have certain 
personally identifiable information removed (ie, subject name, address, and other identifier fields 
not collected on the subject’s eCRF).
13.4
Publication, Disclosure, and Clinical Trial Registration Policy
13.4.1 Publication and Disclosure
The investigator is obliged to provide the Sponsor with complete test results and all data derived 
by the investigator from the study. During and after the study, only the Sponsor may make study 
information available to other study investigators or to regulatory agencies, except as required by 
law or regulation. Except as otherwise allowable in the clinical study site agreement, any public 
disclosure (including publicly accessible websites) related to the protocol or study results is the 
sole responsibility of the Sponsor.
The Sponsor may publish any data and information from the study (including data and information 
generated by the investigator) without the consent of the investigator. The investigator or 
sub-investigator needs to obtain a prior written approval from the Sponsor to publish any 
information from the study externally, such as to a professional association.
13.4.2 Clinical Trial Registration
In order to ensure that information on clinical trials reaches the public in a timely manner and to 
comply with applicable laws, regulations and guidance, Takeda will, at a minimum, register all 
interventional clinical trials it sponsors anywhere in the world on ClinicalTrials.gov and/or other 
publicly accessible websites before start of study, as defined in Takeda Policy/Standard. Takeda 
contact information, along with facility name, investigator’s city, state (for Americas 
investigators), country, and recruiting status will be registered and available for public viewing.
13.4.3 Clinical Trial Results Disclosure
Takeda will post the results of clinical trials on ClinicalTrials.gov or other publicly accessible 
websites, as required by Takeda Policy/Standard, applicable laws and/or regulations.
13.5
Insurance and Compensation for Injury
Each subject in the study must be insured in accordance with the regulations applicable to the 
study site where the subject is participating. If a local underwriter is required, then the Sponsor or 
Sponsor’s designee will obtain clinical study insurance against the risk of injury to study subjects. 
Refer to the study site agreement regarding the Sponsor’s policy on subject compensation and 
treatment for injury. If the investigator or sub-investigator has questions regarding this policy, he 
or she should contact the Sponsor or Sponsor’s designee.

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14.0
ADMINISTRATIVE AND REFERENCE INFORMATION
14.1
Administrative Information
14.1.1 Study Contact Information
A separate contact information list (Protocol Annex 1) will be provided to the study site.
14.1.2 Investigator Agreement
A separate agreement will be provided to the study site.
14.1.3 Study-Related Responsibilities
A separate contact information list (Protocol Annex 1) will be provided to the study site.
14.1.4 List of Abbreviations
AE
adverse event
ALP
alkaline phosphatase
ALT
alanine aminotransferase
AST
aspartate aminotransferase
BMI
body mass index
BUN
blood urea nitrogen
CYP
cytochrome P450
eCRF
electronic case report form
FDA
Food and Drug Administration
GCP
Good Clinical Practice
GGT
gamma-glutamyl transferase
HBsAg
hepatitis B virus surface antigen
HCV
hepatitis C virus
HIV
human immunodeficiency virus
ICH
International Council for Harmonisation of Technical Requirements for Pharmaceuticals 
for Human Use
INR
international normalized ratio
MedDRA
Medical Dictionary for Regulatory Activities
MHRA
Medicines and Healthcare products Regulatory Agency
PMDA
Pharmaceuticals and Medical Devices Agency of Japan
PPI
proton pump inhibitor
SAE
serious adverse event
SUSAR
suspected unexpected serious adverse reaction
TAK-438F
TAK-438 free base

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15.0
DATA HANDLING AND RECORDKEEPING
The full details of procedures for data handling will be documented in the Data Management Plan. 
AEs, medical history, and concurrent conditions will be coded using the MedDRA. Drugs will be 
coded using the World Health Organization Drug Dictionary.
15.1
eCRFs
Completed eCRFs are required for each subject who signs an informed consent.
The Sponsor or its designee will supply study sites with access to eCRFs. The Sponsor will make 
arrangements to train appropriate site staff in the use of the eCRF. These forms are used to transmit 
the information collected in the performance of this study to the Sponsor and regulatory 
authorities. eCRFs must be completed in English. Data are transcribed directly onto eCRFs.
After completion of the entry process, computer logic checks will be run to identify items, such as 
inconsistent dates, missing data, and questionable values. Queries may be issued by Takeda 
personnel (or designees) and will be answered by the study site.
Corrections are recorded in an audit trail that captures the old information, the new information, 
identification of the person making the correction, the date the correction was made, and the reason 
for change.
The investigator must review the eCRFs for completeness and accuracy and must sign and date the 
appropriate eCRFs as indicated. Furthermore, the investigator must retain full responsibility for 
the accuracy and authenticity of all data entered on the eCRFs.
The following data will not be recorded in the eCRFs:

Laboratory results

Measurement results of drug concentrations
After the lock of the clinical study database, any change of, modification of, or addition to the data 
on the eCRFs should be made by the investigator or sub-investigator with use of change and 
modification records of the eCRFs. The investigator must review the data change for completeness 
and accuracy, and must e-sign.
eCRFs will be reviewed for completeness and acceptability at the study site during periodic visits 
by the Sponsor or its designee. The Sponsor or its designee will be permitted to review the 
subject’s medical and hospital records pertinent to the study to ensure accuracy of the eCRFs. The 
completed eCRFs are the sole property of the Sponsor and should not be made available in any 
form to third parties, except for authorized representatives of appropriate governmental health or 
regulatory authorities, without written permission of the Sponsor.
15.2
Record Retention
The investigator and the head of the study site agree to keep the records stipulated in Section 15.1
and those documents that include (but are not limited to) the study-specific documents, the 
identification log of all participating subjects, medical records, all original signed and dated 

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informed consent forms, electronic copy of eCRFs, including the audit trail, and detailed records 
of drug disposition to enable evaluations or audits from regulatory authorities, the Sponsor or its 
designees.
The investigator and the head of the study site are required to retain relevant essential documents 
until the day specified as 1 or 2 below, whichever comes later. However, if the Sponsor requests a 
longer time period for retention, the head of the study site should discuss how long and how to 
retain those documents with the Sponsor.
1. The day on which marketing approval for the study drug is obtained (or the day 3 years after 
the date of notification in the case that the investigation is discontinued.)
2. The day 3 years after the date of early termination or completion for the study.
In addition, the investigator and the head of the study site should retain the relevant essential 
documents until the receipt of a Sponsor-issued notification that states the retention is no longer 
required.

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16.0
REFERENCES
1. The Japanese Society of Gastroenterology. Evidence-based Clinical Practice Guidelines for 
Peptic Ulcer 2015 (2nd Edition). Nankodo; 2015.
2. Partial Revision of the Guideline for Bioequivalence Studies of Generic Products, PFSB
Notification No. 0229-10 (29 February 2012).
3. Enforcement Regulation on the Law for Securing a Stable Supply of Safe Blood Products, 
Ministry of Health and Welfare Ordinance No. 22 (25 June 1956).
4. Japan Society for the Study of Obesity. Diagnostic Criteria for Obesity 2011. Journal of Japan 
Society for the Study of Obesity 2011 (Extra Edition).
5. General Considerations for Clinical Trials, Pharmaceutical Safety Bureau Notification No. 380 
(21 April 1998).

CONFIDENTIAL
TAKEDA PHARMACEUTICALS
PROTOCOL
A Phase 1, Randomized, Open-Label, Crossover Study to Evaluate the Bioequivalence of 
Single Oral Dose of TAK-438ASA tablet and Single Oral Dose of TAK-438 tablet plus
Aspirin Enteric-Coated tablet (Study 1) and the Food Effect of Single Oral Dose of 
TAK-438ASA tablet (Study 2) in Healthy Adult Male Subjects
A Phase 1 Bioequivalence and Food Effect Study of TAK-438ASA tablet
Study Identifier:
TAK-438ASA-1001
Compound:
TAK-438ASA
Date:
9 January 2018
Version/Amendment 
Number:
Initial Version
CONFIDENTIAL PROPERTY OF TAKEDA
This document is a confidential communication of Takeda. Acceptance of this document constitutes the agreement by 
the recipient that no information contained herein will be published or disclosed without written authorization from 
Takeda except to the extent necessary to obtain informed consent from those persons to whom the drug may be 
administered. Furthermore, the information is only meant for review and compliance by the recipient, his or her staff, 
and applicable institutional review committee and regulatory agencies to enable conduct of the study.

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TABLE OF CONTENTS
1.0
STUDY SUMMARY ......................................................................................................6
2.0
STUDY SCHEMATIC..................................................................................................11
3.0
SCHEDULE OF STUDY PROCEDURES (STUDIES 1 AND 2)..................................12
4.0
INTRODUCTION.........................................................................................................14
4.1
Background .............................................................................................................14
4.2
Rationale for the Proposed Study.............................................................................15
4.3
Benefit/Risk Profile .................................................................................................15
5.0
TRIAL OBJECTIVES AND ENDPOINTS ...................................................................17
5.1
Hypothesis...............................................................................................................17
5.2
Trial Objectives .......................................................................................................17
5.2.1
Trial Primary Objective......................................................................................17
5.2.2
Trial Secondary Objective..................................................................................17
5.3
Endpoints.................................................................................................................17
5.3.1
Primary Endpoint...............................................................................................17
5.3.2
Secondary Endpoints..........................................................................................17
5.3.3
Safety Endpoints................................................................................................18
6.0
TRIAL DESIGN AND DESCRIPTION ........................................................................19
6.1
Trial Design.............................................................................................................19
6.2
Procedures for Proceeding to the Pivotal Study........................................................20
6.3
Rationale for Trial Design, Dose, and Endpoints......................................................21
6.3.1
Rationale of Trial Design ...................................................................................21
6.3.2
Rationale for Dose .............................................................................................22
6.3.3
Rationale for Washout Period.............................................................................22
6.3.4
Rationale for Endpoints......................................................................................22
6.3.5
Critical Procedures Based on Trial Objectives: Timing of Procedures ................22
6.4
Trial Beginning and End/Completion.......................................................................23
6.4.1
Definition of Beginning of the Trial ...................................................................23
6.4.2
Definition of End of the Trial.............................................................................23
6.4.3
Definition of Trial Discontinuation ....................................................................23
6.4.4
Criteria for Premature Termination or Suspension of the Trial............................23
6.4.5
Criteria for Premature Termination or Suspension of the Site.............................24
7.0
SELECTION AND DISCONTINUATION/WITHDRAWAL OF SUBJECTS..............25
7.1
Inclusion Criteria .....................................................................................................25
7.2
Exclusion Criteria ....................................................................................................25

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7.3
Excluded Medications, Supplements, Dietary Products............................................27
7.4
Diet, Fluid, Activity.................................................................................................28
7.4.1
Diet and Fluid ....................................................................................................28
7.4.2
Activity..............................................................................................................29
7.5
Documentation of Subjects Failure ..........................................................................29
7.6
Criteria for Discontinuation or Withdrawal of a Subject...........................................30
7.7
Procedures for Discontinuation or Withdrawal of a Subject......................................31
7.8
Subject Replacement................................................................................................31
8.0
CLINICAL STUDY MATERIAL MANAGEMENT.....................................................32
8.1
Clinical Study Drug .................................................................................................32
8.1.1
Clinical Study Drug Labeling.............................................................................32
8.1.2
Clinical Study Drug Inventory and Storage ........................................................33
8.1.3
Randomization Code Creation and Storage ........................................................33
8.1.4
Accountability and Destruction of Sponsor-Supplied Drugs...............................33
9.0
STUDY PROCEDURES...............................................................................................34
9.1
Administrative Procedures.......................................................................................34
9.1.1
Informed Consent Procedure..............................................................................34
9.1.2
Inclusion and Exclusion .....................................................................................34
9.1.3
Medical History/Demography ............................................................................34
9.1.4
Concomitant Medications...................................................................................35
9.2
Clinical Procedures and Assessments.......................................................................35
9.2.1
Full Physical Exam ............................................................................................35
9.2.2
Height and Weight .............................................................................................35
9.2.3
BMI ...................................................................................................................35
9.2.4
Vital Signs .........................................................................................................35
9.2.5
12-Lead ECG.....................................................................................................36
9.2.6
Study Drug Administration ................................................................................36
9.2.7
AE Monitoring...................................................................................................36
9.2.8
Laboratory Procedures and Assessments ............................................................36
9.3
PK Samples .............................................................................................................38
9.3.1
PK Measurements..............................................................................................39
9.3.2
Confinement ......................................................................................................41
10.0
ADVERSE EVENTS ....................................................................................................42
10.1
Definitions and Elements of AEs .............................................................................42
10.1.1 SAEs..................................................................................................................44

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10.1.2 Special Interest AEs...........................................................................................45
10.2
AE Procedures.........................................................................................................46
10.2.1 Assigning Severity/Intensity of AEs...................................................................46
10.2.2 Assigning Causality of AEs................................................................................46
10.2.3 Assigning Causality of AEs to Study Procedures................................................47
10.2.4 Start Date...........................................................................................................47
10.2.5 End Date............................................................................................................47
10.2.6 Pattern of Adverse Event (Frequency)................................................................47
10.2.7 Action Taken With Study Treatment..................................................................47
10.2.8 Outcome ............................................................................................................48
10.2.9 Collection and Reporting of AEs, SAEs, Special Interest AEs, and Abnormal 
LFTs ..................................................................................................................48
10.2.10
Safety Reporting to Investigators, IRBs, and Regulatory Authorities ............50
11.0
STATISTICAL METHODS..........................................................................................51
11.1
Statistical and Analytical Plans ................................................................................51
11.1.1 Analysis Sets......................................................................................................51
11.1.2 Analysis of Demography and Other Baseline Characteristics .............................51
11.1.3 PK Analysis .......................................................................................................51
11.1.4 Safety Analysis ..................................................................................................53
11.2
Interim Analysis and Criteria for Early Termination ................................................54
11.3
Determination of Sample Size..................................................................................54
12.0
QUALITY CONTROL AND QUALITY ASSURANCE...............................................56
12.1
Study-Site Monitoring Visits ...................................................................................56
12.2
Protocol Deviations..................................................................................................56
12.3
Quality Assurance Audits and Regulatory Agency Inspections ................................56
13.0
ETHICAL ASPECTS OF THE STUDY........................................................................57
13.1
IRB Approval ..........................................................................................................57
13.2
Subject Information, Informed Consent, and Subject Authorization .........................57
13.3
Subject Confidentiality ............................................................................................58
13.4
Publication, Disclosure, and Clinical Trial Registration Policy.................................59
13.4.1 Publication and Disclosure.................................................................................59
13.4.2 Clinical Trial Registration..................................................................................59
13.4.3 Clinical Trial Results Disclosure ........................................................................59
13.5
Insurance and Compensation for Injury....................................................................59
14.0
ADMINISTRATIVE AND REFERENCE INFORMATION.........................................60
14.1
Administrative Information......................................................................................60

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14.1.1 Study Contact Information .................................................................................60
14.1.2 Investigator Agreement......................................................................................60
14.1.3 Study-Related Responsibilities...........................................................................60
14.1.4 List of Abbreviations .........................................................................................60
15.0
DATA HANDLING AND RECORDKEEPING............................................................61
15.1
eCRFs......................................................................................................................61
15.2
Record Retention .....................................................................................................61
16.0
REFERENCES..............................................................................................................63
17.0
APPENDICES...............................................................................................................64
LIST OF IN-TEXT TABLES
Table 6.a
Dose Levels and Dosing Schedules ....................................................................20
Table 7.a
Excluded Medications, Supplements, and Dietary Products................................28
Table 9.a
Primary Specimen Collections ...........................................................................39
Table 9.b
Collection of Blood Samples for PK Analysis ....................................................40
Table 9.c
Collection of Urine Samples for PK Analysis.....................................................41
Table 10.a
Takeda Medically Significant AE List................................................................45
LIST OF IN-TEXT FIGURES
Figure 2.a
Schematic of the Study Design (Studies 1 and 2, with 14-day Washout Period)..11
CCI

TAK-438ASA
Study ID TAK-438ASA-1001
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1.0
STUDY SUMMARY
Name of Sponsor:
Takeda Pharmaceuticals Company Limited
Compound:
TAK-438ASA tablet
TAK-438 tablet
Aspirin enteric-coated tablet
Study Identifier: TAK-438ASA-1001
Phase: 1
Protocol Title: A Phase 1, Randomized, Open-Label, Crossover Study to Evaluate the Bioequivalence of Single Oral 
Dose of TAK-438ASA tablet and Single Oral Dose of TAK-438 tablet plus Aspirin Enteric-Coated tablet (Study 1) 
and the Food Effect of Single Oral Dose of TAK-438ASA tablet (Study 2) in Healthy Adult Male Subjects
Trial Design:
This study comprises a bioequivalence study (Study 1) and food effect study (Study 2).
Each of these studies includes Periods 1 and 2 in which subjects are scheduled for a confinement period of 4 days and 
3 nights, with a washout period of at least 14 days between the study drug administrations in Periods 1 and 2.
Study 1: Bioequivalence study
This study is an open-label 2×2 crossover study to investigate the bioequivalence of TAK-438ASA tablet with 
concomitant administration of TAK-438 tablet and aspirin enteric-coated tablet in a fasted (without breakfast) 
condition.
The study will consist of pilot and pivotal studies with the same design (inclusion/exclusion criteria, dose levels and
conditions, and schedules). The pilot study will be implemented in a total of 12 subjects per sequence to provide a 
basis for sample size calculation to verify the bioequivalence in the pivotal study. The pivotal study will be 
implemented in a maximum of 202 subjects per sequence. If bioequivalence is verified for TAK-438 free base 
(TAK-438F) and unchanged aspirin in the pilot study, the pivotal study will not be implemented. If bioequivalence is
verified only for TAK-438F or unchanged aspirin in the pilot study, the pivotal study will be implemented for testing 
the bioequivalence of only the compound for which bioequivalence has not been verified. If bioequivalence is not
verified in the pivotal study, implementation of an add-on subject study will be considered. Any evidence from the
pilot study suggesting difficulties in bioequivalence testing in the pivotal study may lead to the pivotal study not being 
implemented.
Study 2: Food effect study
This study will be an open-label 2×2 crossover food effect study for TAK-438ASA tablet.
Trial Primary Objective:
To evaluate the bioequivalence of a single-dose TAK-438ASA tablet to concomitant administration of a single-dose 
TAK-438 tablet 10 mg and aspirin enteric-coated tablet 100 mg in healthy Japanese adult male subjects (Study 1).
Secondary Objective:
To evaluate the food effect on pharmacokinetics (PK) following administration of TAK-438ASA tablet (Study 2).
Trial Subject Population: Healthy Japanese adult male subjects, aged 20 to 60 years, inclusive.
Planned Number of Subjects:
Study 1: Bioequivalence study
Pilot study: 12 per sequence, 24 in total
Pivotal study: Maximum of 202 per sequence, 404 in 
total
The number of subjects required for the pivotal study
will be calculated based on the results from the pilot
study.
Study 2: Food effect study
Planned Number of Sites:
1 site

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6 per sequence, 12 in total
Whole study (Study 1+ Study 2):
Maximum of 440 in total
Dose Levels:
Study 1: One TAK-438ASA tablet (a fixed dose 
combination of TAK-438 10 mg and aspirin 100 mg) 
or one each of TAK-438 tablet 10 mg and aspirin 
enteric-coated tablet 100 mg, taken orally with 
150 mL of water in a fasted (without breakfast [after 
at least 10 hours of fasting]) condition.
Study 2: One TAK-438ASA tablet (a fixed dose 
combination of TAK-438 10 mg and aspirin 100 mg) 
taken orally with 150 mL of water in a fasted (without 
breakfast) condition or fed (30 minutes after starting
breakfast) condition.
Route of Administration:
Oral
Duration of Treatment:
Study 1: Single-dose administration (a fixed dose 
combination [TAK-438ASA tablet] or a free 
combination of single-agent tablets [TAK-438 tablet 
and aspirin enteric-coated tablet]) in Periods 1 and 2
Study 2: Single-dose administration (a fixed dose 
combination [TAK-438ASA tablet] in a fasted 
[without breakfast] condition or fed [30 minutes after 
starting breakfast] condition) in Periods 1 and 2
Planned Trial Duration:
From the day prior to study drug administration through
48 hours after administration in Periods 1 and 2
Main Criteria for Inclusion:
1.
The subject is a healthy Japanese adult male, aged 20 to 60 years, inclusive, at the time of informed consent.
2.
The subject weighs at least 50 kg and has a body mass index (BMI) from 18.5 to 25.0 kg/m2, inclusive at 
Screening.
Main Criteria for Exclusion:
1.
The subject has received any investigational compound within 16 weeks (112 days) prior to the start of study 
drug administration in Period 1.
2.
The subject has participated in a clinical study of TAK-438 or aspirin and received the study drug.
3.
The subject is an immediate family member of or a study site employee, or is in a dependent relationship with a 
study site employee who is involved in the conduct of this study (eg, spouse, parent, child, sibling) or may 
consent under duress.
4.
The subject has uncontrolled, clinically significant neurologic, cardiovascular, pulmonary, hepatic, renal, 
metabolic, gastrointestinal, urologic, or endocrine disease or other abnormality (other than the disease being 
studied), which may impact the ability of the subject to participate in the study or potentially confound its results.
5.
The subject has aspirin asthma (non-steroidal anti-inflammatory drug-induced bouts of asthma) or a history of 
aspirin asthma.
6.
The subject has hypersensitivity to any component of TAK-438 tablet, aspirin enteric-coated tablet or salicylic 
acid-containing drugs.
7.
The subject has a positive urine drug result for drugs of abuse at Screening.
8.
The subject has a history of drug or alcohol abuse within 2 years prior to the Screening visit or is unwilling to 
agree to abstain from alcohol and drugs throughout the study.

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9.
The subject requires any excluded medication, supplements, or food products.
10.
The subject has current or recent (within 6 months) gastrointestinal disease that would be expected to influence 
the absorption of drugs (ie, a history of malabsorption, esophageal reflux, peptic ulcer disease, erosive 
esophagitis), frequent (more than once per week) occurrence of heartburn, or any surgical intervention.
11.
The subject has a history of cancer, except basal cell carcinoma which has been in remission for at least 5 years 
prior to Day 1.
12.
The subject has a positive test result for hepatitis B virus surface antigen (HBsAg), hepatitis C virus (HCV) 
antibody, human immunodeficiency virus (HIV) antibody/antigen, or serological reactions for syphilis at 
Screening.
13.
The subject has poor peripheral venous access.
14.
The subject has undergone whole blood collection of at least 200 mL within 4 weeks (28 days) or at least 400 mL 
within 12 weeks (84 days) prior to the start of study drug administration in Period 1.
15.
The subject has undergone whole blood collection of at least 800 mL in total within 52 weeks (364 days) prior to 
the start of study drug administration in Period 1.
16.
The subject has undergone blood component collection within 2 weeks (14 days) prior to the start of study drug 
administration in Period 1.
17.
The subject has a Screening or Check-in (Day -1) electrocardiogram (ECG) that was abnormal (clinically 
significant).
18.
The subject has abnormal Screening laboratory values that suggest a clinically significant underlying disease or 
subject with the following laboratory abnormalities: alanine aminotransferase (ALT) or aspartate 
aminotransferase (AST) above the upper limits of normal (ULN).
19.
The subject who, in the opinion of the investigator or sub-investigator, is unlikely to comply with the protocol or 
is unsuitable for any other reason.
Main Criteria for Evaluation and Analyses:
The primary endpoint of the study is:
Study 1:
PK (plasma concentration)

AUClast and Cmax of TAK-438F.

AUClast and Cmax of unchanged aspirin.
The secondary endpoints of the study are:
Study 1:
PK (plasma concentration)

AUC∞, tmax, MRT∞,ev, and λz of TAK-438F.

AUC∞, tmax, MRT∞,ev, and λz of unchanged aspirin.
Study 2:
PK (plasma concentration)

AUC∞, AUCt, AUClast, Cmax, tmax and t1/2z of TAK-438F and its metabolites (M-I, M-II, M-III, and M-IV-Sul).

AUC∞, AUCt, AUClast, Cmax, tmax and t1/2z of unchanged aspirin and its metabolite (salicylic acid).
PK (urine concentration)

Aet, fe,t, and CLR of TAK-438F and its metabolites (M-I, M-II, M-III, and M-IV-Sul).

Aet, fe,t, and CLR of unchanged aspirin and its metabolites (salicylic acid and salicyluric acid).
Safety:
Study 1:

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
Treatment-emergent adverse events (TEAEs), clinical laboratory tests, vital signs, weight, and 12-lead ECG.
Study 2:

TEAEs, clinical laboratory tests, vital signs, weight, and 12-lead ECG.
Statistical Considerations:
PK:
The following analyses will be performed using the PK analysis set.
Analytical methods:
1)
Plasma concentrations
Study 1:
At each time point scheduled for blood sampling, descriptive statistics of plasma concentrations of TAK-438F 
and unchanged aspirin will be provided for each study medication (ie, TAK-438ASA tablet [as a fixed dose 
combination] or concomitant administration of TAK-438 tablet and aspirin enteric-coated tablet [as a free 
combination], the same hereinafter). Case plots and mean plots with standard deviations (SD) will be provided
for each study medication. Descriptive statistics of PK parameters will be provided for each study medication.
Additionally, descriptive statistics will be provided for AUClast and Cmax ratios (TAK-438ASA tablet [as a fixed 
dose combination]/concomitant administration of TAK-438 tablet and aspirin enteric-coated tablet [as a free 
combination]).
Testing for bioequivalence:
For log-transformed (natural log) AUClast and Cmax of TAK-438F and unchanged aspirin (ie, the primary 
endpoint of the study), the two-sided 90% confidence interval (CI) of the difference in the least square means
between the study medications (TAK-438ASA tablet [as a fixed dose combination] −concomitant 
administration of TAK-438 tablet and aspirin enteric-coated tablet [as a free combination]) will be provided
using the analysis of variance (ANOVA) model. The same analyses will be performed for AUC∞, tmax, MRT∞,ev, 
and λz (ie, the secondary endpoint of the study) to provide additional information.
Study 2:
At each time point scheduled for blood sampling, descriptive statistics will be provided for the plasma
concentrations of TAK-438F and its metabolites (M-I, M-II, M-III, and M-IV-Sul), and of unchanged aspirin and
its metabolite (salicylic acid) for each dosing condition of TAK-438ASA tablet (fasted [without breakfast]
condition or fed [30 minutes after starting breakfast] condition, the same hereinafter). Case plots and mean plots 
with SD will be provided for each dosing condition. Descriptive statistics of PK parameters will be provided for 
each dosing condition.
Testing of food effect:
For log-transformed (natural log) AUC∞, AUCt, AUClast, and Cmax of TAK-438F and unchanged aspirin, the 
two-sided 90% and 95% CI of the difference in the least square means between the dosing conditions of 
TAK-438ASA tablet (fed [30 minutes after starting breakfast] condition – fasted [without breakfast] condition) 
will be provided using the ANOVA model.
2)
Urinary concentrations (Study 2 only)
For Aet, fe,t and CLR of TAK-438F and its metabolites (M-I, M-II, M-III, and M-IV-Sul), and of unchanged 
aspirin and its metabolites (salicylic acid and salicyluric acid), descriptive statistics will be provided for each 
dosing condition.
Safety:
The following analyses will be performed using the safety analysis set.
Analytical methods:
1)
TEAEs
A TEAE is defined as an AE with a date of onset that occurs on or after the start of study drug administration. 
Frequency distribution of TEAEs will be provided for all TEAEs, drug-related TEAEs, TEAEs by intensity, 
drug-related TEAEs by intensity, and serious TEAEs for each study medication (in Study 1) or for each dosing 

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CONFIDENTIAL
condition (in Study 2). TEAEs will be coded using the Medical Dictionary for Regulatory Activities (MedDRA) 
dictionary and tabulated by system organ class (SOC) and preferred term (PT).
2)
Clinical laboratory tests, vital signs, weight, and 12-lead ECG
For continuous variables, descriptive statistics of observed values and changes from baseline will be provided for 
each evaluation point for each study medication (in Study 1) or for each dosing condition (in Study 2).
For categorical variables, shift tables showing the number of subjects in each category at baseline and each 
post-baseline scheduled evaluation point will be provided for each study medication (in Study 1) or for each 
dosing condition (in Study 2).
Sample Size Justification:
Study 1:
Planned number of subjects is 12 per sequence (total of 24 subjects) in the pilot study, and a maximum of 202 per 
sequence (total of 404 subjects) in the pivotal study. Statistical basis for the sample size is presented below.
Assuming a root mean square error of 0.20 for PK parameters in the pilot study, the power of two one-sided t-tests to 
verify the bioequivalence [H0: ln(μ)≤ln(θ1), ln(μ)≥ln(θ2); H1: ln(θ1)<ln(μ)<ln(θ2); where μ=μt/μs, μt is the mean for
TAK-438ASA tablet, μs is the mean for the concomitant administration of TAK-438 tablet and aspirin enteric-coated 
tablet, θ1=0.80, and θ2=1.25] at a one-sided significance level of 5% and μ=0.95 to 1.05 would be 89% to 96% with a
sample size of 12 subjects per sequence (total of 24 subjects).
In the case that the pivotal study will be implemented, the number of subjects will be recalculated based on the results 
from the pilot study. Assuming a maximal root mean square error of 0.57 for PK parameters in the pivotal study, 
which is based on the results from preceding studies of TAK-438 and the bioequivalence study of another combination 
tablet using the same aspirin enteric-coated tablet (AG-1749ASA/CPH-001), two one-sided t-tests with a one-sided 
significance level of 5% and μ=0.90 to 1.10 would need a maximum of 202 subjects per sequence (total of 404 
subjects) to provide 90% power to verify the bioequivalence.
Study 2:
Planned number of subjects is 6 per sequence (total of 12 subjects) to evaluate the PK and safety of TAK-438ASA. 
This sample size has not been determined by statistical considerations.

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2.0
STUDY SCHEMATIC
Figure 2.a
Schematic of the Study Design (Studies 1 and 2, with 14-day Washout Period)
Element
Screening
Period 1
Period 2
Study Day
-28 to -2
-1
1
2
3
15
16
17
18
Visit/
Confinement
Visit
Confinement
Confinement
Procedure
Informed consent
Screening tests
Check-in/Examinations
Examinations/Randomization 
Administration of study drug
for Period 1
Examinations
Examinations/Discharge
Washout
Check-in/Examinations
Administration of study drug
for Period 2//Examinations
Examinations
Examinations/Discharge

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3.0
SCHEDULE OF STUDY PROCEDURES (STUDIES 1 AND 2)
Screening
Day -28 to -2
Periods 1 and 2*
Early Termination
Study Day:
Day -1
Day 1
Predose Day 1
Day 2
Day 3
Basic Procedures
Informed consent
X
Inclusion/exclusion criteria
X
X
X
Medical history/Demography
X
Medication history/Concomitant 
medications
Clinical Procedures/Assessments (a)
Physical examination (b)
X
X
X
X
X
X
X
Height, BMI
X
Weight
X
X
X
X
Vital signs (b)
X
X
X
X
X
X
X
12-lead ECG (c)
X
X
X
X
X
Study drug administration 
X
AE monitoring
Clinical laboratory tests (a)
Hematology (d)
X
X
X
X
Chemistry (d)
X
X
X
X
Urinalysis (d)
X
X
X
X
Urine drug screen
X
HBsAg, anti-HCV, HIV 
antibody/antigen, and syphilis screen
X
PK Evaluations
Plasma sample for TAK-438 PK (e)
X
X
X
X
X (i)
Plasma sample for aspirin PK (f)
X
X
X
X (j)
Urine sample for TAK-438 PK (g)
X
X
X
X
Urine sample for aspirin PK (h)
X
X
X
Other
Confinement/Discharge (Visit)
Visit
Confinement
Discharge Confinement/Visit
Footnotes are on the following page.

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AE=adverse event, BMI=body mass index, ECG=electrocardiogram, HBsAg=hepatitis B virus surface antigen, 
HCV=hepatitis C virus, HIV=human immunodeficiency virus, PK=pharmacokinetics.
*A washout period of at least 14 days will be placed between the study drug administrations in Periods 1 and 2.
Eligibility regarding the inclusion/exclusion criteria will not be confirmed in Period 2.
(a) Clinical procedures/assessments and clinical laboratory tests will be allowed at any time unless otherwise 
specified.
(b) Physical examination and vital sign measurements will be performed at:
Day -1: 18 hours predose.
Days 1 to 3: predose, 2, 24 and 48 hours postdose.
(c) 12-lead ECG will be recorded at:
Day -1: 18 hours predose.
Day 1: 2 hours postdose.
Day 3: 48 hours postdose.
(d) Samples for clinical laboratory tests will be collected at:
Days 1 to 3: predose and 48 hours postdose.
(e) Plasma samples for TAK-438 PK evaluations will be collected at:
Days 1 to 3: predose, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, 16, 24, 36, and 48 hours postdose in Studies 1 and 2.
If bioequivalence is verified only for TAK-438 free base (TAK-438F) in the pilot study of Study 1, the samples 
will not be collected in the pivotal study of Study 1.
(f) Plasma samples for aspirin PK evaluations will be collected at:
Day 1: predose, 1, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 10, 11, and 12 hours postdose in Studies 1 
and 2.
Day 2:16 and 24 hours postdose, only in Study 2.
If bioequivalence is verified only for unchanged aspirin in the pilot study of Study 1, the samples will not be 
collected in the pivotal study of Study 1.
(g) Urine samples for TAK-438 PK evaluations will be collected only in Study 2 at:
Days 1 to 3: predose (spot urine), 0-4, 4-8, 8-12, 12-24, 24-36, and 36-48 hours postdose.
(h) Urine samples for aspirin PK evaluations will be collected only in Study 2 at:
Days 1 and 2: predose (spot urine), 0-4, 4-8, 8-12, and 12-24 hours postdose.
(i)
Plasma samples for TAK-438 PK evaluations should be collected only in the case of early termination within 48 
hours after the study drug administration.
(j)
Plasma samples for aspirin PK evaluations should be collected only in the case of early termination within 12
hours after the study drug administration in Study 1, and within 24 hours after the study drug administration in 
Study 2.

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4.0
INTRODUCTION
4.1
Background
Antiplatelet therapy with low-dose aspirin is being widely used in patients with a history of 
ischemic heart disease, ischemic cerebrovascular disease, or other conditions. However, even 
when used at a low dose, aspirin is potent enough to inhibit endogenous prostaglandin synthesis in 
the gastric mucosa, thereby disabling acid-resistance of the gastric mucosa, and causing gastric or 
duodenal ulcers, or low-dose aspirin induced ulcers.
Evidence-based Clinical Practice Guidelines for Peptic Ulcer 2015 (2nd edition) edited by the 
Japanese Society of Gastroenterology [1] recommend the use of proton pump inhibitors (PPIs) to 
prevent the recurrence of low-dose-aspirin-induced upper gastrointestinal tract ulcer.
Conventional PPIs including lansoprazole, rabeprazole, and esomeprazole are indicated for 
prophylaxis of recurrent gastric or duodenal ulcers during low-dose aspirin therapy. As for 
lansoprazole, Takelda® Combination Tablet received marketing approval in March 2014, which is 
a fixed dose combination of lansoprazole and low-dose aspirin designed to more reliably prevent
the recurrence of gastric or duodenal low-dose-aspirin-induced ulcers through its improved 
convenience of use.
TAK-438 (vonoprazan) is a novel class of PPIs, collectively referred to as potassium-competitive 
acid blockers (P-CAB), which was developed by Takeda Pharmaceutical Company Limited. 
TAK-438 inhibits H+, K+-ATPase in the final step of acid secretion from stomach parietal cells. 
Unlike conventional PPIs, TAK-438 inhibits H+, K+-ATPase competitively with potassium ions 
without activation by acid. Acid-stability and water-solubility of TAK-438 enable a smaller 
variability in time-of-onset of action compared with conventional PPIs without requiring 
pharmaceutical dosage form such as enteric-coated formulations. TAK-438 is predominantly 
metabolized by cytochrome P450 (CYP) 3A4, and the contribution of polymorphic CYP2C19 is 
considered to be limited. Whereas conventional PPIs require 3 to 5 days to exert their maximum 
acid-inhibitory effects, TAK-438 is expected to exhibit its maximum acid-inhibitory effects in a 
much shorter time than conventional PPIs do, and to exert potent and sustained acid-inhibitory 
effects, which warrant better treatment outcomes. Prophylaxis of the recurrence of gastric or 
duodenal ulcers by lansoprazole remains incomplete as indicated by a significant proportion of 
subjects with the recurrence under treatment with lansoprazole. TAK-438 was developed as a new 
acid suppressant potentially more effective than conventional PPIs, and received Japanese 
marketing approval as Takecab® Tablet in December 2014 for the indication of prophylaxis of 
recurrent gastric or duodenal ulcers during low-dose aspirin therapy.
The marketing approval of TAK-438 for this indication was based on the results of a double-blind 
active-controlled study comparing TAK-438 10 mg or 20 mg once daily versus lansoprazole 
15 mg administered once daily for 24 weeks in the patients with a history of gastric or duodenal 
ulcers who require low-dose aspirin therapy for prophylaxis of thromboembolism after ischemic 
heart disease, ischemic cerebrovascular disease, or other conditions. The recurrence rate of gastric 
or duodenal ulcers at Week 24 (ie, the primary endpoint of the study) was 0.5% in the TAK-438 
10 mg group, 1.5% in the TAK-438 20 mg group, and 2.8% in the lansoprazole group. Both 10 mg 

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and 20 mg doses of TAK-438 were demonstrated to be non-inferior to lansoprazole at a
non-inferiority margin of 8.7%; the difference between the TAK-438 10 mg group and 
lansoprazole group was -2.3% (95% confidence interval [CI], -4.743% to 0.124%), and that 
between the TAK-438 20 mg group and lansoprazole group was -1.3% (95% CI, -4.095% to 
1.523%). An open-label extension study was conducted in the subjects who completed this study
to compare TAK-438 10 mg or 20 mg versus lansoprazole in a maintenance treatment (a minimum 
of 28 weeks and a maximum of 80 weeks). The recurrence rate of gastric or duodenal ulcers at 
Week 104 was 0.5% in the TAK-438 10 mg group, 1.5% in the TAK-438 20 mg group, and 3.3% 
in the lansoprazole group. The incidence of gastric or duodenal bleeding lesions at Week 24 was 
0.0% in the TAK-438 10 mg group, 0.0% in the TAK-438 20 mg group, and 2.9% in the 
lansoprazole group. The differences between the TAK-438 treatments and lansoprazole treatment 
were significant: -2.9% (95% CI, -5.135% to -0.607%) between the TAK-438 10 mg group and 
lansoprazole group, and a similar difference between the TAK-438 20 mg group and lansoprazole 
group. The incidence of gastric or duodenal bleeding lesions remained significantly lower in both
TAK-438 groups than in the lansoprazole group until the last evaluation time point (Week 104).
These results provided the rationale for a fixed dose combination containing TAK-438 and 
low-dose aspirin, which potentially help prevent the recurrence of gastric or duodenal ulcers 
associated with the use of aspirin. Indeed, the proposed fixed dose combination was thought to 
meet one of the medical needs (ie, alleviation of adverse effects) that warrant filing of combination
medicinal products as specified in Points to be Considered in Filing of New Drug Application of 
Pharmaceuticals, Pharmaceutical and Food Safety Bureau (PFSB) Notification No. 1121-12 
issued on 21 November 2014. Furthermore, when judged in light of Appendix “Others” Q7 in 
Points to be Considered in Filing of New Drug Application of Pharmaceuticals, Particularly on 
the Q&A for Handling of Oral Combination Medicinal Products, PFSB Notification issued on 15 
March 2011, the proposed fixed dose combination containing TAK-438 and aspirin appeared to be 
worth developing as further scientific rationale has been provided in a prospective clinical study 
for combining TAK-438 and aspirin without compromising each other’s efficacy, as confirmed by 
the preceding studies including a drug-drug interaction study.
4.2
Rationale for the Proposed Study
To develop a fixed dose combination of TAK-438 10 mg and aspirin 100 mg (TAK-438ASA), this
study was planned to verify the bioequivalence of a single-dose TAK-438ASA tablet 
toconcomitant administration of a single-dose TAK-438 tablet and aspirin enteric-coated tablet 
(Study 1) as well as to evaluate the food effect on pharmacokinetics (PK) of TAK-438ASA 
(Study 2).
4.3
Benefit/Risk Profile
There will be no benefit to subjects in this study other than receiving physical examinations and 
obtaining information about their general health. Instead, patients with conditions including 
ischemic heart disease and cerebrovascular disease may benefit in the future from what can be 
learned in this study.

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Because both of the compounds contained in this fixed dose combination (TAK-438 and aspirin) 
have been already approved for marketing and their safety is established, the risk to subject is 
considered not to exceed the risk of receiving either compound.
For further information on TAK-438ASA, please refer to the Investigator’s Brochure.

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5.0
TRIAL OBJECTIVES AND ENDPOINTS
5.1
Hypothesis
This study was designed based on the following hypothesis:
Bioequivalence of a single-dose TAK-438ASA tablet to concomitant administration of a 
single-dose TAK-438 tablet and aspirin enteric-coated tablet (with the same single-agent doses as 
contained in TAK-438ASA tablet) is confirmed.
5.2
Trial Objectives
5.2.1
Trial Primary Objective
The primary objective of the study is to evaluate the bioequivalence of a single-dose 
TAK-438ASA tablet to concomitant administration of a single-dose TAK-438 tablet 10 mg and
aspirin enteric-coated tablet 100 mg in healthy Japanese adult male subjects (Study 1).
5.2.2
Trial Secondary Objective
The secondary objective of the study is to evaluate the food effect on PK following administration 
of TAK-438ASA tablet (Study 2).
5.3
Endpoints
5.3.1
Primary Endpoint
The primary endpoint of the study is:
Study 1:
PK (plasma concentration)

AUClast and Cmax of TAK-438F.

AUClast and Cmax of unchanged aspirin.
5.3.2
Secondary Endpoints
Secondary endpoints include:
Study 1:
PK (plasma concentration)

AUC∞, tmax, MRT∞,ev, and λz of TAK-438F.

AUC∞, tmax, MRT∞,ev, and λz of unchanged aspirin.
Safety endpoints
Treatment-emergent adverse events (TEAEs), clinical laboratory tests, vital signs, weight, and 
resting 12-lead electrocardiogram (ECG) findings

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Study 2:
PK (plasma concentration)

AUC∞, AUCt, AUClast, Cmax, tmax and t1/2z of TAK-438F and its metabolites (M-I, M-II, M-III, 
and M-IV-Sul).

AUC∞, AUCt, AUClast, Cmax, tmax and t1/2z of unchanged aspirin and its metabolite (salicylic 
acid).
PK (urine concentration)

Aet, fe,t and CLR of TAK-438F and its metabolites (M-I, M-II, M-III, and M-IV-Sul).

Aet, fe,t and CLR of unchanged aspirin and its metabolites (salicylic acid and salicyluric acid).
5.3.3
Safety Endpoints
Safety endpoints will be assessed through the following parameters:
Treatment-emergent adverse events (TEAEs), clinical laboratory tests, vital signs, weight, and 
12-lead electrocardiogram (ECG).

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6.0
TRIAL DESIGN AND DESCRIPTION
6.1
Trial Design
This study comprises a bioequivalence study (Study 1) and food effect study (Study 2).
Each of these studies includes Periods 1 and 2 in which subjects are scheduled for a confinement 
period of 4 days and 3 nights, with a washout period of at least 14 days between the study drug 
administrations in Periods 1 and 2.
Study 1: Bioequivalence study
This study is an open-label 2×2 crossover study to investigate the bioequivalence of 
TAK-438ASA tablet with concomitant administration of TAK-438 tablet and aspirin 
enteric-coated tablet in a fasted (without breakfast) condition.
The study will consist of pilot and pivotal studies with the same design (inclusion/exclusion 
criteria, dose levels and conditions, and schedules). The pilot study will be implemented in a total 
of 12 subjects per sequence to provide a basis for sample size calculation to verify the 
bioequivalence in the pivotal study. The pivotal study will be implemented in a maximum of 
202 subjects per sequence. If bioequivalence is verified for TAK-438 free base (TAK-438F) and 
unchanged aspirin in the pilot study, the pivotal study will not be implemented. If bioequivalence
is verified only for TAK-438F or unchanged aspirin in the pilot study, the pivotal study will be 
implemented for testing the bioequivalence of only the compound for which bioequivalence has 
not been verified. If bioequivalence is not verified in the pivotal study, implementation of an 
add-on subject study will be considered. Any evidence from the pilot study suggesting difficulties 
in bioequivalence testing in the pivotal study may lead to the pivotal study not being implemented.
Study 2: Food effect study
This study will be an open-label 2×2 crossover food effect study for TAK-438ASA tablet.
The planned dose levels and dosing schedules of TAK-438ASA to be evaluated are outlined in 
Table 6.a.

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Table 6.a
Dose Levels and Dosing Schedules
Study 1: Bioequivalence study
Pilot study
Sequence
Number 
of
Subjects
Period 1
Period 2
a
12
One TAK-438ASA tablet 
(a fixed dose combination containing 
TAK-438 10 mg and aspirin 100 mg)
One TAK-438 tablet 10 mg +
One aspirin enteric-coated tablet 100 mg
b
12
One TAK-438 tablet 10 mg +
One aspirin enteric-coated tablet 100 mg
One TAK-438ASA tablet 
(a fixed dose combination containing 
TAK-438 10 mg and aspirin 100 mg)
Dosing Condition
Fasted (without breakfast) condition
Pivotal Study
Sequence
Number 
of
Subjects*
Period 1
Period 2
a
Maximum 
of 202
One TAK-438ASA tablet 
(a fixed dose combination containing 
TAK-438 10 mg and aspirin 100 mg)
One TAK-438 tablet 10 mg +
One aspirin enteric-coated tablet 100 mg
b
Maximum 
of 202
One TAK-438 tablet 10 mg +
One aspirin enteric-coated tablet 100 mg
One TAK-438ASA tablet 
(a fixed dose combination containing 
TAK-438 10 mg and aspirin 100 mg)
Dosing Condition
Fasted (without breakfast) condition
*Number of subjects required for the pivotal study is to be calculated based on the results from pilot study.
Study 2: Food effect study
Sequence
Number 
of
Subjects
Period 1
Period 2
c
6
One TAK-438ASA tablet 
(a fixed dose combination containing 
TAK-438 10 mg and aspirin 100 mg) taken in a 
fasted (without breakfast) condition
One TAK-438ASA tablet 
(a fixed dose combination containing 
TAK-438 10 mg and aspirin 100 mg) taken in a 
fed (30 minutes after starting breakfast) condition
d
6
One TAK-438ASA tablet 
(a fixed dose combination containing 
TAK-438 10 mg and aspirin 100 mg) taken in a 
fed (30 minutes after starting breakfast) condition
One TAK-438ASA tablet 
(a fixed dose combination containing 
TAK-438 10 mg and aspirin 100 mg) taken in a 
fasted (without breakfast) condition
6.2
Procedures for Proceeding to the Pivotal Study
In Study 1, an interim analysis will be performed after the completion of the pilot study to 
determine whether the results may warrant further analysis in the pivotal study. On the basis of 
bioequivalence assessment in the pilot study, the Sponsor will decide, after discussion(s) with the 
medical experts, on whether to proceed to the pivotal study and promptly notify the investigator of 
the decision.

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In the case that the results from interim analysis satisfy the criteria of bioequivalence:
Study 1 will be completed without implementing the pivotal study.
In the case that the results from interim analysis do not meet the criteria of bioequivalence:
The pivotal study will be implemented after the number of subjects required to conclude the 
bioequivalence is calculated based on the results from the pilot study. If bioequivalence is verified
only for TAK-438F or unchanged aspirin in the pilot study, the pivotal study will be implemented 
for testing the bioequivalence of only the compound for which bioequivalence has not been 
verified. Any evidence from the pilot study suggesting difficulties in bioequivalence testing in the 
pivotal study may lead to the pivotal study not being implemented.
Criteria of bioequivalence:
In Study 1, the study drugs will be assessed for bioequivalence according to Partial Revision of the 
Guideline for Bioequivalence Studies of Generic Products, PFSB Notification No. 0229-10 issued 
on 29 February 2012 [2]. If any of the following criteria is satisfied, TAK-438ASA tablet and the 
concomitant administration of TAK-438 tablet and aspirin enteric-coated tablet will be concluded 
to be bioequivalent.

For both AUClast and Cmax of TAK-438F and unchanged aspirin, the two-sided 90% CI of the 
difference in the means of log-transformed (natural log) parameter between the study 
medications is between 0.8 and 1.25, inclusive.

For both AUClast and Cmax of TAK-438F and unchanged aspirin, the difference in the means of 
log-transformed (natural log) parameter between the study medications is between 0.90 and 
1.11, inclusive. Furthermore, the results of the elution test satisfy the requirements specified in 
Partial Revision of the Guideline for Bioequivalence Studies of Generic Products [2].
6.3
Rationale for Trial Design, Dose, and Endpoints
6.3.1
Rationale of Trial Design
To appropriately evaluate the PK and safety profile of TAK-438ASA tablet, both Studies 1 and 2 
are planned to enroll only healthy adult males with no disease.
Essentially based on Partial Revision of the Guideline for Bioequivalence Studies of Generic 
Products [2], both Studies 1 and 2 are planned to involve a 2×2 crossover design in which the 
subjects serve as their own controls to allow comparisons with a minimized effect of inter-subject 
variability. In this scheme, the subjects will be randomized to either of the two sequences with 
different dosing schedules to avoid potential bias. A 14-day washout period has been incorporated 
between the study drug administration in Periods 1 and 2 to minimize the carry-over effect of the 
study drug. Furthermore, as the primary objective of this study is to evaluate the PK profile of the 
study drug, which is an objective measure, an open-label design is considered appropriate.

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6.3.2
Rationale for Dose
The dose of TAK-438 in this study will be 10 mg, which is the approved dose for prophylaxis of 
recurrent gastric or duodenal ulcers during low-dose aspirin therapy. Aspirin enteric-coated tablet 
100 mg, commonly used as a low-dose aspirin in clinical settings, will be used in this study.
6.3.3
Rationale for Washout Period
Given that aspirin is known to act irreversibly on platelets, the washout period was determined to 
be 14 days, longer than the sum of the washout period recommended in Partial Revision of the 
Guideline for Bioequivalence Studies of Generic Products [2] (ie, 5 times the elimination half-life 
of the study drug) and the average lifespan of platelets (ie, 10 days).
Note: The elimination half-life of TAK-438F, M-I, M-II, M-III, and M-IV-Sul is 7.7, 9.1, 9.7, 7.5, 
and 5.8 hours, respectively, after a single-dose administration of TAK-438 20 mg under fasted 
conditions.
The elimination half-life of unchanged aspirin and salicylic acid is 0.44 and 2.03 hours,
respectively, after a single-dose administration of 
under fasted conditions
(refer to package insert for 
).
6.3.4
Rationale for Endpoints
6.3.4.1
PK Endpoints
As Study 1 is intended to assess the bioequivalence in accordance with Partial Revision of the 
Guideline for Bioequivalence Studies of Generic Products [2], the endpoints are the PK
parameters of TAK-438F and unchanged aspirin.
As Study 2 is intended to evaluate the food effect on PK, the endpoints are the plasma 
concentrations of TAK-438F and its metabolites (M-I, M-II, M-III, and M-IV-Sul), unchanged 
aspirin and its metabolite (salicylic acid), as well as the urine concentrations of TAK-438F and its 
metabolites (M-I, M-II, M-III, and M-IV-Sul), unchanged aspirin and its metabolites (salicylic 
acid and salicyluric acid).
6.3.4.2
Safety Endpoints
Both Studies 1 and 2 will evaluate the safety of the study drugs based on the safety endpoints
conventionally used in clinical pharmacological studies, which include TEAEs, clinical laboratory 
tests, vital signs, weight, and 12-lead ECG.
6.3.5
Critical Procedures Based on Trial Objectives: Timing of Procedures
For this study, the collection of blood samples for PK evaluation is the critical procedure.
!
At any postdose time point, the blood samples for PK evaluation need to be collected as close 
to the exact nominal time point as possible.
CCI
CCI

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
All other procedures should be completed as close to the scheduled times as possible, either
before or after them.

When other procedures are scheduled at the same time as PK sampling, the blood draw will
take priority and other procedures will be performed within an acceptable time window (refer
to Appendix B).

The order of priority can be changed with joint agreement of the investigator and the Sponsor.

Any unscheduled procedures required for urgently addressing a safety concern will take
precedence over all routine scheduled procedures.
6.4
Trial Beginning and End/Completion
6.4.1
Definition of Beginning of the Trial
The entire study begins when the first subject signs the study’s informed consent form.
6.4.2
Definition of End of the Trial
The entire study ends when the last subject completes the last planned or follow-up visit (or the last
contact [eg, phone call] associated with a planned visit), discontinues the study, or becomes lost to 
follow-up (ie, the investigator is unable to contact the subject).
6.4.3
Definition of Trial Discontinuation
The study may be discontinued for any of the following nonsafety reasons:

Any finding (eg, PK, pharmacodynamics [PD], efficacy, biologic targets) from another
nonclinical or clinical study using the study drug(s) may lead to the study discontinuation for a
nonsafety reason.

Data from comparator(s), drug(s) of the same class, or methodology(ies) used in this study
become available, possibly leading to the study discontinuation for a nonsafety reason.

The study may be discontinued because of a nonscientific and nonsafety reason, such as slow
enrollment.
The study may be discontinued because of the following safety reasons:

The study may be terminated early when unanticipated safety concerns arise from clinical or
preclinical studies using the study drug(s), comparator(s), drug(s) of the same class, or
methodology(ies) used in this study.
6.4.4
Criteria for Premature Termination or Suspension of the Trial
6.4.4.1
Criteria for Premature Termination or Suspension of Trial
The study will be completed as planned unless 1 or more of the following criteria are met that 
require temporary suspension or early termination of the study.

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1. New information or other evaluation regarding the safety or efficacy of the study drug that 
indicates a change in the known risk/benefit profile for TAK-438ASA, such that the risk is no 
longer acceptable for subjects participating in the study.
2. Significant violation of Good Clinical Practice (GCP) that compromises the ability to achieve 
the primary study objectives or compromises subject safety.
3. Any subject experiences any of the Takeda Medically Significant List events (as outlined in 
Table 10.a).
4. Liver Function Test (LFT) abnormalities:
a. Any subject experiences alanine aminotransferase (ALT) and/or aspartate aminotransferase 
(AST) >5 × upper limit of normal (ULN) in the absence of a concomitant bilirubin increase.
b. Any subject experiences ALT and/or AST >3 ×ULN in the presence of a total bilirubin >2 
×ULN or an international normalized ratio (INR) >1.5 without findings of kanjyu (incorrect 
word, translation impossible) or any other alternative etiology to explain the elevations (ie, 
Hy’s Law cases).
c. Any subject experiences ALT and/or AST >3 ×ULN with appearance of fatigue, nausea, 
vomiting, right upper quadrant pain or tenderness, fever, rash and/or eosinophilia (>5%).
6.4.4.2
Procedures for Premature Termination or Suspension of the Trial
In the event that the Sponsor, the institutional review board (IRB), or the regulatory authority 
elects to terminate or suspend the study or the participation of a study site, a study-specific 
procedure for early termination or suspension will be provided by the Sponsor; the procedure will 
be followed by the study site during the course of termination or study suspension.
6.4.5
Criteria for Premature Termination or Suspension of the Site
6.4.5.1
Criteria for Premature Termination or Suspension of the Site
The study site may be terminated prematurely or suspended if the site (including the investigator) 
is found in significant violation of GCP, protocol, or contractual agreement, is unable to ensure 
adequate performance of the study, or as otherwise permitted by the contractual agreement.
6.4.5.2
Procedures for Premature Termination or Suspension of the Site
In the event that the Sponsor, the IRB, or the regulatory authority elects to terminate or suspend the 
study or the participation of a study site, a study-specific procedure for early termination or 
suspension will be provided by the Sponsor; the procedure will be followed by the study site
during the course of termination or study suspension.

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7.0
SELECTION AND DISCONTINUATION/WITHDRAWAL OF SUBJECTS
7.1
Inclusion Criteria
Subject eligibility is determined according to the following criteria:
1. In the opinion of the investigator or sub-investigator, the subject is capable of understanding 
and complying with protocol requirements.
2. The subject signs and dates a written, informed consent form prior to the initiation of any study 
procedures.
3. The subject is a healthy Japanese adult male, aged 20 to 60 years, inclusive, at the time of 
informed consent.
4. The subject weighs at least 50 kg and has a body mass index (BMI) from 18.5 to 25.0 kg/m2, 
inclusive at Screening.
Justifications of the inclusion criteria
Criteria 1, 2, and 3:
These are selected as the standard criteria for the conduct of clinical pharmacological studies in 
healthy adults.
Criterion 4:
Since whole blood collections of 400 mL from individuals weighing less than 50 kg is harmful to 
their health, according to Enforcement Regulation on the Law for Securing a Stable Supply of Safe 
Blood Products, Ministry of Health and Welfare Ordinance No. 22 issued in 1956 [3], the lower 
weight limit is set to 50 kg. BMI of the subjects are to be within the range of the standard weight 
according to the Diagnostic Criteria for Obesity proposed by the Japan Society for the Study of 
Obesity [4].
7.2
Exclusion Criteria
Any subject who meets any of the following criteria will not qualify for entry into the study:
1. The subject has received any investigational compound within 16 weeks (112 days) prior to the 
start of study drug administration in Period 1.
2. The subject has participated in a clinical study of TAK-438 or aspirin and received the study
drug.
3. The subject is an immediate family member of or a study site employee, or is in a dependent 
relationship with a study site employee who is involved in the conduct of this study (eg, 
spouse, parent, child, sibling) or may consent under duress.
4. The subject has uncontrolled, clinically significant neurologic, cardiovascular, pulmonary, 
hepatic, renal, metabolic, gastrointestinal, urologic, or endocrine disease or other abnormality 
(other than the disease being studied), which may impact the ability of the subject to participate 
in the study or potentially confound its results.

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5. The subject has aspirin asthma (non-steroidal anti-inflammatory drug-induced bouts of 
asthma) or a history of aspirin asthma.
6. The subject has hypersensitivity to any component of TAK-438 tablet, aspirin enteric-coated 
tablet or salicylic acid-containing drugs.
7. The subject has a positive urine drug result for drugs of abuse at Screening.
8. The subject has a history of drug or alcohol abuse within 2 years prior to the Screening visit or 
is unwilling to agree to abstain from alcohol and drugs throughout the study.
9. The subject has taken any excluded medication, supplements, or food products during the time 
periods listed in Section 7.3.
10. The subject has current or recent (within 6 months) gastrointestinal disease that would be 
expected to influence the absorption of drugs (ie, a history of malabsorption, esophageal 
reflux, peptic ulcer disease, erosive esophagitis), frequent (more than once per week)
occurrence of heartburn, or any surgical intervention.
11. The subject has a history of cancer, except basal cell carcinoma which has been in remission 
for at least 5 years prior to Day 1.
12. The subject has a positive test result for hepatitis B virus surface antigen (HBsAg), hepatitis C 
virus (HCV) antibody, human immunodeficiency virus (HIV) antibody/antigen, or serological 
reactions for syphilis at Screening.
13. The subject has poor peripheral venous access.
14. The subject has undergone whole blood collection of at least 200 mL within 4 weeks (28 days) 
or at least 400 mL within 12 weeks (84 days) prior to the start of study drug administration in 
Period 1.
15. The subject has undergone whole blood collection of at least 800 mL in total within 52 weeks 
(364 days) prior to the start of study drug administration in Period 1.
16. The subject has undergone blood component collection within 2 weeks (14 days) prior to the 
start of study drug administration in Period 1.
17. The subject has a Screening or Check-in (Day -1) electrocardiogram (ECG) that was abnormal 
(clinically significant).
18. The subject has abnormal Screening laboratory values that suggest a clinically significant 
underlying disease or subject with the following laboratory abnormalities: ALT or AST above 
the ULN.
19. The subject who, in the opinion of the investigator or sub-investigator, is unlikely to comply 
with the protocol or is unsuitable for any other reason.
Justifications of the exclusion criteria
Criterion 1:

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This criterion is meant to ensure the safety of subjects by specifying a minimum interval that they 
are not affected by any previous clinical study, which is based on the General Considerations for 
Clinical Trials, Pharmaceutical Safety Bureau Notification No. 380, issued on 21 April 1998 [5].
Criteria 2, 3, 4, 7, 8, 11, 12, 13, and 19:
These are the standard criteria for clinical pharmacological studies in healthy adults and included 
in consideration of subjects’ safety.
Criteria 5, 6, 17, and 18:
These criteria are selected in consideration of subjects’ safety.
Criterion 9:
This is a standard criterion for clinical pharmacological studies in healthy adults and included in 
considerations of subjects’ safety and possible effects on PK evaluations.
Criterion 10:
This criterion is selected in considerations of subjects’ safety and possible effects on PK 
evaluations.
Criteria 14 to 16:
These criteria are in accordance with Enforcement Regulation on the Law for Securing a Stable 
Supply of Safe Blood Products, Ministry of Health and Welfare Ordinance No. 22, issued in 1956
[3].
7.3
Excluded Medications, Supplements, Dietary Products
Use of excluded agents (prescription or nonprescription) or dietary products is outlined in Table 
7.a.
Use of prohibited concomitant drugs will be allowed when the investigator or sub-investigator 
deem it necessary to do so for reasons including treatment of an AE.

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Table 7.a
Excluded Medications, Supplements, and Dietary Products
Throughout the study period, 
beginning from 28 days prior to
study drug administration (Day 1)
in Period 1
From 7 days prior to study drug 
administration (Day 1) to discharge 
in Periods 1 and 2
From 24 hours prior to study drug 
administration (Day 1) to Discharge
in Periods 1 and 2

Prescription medications

OTC medications

Neutraceuticals 
(St. John’s wort, ginseng, kava 
kava, ginkgo biloba, and 
melatonin)

Chinese herbals

Immunization/Vaccines

Nicotine-containing products

Vitamin supplements

Alcohol-containing products

Grapefruit/grapefruit juice

Caffeine-containing products
OTC=over-the-counter.
Subjects must be instructed not to take any medications including over-the-counter (OTC) 
products, without consulting with the investigator or sub-investigator.
7.4
Diet, Fluid, Activity
7.4.1
Diet and Fluid

Diet
Studies 1 and 2:
On the day before the visit for blood collection of laboratory tests (Screening visit), the subject 
must finish the dinner by 21:00, and must fast until blood collection in the next morning. For 
laboratory tests scheduled in the afternoon on a study visit, blood samples should be collected 
at least 10 hours after the last meal.
During confinement, the subjects are to take only served meals and are not allowed to take any 
other food. Meal menus will be the same for Periods 1 and 2.
Excessive eating or drinking should be avoided during the study period.
Study 1:
Dinner will be at approximately 19:00 on the day before study drug administration. The 
subjects must fast for at least 10 hours prior to and for 4 hours after dosing.
On the day of the study drug administration, the subjects must not have breakfast. The 
approximate time is 13:00 for lunch and 19:00 for dinner. If the lunch or dinner time conflicts 
with the laboratory test schedule, the subject must have lunch or dinner promptly after 
completion of the laboratory tests. On the next day of study drug administration, the 
approximate time is 9:30 for breakfast, 13:00 for lunch, and 19:00 for dinner. If the breakfast 
time conflicts with the laboratory test schedule, the subject must take breakfast promptly after 
completion of the laboratory tests.
Taking breakfast on Day 3 (the day of discharge) is optional.

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Study 2:
On the day of the study drug administration in a fasted condition without breakfast, the subject 
must fast for at least 10 hours prior to dosing. On the day of the study drug administration after 
breakfast, the subject must take breakfast at approximately 8:30, and take the study drug 
30 minutes after start of the breakfast.
In either dosing condition, the subject will continue to fast for an additional 4 hours after
dosing. On the day of the study drug administration, the approximate time is 13:00 for lunch 
and 19:00 for dinner. If the lunch or dinner time conflicts with the laboratory test schedule, the 
subject must take lunch or dinner promptly after completion of the laboratory tests. On the next 
day of study drug administration, the approximate time is 9:30 for breakfast, 13:00 for lunch,
and 19:00 for dinner. If the breakfast time conflicts with the laboratory test schedule, the 
subject must take breakfast promptly after completion of the laboratory tests.
Taking breakfast on Day 3 (the day of discharge) is optional.

Beverages
On the day of study drug administration, subjects must not drink any liquid from 1 hour prior to 
and 4 hours after dosing, with the exception of breakfast drinks and the water (150 mL) to take
the study drug.

Smoking
Smoking is not allowed during the study period, beginning from 28 days prior to the start of 
study drug administration (Day 1).
7.4.2
Activity
Supine position is not allowed for 4 hours after dosing, unless required for examinations, or for 
other reasons.
Excessive exercise is not allowed during the study period. Subjects should do 15 minutes of light 
exercise a day during the confinement.
Blood donations are not allowed for at least 12 weeks (84 days) after the final examination in this 
study. The investigator or sub-investigator will instruct the subjects on the prohibition of blood 
donations.
If a subject visits another medical institution during the study period, the investigator or 
sub-investigator should be informed of the visit in advance whenever possible, and should be 
reported the circumstances and therapy after visit. The investigator or sub-investigator should 
communicate that medical institution about the subject’s participation in the study.
7.5
Documentation of Subjects Failure
The investigator or sub-investigator must account for all subjects who sign informed consent. If a 
subject is withdrawn from the study before the first study drug administration in Period 1, the 
investigator or sub-investigator should complete the electronic case report form (eCRF).
Primary reasons for subject failure are to be recorded in the eCRF using the following categories:

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
Death.

AE.

Screen failure (failed inclusion criteria or did meet exclusion criteria) <specify reason>.

Protocol deviation.

Lost to follow-up.

Withdrawal by subject <specify reason>.

Study terminated by Sponsor.

Sample size sufficient.

Other <specify reason>.
Any subject identification number, once assigned to a subject, should not be reused if the assigned 
subject discontinues the study prior to study drug administration in Period 1. Nevertheless, if a 
reserve subject is enrolled in the other sequence, the same subject identification number may be 
used.
7.6
Criteria for Discontinuation or Withdrawal of a Subject
Primary reasons for discontinuation or withdrawal of a subject from the study or study drug should 
be recorded in the eCRF using the following categories. For the subject who is withdrawn from the 
study before the first study drug administration in Period 1, refer to Section 7.5.
1. Death.
The subject died on study.
Note: If the subject dies on study, the event will be considered as serious adverse event (SAE). 
Refer to Section 10.2.9.3 for the reporting procedures.
2. AE.
The subject has experienced an AE that requires early termination because continued 
participation imposes an unacceptable risk to the subject’s health or the subject is unwilling to 
continue because of the AE.
In multidose studies, study drug should be discontinued immediately with appropriate clinical 
follow-up (including repeat laboratory tests, until the subject’s laboratory profile has returned 
to normal/baseline status, refer to Section 9.2.8), if the following circumstances occur at any 
time during study drug treatment:

LFT abnormalities.
-
ALT or AST >8×ULN, or
-
ALT or AST >5×ULN and persists for more than 2 weeks, or
-
ALT or AST >3×ULN in conjunction with elevated total bilirubin >2×ULN or INR 
>1.5, or

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-
ALT or AST >3×ULN with appearance of fatigue, nausea, vomiting, right upper 
quadrant pain or tenderness, fever, rash and/or eosinophilia (>5%).
3. Protocol deviation.
The discovery after the start of study drug administration in Period 1 that the subject failed to 
meet protocol entry criteria or did not adhere to protocol requirements, and continued 
participation poses an unacceptable risk to the subject’s health.
4. Lost to follow-up.
The subject did not return to the clinic and attempts to contact the subject were unsuccessful. 
Attempts to contact the subject must be documented in the subject’s source documentation.
5. Withdrawal by subject.
The subject wishes to withdraw from the study. The reason for withdrawal, if provided, should 
be recorded in the eCRF.
Note: All attempts should be made to determine the underlying reason for the withdrawal and, 
where possible, the primary underlying reason should be recorded (ie, withdrawal due to an 
AE should not be recorded in the “voluntary withdrawal” category).
6. Study terminated by the Sponsor.
The Sponsor terminates the study.
7. Other
Note: The specific reasons should be recorded in the “specify” field of the eCRF.
7.7
Procedures for Discontinuation or Withdrawal of a Subject
The investigator or sub-investigator may discontinue a subject’s study participation at any time 
during the study if the subject meets the study termination criteria described in Section 7.6. In 
addition, a subject may discontinue his participation without giving a reason at any time during the 
study. Should a subject’s participation be discontinued, the primary criterion for termination must 
be recorded by the investigator or sub-investigator. In addition, efforts should be made to perform 
all procedures scheduled for the Early Termination Visit.
7.8
Subject Replacement
In consideration of possible subject withdrawals for some reasons prior to the study drug 
administration in Period 1 after Screening, a certain number of individuals judged eligible at 
Screening are to be retained as standbys only for Period 1. Subject replacement is not allowed for 
dropouts after the start of study drug administration.

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8.0
CLINICAL STUDY MATERIAL MANAGEMENT
8.1
Clinical Study Drug
Dosage form:
Studies 1 and 2
1. TAK-438ASA tablet
Appearance: a white film-coated tablet
Content: vonoprazan 10 mg (13.36 mg as vonoprazan fumarate) and aspirin 100 mg per tablet
Generic name: To be determined
2. TAK-438 10 mg tablet (Takecab® Tablet 10 mg)
Appearance: a pale yellowish film-coated tablet
Content: vonoprazan 10 mg (13.36 mg as vonoprazan fumarate) per tablet
Chemical name:
1-[5-(2-Fluorophenyl)-1-(pyridine-3-ylsulfonyl)-1H-pyrrol-3-yl]-N-methylmethanamine 
monofumarate
Generic name: vonoprazan fumarate (JAN)
3. Aspirin 100 mg enteric-coated tablet (
)
Appearance: a white enteric-coated tablet (film-coated tablet)
Content: aspirin 100 mg per tablet
Chemical name: 2-Acetoxybenzoic acid
Generic name: aspirin (JAN)
Packaging:
TAK-438ASA tablets are to be supplied in amber glass bottles with desiccants which contains 
6 tablets of the study drug per bottle. TAK-438 10 mg tablets are to be supplied in commercially
available cartons, each of which contains 10 sheets of press through package (PTP), each sheet 
containing 10 tablets. Aspirin 100 mg enteric-coated tablets are also to be supplied in 
commercially available cartons, each of which contains 50 sheets of PTP, each sheet containing
10 tablets. Each carton containing either of the study drugs is to be labeled “study drug”.
Manufacturing:
TAK-438ASA tablet are manufactured by
TAK-438 10 mg tablets and aspirin 
100 mg enteric-coated tablets are to be supplied as commercially available Takecab® Tablet 10 mg 
and
, respectively.
8.1.1
Clinical Study Drug Labeling
Each carton of the study drugs must be labeled to indicate that the product is for clinical study, the 
study drug identification code, the amount, the Sponsor and its address, the manufacturing 
number, the method for storage, and the expiration date.
PPD
CCI
CCI

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8.1.2
Clinical Study Drug Inventory and Storage
All the study drugs are to be stored at room temperature (1°C to 30°C).
The study drugs must be kept in an appropriate, limited-access, secure place until it is used or 
returned to the Sponsor or designee for destruction. The study drugs must be stored under the 
conditions specified on the label until dispensing. A daily temperature log of the drug storage area 
must be maintained every working day.
8.1.3
Randomization Code Creation and Storage
The Sponsor-designated person responsible for randomization will prepare the randomization 
schedule and procedure prior to the start of the study. All randomization information will be stored 
in a secured area, accessible only by authorized personnel.
8.1.4
Accountability and Destruction of Sponsor-Supplied Drugs
The on-site pharmacist (the site designee) will receive a pharmacy manual created by the Sponsor, 
and follow the manual for storage and accountability of the Sponsor-supplied drug supplies. The
investigator will receive the manual from the Sponsor as well. The manual will provide 
instructions on ensuring appropriate receipt, handling, storage, accountability, and dispensation of 
the Sponsor-supplied drug. The manual will also describe procedures for the collection of unused 
medications from the subject and their return to the Sponsor, or the destruction of any unused 
supplies.
The on-site pharmacist (the site designee) will immediately return any unused study drugs in a 
sealed package to the Sponsor after the study is closed at the study site.

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9.0
STUDY PROCEDURES
The investigator or sub-investigator should collect data according to the procedures described in 
the following sections. For each procedure, subjects are to be assessed by the same investigator, 
sub-investigator or site designee whenever possible. The Schedule of Study Procedures is located 
in Section 3.0.
9.1
Administrative Procedures
9.1.1
Informed Consent Procedure
Informed consent must be obtained prior to the initiation of any study procedures. The 
requirements of informed consent are described in Section 13.2.
9.1.1.1
Assignment of Subject Identification Numbers
A unique subject identification number will be assigned to each subject at the time that informed 
consent is explained; this subject identification number will be used throughout the study.
9.1.1.2
Study Drug Assignment
The investigator or sub-investigator will assign the study drugs to subjects who are judged eligible 
based on the examinations prior to study drug administration (eg, screening and laboratory tests). 
For each study and sequence, the subjects will be assigned to the study drug in ascending order of 
their subject identification number according to the randomization schedule.
Subjects will be assigned to receive a 5-digit medication identification number in which 
ten-thousands digit represents the study type, thousands digit represents the sequence of the 
crossover study, and the remaining digits represents the sequential number within each sequence. 
The 5-digit number will be used by the study site to identify the PK samples, and will be the only 
subject identifier used on all PK sample collections. It should also be indicated on the PK sample
vials shipped to the bioanalytical laboratory, and will be used by the laboratory to report the 
subject data results instead of the subject identification number. It does not replace the last 3 digit 
numbers of the subject identification number. In case of subject replacement, the study drug with a 
medication identification number for the withdrawn subject will be used by the replacing subject.
The investigator or its designee will record the subject identification number in the eCRF.
9.1.2
Inclusion and Exclusion 
Each subject will be assessed according to the eligibility criteria provided in Section 7.0.
9.1.3
Medical History/Demography
Demographic information to be obtained will include date of birth, sex, race as described by the 
subject, height, weight, caffeine use, alcohol use, and smoking classification of the subject.
Medical history to be obtained will include determining whether the subject has any significant 
conditions or diseases that resolved within 1 year prior to the signing of informed consent. 

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Ongoing conditions will be considered concurrent medical conditions, which should include 
clinically significant laboratory, 12-lead ECG, or physical examination abnormalities noted at 
screening/baseline examination. Any concurrent medical conditions (ie, diagnoses) should be 
described. Medication history to be obtained will include any medication relevant to eligibility 
criteria and safety evaluations stopped at or within 4 weeks (28 days) prior to the signing of 
informed consent.
9.1.4
Concomitant Medications
Concomitant medication is any drug given in addition to the study drug. These may be prescribed 
by a physician or obtained by the subject over the counter. Concomitant medication is not provided 
by the Sponsor. Subjects will be asked whether they have taken any medication other than the 
study drug (used from the signing of informed consent through the end of the study), and all 
medication including vitamin supplements, OTC medications, and oral herbal preparations, must 
be recorded in the eCRF. Documentation will include generic medication names, route of 
administrations, start and end dates, and reasons for use.
9.2
Clinical Procedures and Assessments
9.2.1
Full Physical Exam
A physical examination will consist of the following body systems: (1) eyes; (2) ears, nose, throat; 
(3) cardiovascular system; (4) respiratory system; (5) gastrointestinal system; (6) dermatologic 
system; (7) extremities; (8) musculoskeletal system; (9) nervous system; (10) lymph nodes; and 
(11) other.
9.2.2
Height and Weight
Each subject should have his height and weight measured. Height will be recorded in centimeters 
without decimal places (rounding off the first decimal place). Weight will be collected in 
kilograms (kg) with the first decimal place (rounding off the second decimal place).
9.2.3
BMI
BMI should be derived as:
Metric: BMI=weight (kg)/height (m)2
The values should be calculated to the first decimal place (rounding off the second decimal place).
A subject's eligibility with respect to the BMI is determined based on the rounded off value. BMI 
will not be recorded in the eCRF.
9.2.4
Vital Signs
Vital signs will include body temperature (axilla measurement), respiratory rate, supine blood 
pressure (systolic and diastolic, after resting more than 5 minutes), and pulse (beats per minute).

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The same method (eg, the same and appropriately sized cuff, manual or automated) must be used 
for all measurements for each individual subject and should be the same for all subjects. All 
measurements will be recorded on the source documents and in the eCRF.
When vital signs are scheduled at the same time as blood draws, the blood draw will take priority 
and vital signs will be obtained within an acceptable time window (refer to Appendix B).
9.2.5
12-Lead ECG
A 12-lead ECG will be recorded. Subjects should be resting in a supine position for at least 
5 minutes before each ECG recording. The investigator or sub-investigator (or a qualified 
cardiologist at the study site) will interpret the ECG using one of the following categories: normal 
or abnormal. If an ECG is abnormal, the investigator or sub-investigator (or a qualified 
cardiologist at the study site) will judge clinical significance of the abnormality. The time that the 
ECG was performed will be recorded. The following parameters will be recorded on the eCRF 
from the subject’s ECG trace: heart rate, RR interval, PR interval, QT interval, QRS interval, and 
corrected QT interval using Fridericia’s formula (QTcF).
9.2.6
Study Drug Administration
Each subject will receive the study drug in Periods 1 and 2 as described below. The administration
conditions will be the same for the pilot and pivotal studies in Study 1.
Study 1: The subject will orally receive one TAK-438ASA tablet (a fixed dose combination of
TAK-438 10 mg and aspirin 100 mg) or one each of TAK-438 tablet 10 mg and aspirin 
enteric-coated tablet 100 mg with 150 mL of water in a fasted (without breakfast [after 
at least 10 hours of fasting]) condition.
Study 2: The subject will orally receive one TAK-438ASA tablet (a fixed dose combination of
TAK-438 10 mg and aspirin 100 mg) with 150 mL of water in a fasted (without 
breakfast) condition or fed (30 minutes after starting breakfast) condition.
9.2.7
AE Monitoring
AE monitoring will begin following the signing of informed consent. A complete description of 
AE procedures, including AE collection, is provided in Section 10.2.
9.2.8
Laboratory Procedures and Assessments
All samples will be collected in accordance with acceptable laboratory procedures. Laboratory 
samples will be taken following a minimum 10-hour fast on the days stipulated in the Schedule of 
Study Procedures (Section 3.0).

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9.2.8.1
Clinical Laboratory Tests
Hematology
Hematology will consist of the following tests:
RBC
WBC count with differential
(neutrophils, eosinophils, basophils, monocytes, lymphocytes)
Hemoglobin
Hematocrit
Platelets
Chemistry
Chemistry evaluations will consist of the following standard chemistry panel:
ALT
Albumin
ALP
AST
Total bilirubin
Total protein
Creatinine
BUN
Creatine kinase
GGT
Potassium
Sodium
Fasting glucose
Chloride
Urinalysis
Urinalysis will consist of the following tests:
pH
Specific gravity
Qualitative tests for protein
Qualitative tests for glucose

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Other
Tests performed at eligibility assessment:
Serum
Immunology tests:
HBsAg, HCV antibody, HIV antigen/antibody, serum test for 
syphilis
Urine
Urine drug tests:
phencyclidine, benzodiazepines, cocaine, antihypnotic agents, 
cannabinoids, opioids, barbiturates, and tricyclic antidepressants
HBsAg= hepatitis B virus surface antigen, HCV= hepatitis C virus, HIV= human immunodeficiency virus, RBC=red 
blood cells, WBC=white blood cells.
Note: The investigator or sub-investigator will report the results of immunology and urine drug screen directly to 
subjects. The Sponsor will confirm the overall test results (as “Positive” or “All negative”), rather than detailed results, 
for subjects (including reserve subjects) to be administered the study drug.
The local laboratory will perform laboratory tests for hematology, chemistry, and urinalysis. The 
results of laboratory tests will be returned to the investigator or sub-investigator, who is 
responsible for reviewing and filing these results.
If subjects experience an ALT or AST of >2 ×ULN, follow-up laboratory tests (at a minimum, 
serum alkaline phosphatase [ALP], ALT, AST, total bilirubin, gamma-glutamyl transferase 
[GGT], and INR) should be performed within a maximum of 7 days and preferably within 48 to 72 
hours after the abnormality was noted.
Refer to Sections 10.2.9.3 and 10.2.9.4 for the appropriate guidance on reporting abnormal LFTs
as SAEs or AESIs.
The investigator will maintain a copy of the reference ranges for the laboratory used.
9.3
PK Samples
Samples for PK analyses will be collected as specified in the Schedule of Study Procedures 
(Section 3.0). Please refer to the separately created procedure for information on the collection, 
processing, and shipment of samples to the central laboratory. The actual time of sample collection 
for PK analyses will be recorded on source documents and the eCRF.
Primary specimen collection parameters are provided in Table 9.a.

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Table 9.a
Primary Specimen Collections
Specimen Name
Primary 
Specimen
Description of Intended Use
Sample 
Collection
Plasma sample for TAK-438 PK
Plasma
PK analysis
Mandatory (a)
Urine sample for TAK-438 PK
Urine
PK analysis
Mandatory
(Study 2 only)
Plasma sample for aspirin PK
Plasma
PK analysis
Mandatory (b)
Urine sample for aspirin PK
Urine
PK analysis
Mandatory
(Study 2 only)
(a) If bioequivalence is verified only for TAK-438F in the pilot study of Study 1, the samples will not be collected in 
the pivotal study of Study 1.
(b) If bioequivalence is verified only for unchanged aspirin in the pilot study of Study 1, the samples will not be 
collected in the pivotal study of Study 1.
9.3.1
PK Measurements
The PK parameters of TAK-438F and its metabolites (M-I, M-II, M-III, and M-IV-Sul), 
unchanged aspirin and its metabolite (salicylic acid) will be determined from the 
concentration-time profiles for all evaluable subjects. Actual sampling times, rather than 
scheduled sampling times, will be used in all computations.
The following PK parameters will be calculated from plasma concentrations of TAK-438F and its
metabolites (M-I, M-II, M-III, and M-IV-Sul), unchanged aspirin and its metabolite (salicylic 
acid), unless otherwise specified:
Symbol/Term
Definition
Plasma
AUClast
Area under the concentration-time curve from time 0 to time of the last quantifiable concentration.
AUCt
Area under the concentration-time curve from time 0 to time t.
AUC∞
Area under the concentration-time curve from time 0 to infinity.
Cmax
Maximum observed concentration.
tmax
Time of first occurrence of Cmax.
t1/2z
Terminal disposition phase half-life.
λz
Terminal disposition phase rate constant.
MRT∞,ev
Mean residence time after extravascular administration from time 0 to infinity.
The following PK parameters will be calculated from urine concentrations of TAK-438F and its
metabolites (M-I, M-II, M-III, and M-IV-Sul), unchanged aspirin and its metabolites (salicylic 
acid and salicyluric acid), unless otherwise specified:

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Symbol/Term
Definition
Urine
Aet
Amount of drug excreted in urine from time 0 to time t.
fe,t
Fraction of administered dose of drug excreted in urine from time 0 to time t.
CLR
Renal clearance.
9.3.1.1
Plasma for PK Measurements
Blood samples for PK analyses of TAK-438 (one 4-mL sample per scheduled time) and those of 
aspirin (one 2-mL sample per scheduled time) will be collected in Vacutainers.
Blood samples for PK analyses of TAK-438 and aspirin will be collected according to the schedule 
described in Table 9.b.
Table 9.b
Collection of Blood Samples for PK Analysis
Study 1:
Analyte
Matrix
Study Day
Scheduled Time
TAK-438F (a)
Plasma
Days 1 to 3
Predose, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, 16, 24, 36, and 48 hours 
postdose
Unchanged aspirin (b)
Plasma
Day 1
Predose, 1, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 
10, 11, and 12 hours postdose
(a) If bioequivalence is verified only for TAK-438F in the pilot study, the samples will not be collected in the pivotal
study.
(b) If bioequivalence is verified only for unchanged aspirin in the pilot study, the samples will not be collected in the 
pivotal study.
Study 2:
Analyte
Matrix
Study Day
Scheduled Time
TAK-438F, M-I, M-II, 
M-III and M-IV-Sul
Plasma
Days 1 to 3
Predose, 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, 16, 24, 36, and 48 hours 
postdose
Unchanged aspirin and 
salicylic acid
Plasma
Days 1 and 2 Predose, 1, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 
10, 11, 12, 16, and 24 hours postdose
If a subject is prematurely withdrawn from the study after the start of study drug administration, a 
blood sample at the time of early termination will be collected as follows.
In Study 1, blood sample for PK analysis of TAK-438 will be collected only if the subject is
withdrawn from the study within 48 hours after the start of study drug administration, while the 
blood sample for aspirin will be collected only if the subject is withdrawn from the study within 
12 hours after the start of study drug administration.
In Study 2, blood sample for PK analysis of TAK-438 will be collected only if the subject is 
withdrawn from the study within 48 hours after the start of study drug administration, while the 
blood sample for aspirin will be collected only if the subject is withdrawn from the study within 
24 hours after the start of study drug administration.

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9.3.1.2
Urine for PK Measurements (in Study 2 Only)
Urine samples for PK analysis of TAK-438 and aspirin will be collected and stored in 
polypropylene containers.
Urine samples for PK analyses of TAK-438 and aspirin will be collected according to the schedule 
described in Table 9.c.
Table 9.c
Collection of Urine Samples for PK Analysis
Analyte
Matrix
Study Day
Scheduled Time
TAK-438F, M-I, M-II, M-III 
and M-IV-Sul
Urine
Days 1 to 3
Predose (spot urine), 0-4, 4-8, 8-12, 12-24, 24-36, and 
36-48 hours postdose
Unchanged aspirin, salicylic 
acid, and salicyluric acid
Urine
Days 1 and 2
Predose (spot urine), 0-4, 4-8, 8-12, and 12-24 hours 
postdose
9.3.1.3
Analytical Methods Used for PK Samples
Plasma and urine concentrations of TAK-438F and its metabolites (M-I, M-II, M-III, and 
M-IV-Sul), and of unchanged aspirin and its metabolites (salicylic acid and salicyluric acid) will
be measured using liquid chromatography-tandem mass spectrometry (LC/MS/MS).
9.3.2
Confinement
In both Studies 1 and 2, each subject will be checked-in to the study site on Day -1 and hospitalized
until 48 hours postdose on Day 3. Subjects will undergo daily examinations, observations, and 
assessments as specified in the Schedule of Study Procedures in Section 3.0. Subjects will be 
discharged after being confirmed by physical examination and tests on Day 3 to have no 
significant abnormality in his health.

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10.0
ADVERSE EVENTS
10.1
Definitions and Elements of AEs
An AE is defined as any untoward medical occurrence in a clinical investigation subject who has 
signed informed consent to participate in a study; it does not necessarily have to have a causal 
relationship with the treatment or study participation.
An AE can therefore be any unfavorable and unintended sign (eg, a clinically significant abnormal 
laboratory finding), symptom, or disease temporally associated with the study participation, 
whether or not it is considered related to the drug or study procedure.
An untoward finding generally may:

Indicate a new diagnosis or unexpected worsening of a pre-existing condition. (Intermittent 
events for pre-existing conditions or underlying disease should not be considered AEs.)

Necessitate therapeutic intervention.

Require an invasive diagnostic procedure.

Require discontinuation or a change in dose of study drug or a concomitant medication.

Be considered unfavorable by the investigator or sub-investigator for any reason.
Diagnoses versus signs and symptoms:

Each event should be recorded to represent a single diagnosis. Accompanying signs (including 
abnormal laboratory values or ECG findings) or symptoms should NOT be recorded as 
additional AEs. If a diagnosis is unknown, sign(s) or symptom(s) should be recorded 
appropriately as an AE(s).
Laboratory values and ECG findings:

Changes in laboratory values or ECG parameters maybe considered AEs if they are judged to 
be clinically significant by the investigator or sub-investigator (ie, if some action or 
intervention is required or if the investigator or sub-investigator judges the change to be 
beyond the range of normal physiologic fluctuation). A laboratory re-test and/or continued 
monitoring of an abnormal value are not considered an intervention. In addition, repeated or 
additional noninvasive testing for verification, evaluation or monitoring of an abnormality is 
not considered an intervention.

If abnormal laboratory values or ECG findings are the result of pathology for which there is an 
overall diagnosis (eg, increased creatinine in renal failure), the diagnosis only should be 
reported appropriately as an AE.
Pre-existing conditions:

A pre-existing condition (present at the time of signing of informed consent) is considered a 
concurrent medical condition and should NOT be recorded as an AE. A baseline evaluation 
(eg, laboratory test, ECG, X-ray, etc) should NOT be recorded as an AE unless related to a 

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study procedure. However, if the subject experiences a worsening or complication of such a 
concurrent medical condition, the worsening or complication should be recorded appropriately 
as an AE (worsening or complication occurs after informed consent is signed). Investigators or 
sub-investigators should ensure that the event term recorded captures the change in the 
condition (eg, “worsening of…”).

If a subject has a pre-existing episodic condition (eg, asthma, epilepsy), any occurrence of an 
episode should only be captured as an AE if the episodes become more frequent, serious, or 
severe in nature, that is, investigators or sub-investigators should ensure that the AE term 
recorded captures the change from baseline in the condition (eg, “worsening of…”).

If a subject has a degenerative concurrent condition (eg, cataracts, rheumatoid arthritis), 
worsening of the condition should only be captured as an AE if occurring to a greater extent to 
that which would be expected. Again, investigators or sub-investigators should ensure that the 
AE term recorded captures the change in the condition (eg, “worsening of…”).
Worsening of AEs:

If the subject experiences a worsening or complication of an AE after the first administration of 
study drug or after any change in study drug, the worsening or complication should be 
recorded as a new AE. Investigators or sub-investigators should ensure that the AE term 
recorded captures the change in the condition (eg, “worsening of…”).
Changes in severity of AEs:

If the subject experiences a change in the severity of an AE that is not associated with a change 
in study drug, the event should be captured once with the maximum severity recorded.
Preplanned surgeries or procedures:

Preplanned procedures (surgeries or therapies) that were scheduled prior to signing of 
informed consent are not considered AEs. However, if a preplanned procedure is performed 
early (eg, as an emergency) due to a worsening of the pre-existing condition, the worsening of 
the condition should be captured appropriately as an AE. Complications resulting from any 
planned surgery should be reported as AEs.
Elective surgeries or procedures:

Elective procedures performed where there is no change in the subject’s medical condition 
should not be recorded as AEs but should be documented in the subject’s source documents. 
Complications resulting from an elective surgery should be reported as AEs.
Overdose:

An overdose is defined as a known deliberate or accidental administration of investigational 
drug, to or by a study subject, at a dose above that which is assigned to that individual subject 
according to the study protocol. It is up to the investigator, sub-investigator, or the reporting 
physician to decide whether a dose is to be considered an overdose, in consultation with the 
Sponsor.

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
All cases of overdose (with or without associated AEs) will be documented on an Overdose 
page of the eCRF, in order to capture this important safety information consistently in the 
database. AEs associated with an overdose will be documented on AE page of the eCRF 
according to Section 10.0.

SAEs of overdose should be reported according to the procedure outlined in Section 10.2.9.

In the event of drug overdose, the subject should be treated symptomatically.
10.1.1 SAEs
An SAE is defined as any untoward medical occurrence that at any dose:
1. Results in DEATH.
2. Is LIFE THREATENING.

The term “life threatening” refers to an event in which the subject was at risk of death at the 
time of the event; it does not refer to an event that hypothetically might have caused death 
if it were more severe.
3. Requires inpatient HOSPITALIZATION or prolongation of existing hospitalization.
4. Results in persistent or significant DISABILITY/INCAPACITY.
5. Is a CONGENITAL ANOMALY/BIRTH DEFECT.
6. Is an IMPORTANT MEDICAL EVENT that satisfies any of the following:

May require intervention to prevent items 1 through 5 above.

May expose the subject to danger, even though the event is not immediately life 
threatening or fatal or does not result in hospitalization.

Includes any event or synonym described in the Takeda Medically Significant AE List 
(Table 10.a).

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Table 10.a
Takeda Medically Significant AE List 
Term
Acute respiratory failure/acute respiratory 
distress syndrome (ARDS)
Hepatic necrosis
Acute liver failure
Torsade de pointes/ventricular fibrillation/ 
ventricular tachycardia
Anaphylactic shock
Acute renal failure
Malignant hypertension
Pulmonary hypertension
Convulsive seizures (including convulsion and 
epilepsy)
Pulmonary fibrosis (including interstitial lung disease)
Agranulocytosis
Confirmed or suspected endotoxin shock
Aplastic anemia
Confirmed or suspected transmission of infectious agent by 
a medicinal product
Toxic epidermal necrolysis / oculomucocutaneous 
syndrome (Stevens-Johnson syndrome)
Neuroleptic malignant syndrome/malignant hyperthermia
Spontaneous abortion/stillbirth and fetal death
Note: Terms identified on the Medically Significant AE List represent the broad medical concepts to be considered as 
“Important Medical Events” satisfying SAE reporting requirements.
10.1.2 Special Interest AEs
A special interest AE (serious or non-serious) is an event of concern specific to the study drug. The 
special interest AEs in this study will be defined as liver dysfunction, gastrointestinal Clostridium 
difficile infection, and hypersensitivity.
The investigator and sub-investigator will monitor the subject for the occurrence of special interest
AEs. An occurrence of any special interest AE should be reported according to the procedure 
described in Section 10.2.9.4. Such events may require further investigation to establish their
evaluation.
10.1.2.1 Liver Dysfunction
Liver dysfunction is defined as follows:

ALT or AST >2×ULN, or

Total bilirubin >2×ULN
A Liver Dysfunction Form must be completed with relevant detailed information on the subject, 
possible alternative etiologies (eg, acute viral hepatitis A or B or other acute liver disease or 
medical history/concurrent medical conditions), clinical course, and action taken for the event. 
Refer to Section 9.2.8.1 for the follow-up laboratory testing.
10.1.2.2 Gastrointestinal Clostridium difficile Infection
Gastrointestinal Clostridium difficile infection is defined as follows:

An AE with any of the following preferred terms (PT) of the Medical Dictionary for 
Regulatory Activities (MedDRA) Ver.20.1: Clostridial infection, Clostridium bacteraemia, 

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Clostridium colitis, Clostridium difficile colitis, Clostridium difficile infection, Clostridial 
sepsis, Clostridium test positive, Gastroenteritis clostridial, or pseudomembranous colitis.
A Gastrointestinal Clostridium difficile Infection Form must be completed with relevant detailed
information on the subject, possible alternative etiologies (eg, concomitant use of antibacterial 
agents or immunosuppressive agents, or medical history/concurrent medical conditions), the 
clinical course, and action taken for the event.
10.1.2.3 Hypersensitivity
A hypersensitivity-related AE is defined as follows.

An AE related to hypersensitivity (eg, anaphylactic reaction, angioedema, erythema 
multiforme, urticaria, or rash) that led to discontinuation of the study drug.
A Hypersensitivity Form must be completed with relevant detailed information on the subject, 
possible alternative etiologies, the clinical course, and action taken for the event.
The special interest AEs should be record as AEs in the eCRF. The completed eCRF along with all 
other required documentation should be submitted to the Sponsor.
10.2
AE Procedures
10.2.1 Assigning Severity/Intensity of AEs
The different categories of severity/intensity are:
Mild:
An AE that is usually transient and may require only minimal treatment or 
therapeutic intervention. The event does not generally interfere with usual 
activities of daily living.
Moderate:
An AE that is usually alleviated with additional specific therapeutic 
intervention. The event interferes with usual activities of daily living, causing 
discomfort but poses no significant or permanent risk of harm to the research 
participant.
Severe:
An AE that interrupts usual activities of daily living, or significantly affects 
clinical status, or may require intensive therapeutic intervention.
10.2.2 Assigning Causality of AEs
The causal relationship of each AE to study drug(s) will be assessed using the following 
categories:

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Related:
An AE that follows a reasonable temporal sequence from administration of a 
drug (including the course after withdrawal of the drug), or for which a causal 
relationship is at least a reasonable possibility, ie, the relationship cannot be 
ruled out, although factors other than the drug, such as underlying diseases, 
complications, concomitant drugs and concurrent treatments, may also be 
responsible.
Not Related:
An AE that does not follow a reasonable temporal sequence from administration 
of a drug and/or that can reasonably be explained by other factors, such as 
underlying diseases, complications, concomitant medications and concurrent 
treatments.
10.2.3 Assigning Causality of AEs to Study Procedures
The causal relationship of each AE to study procedures will be assessed.
The causality of an event should be assessed as Related if the investigator or sub-investigator 
considers that there is a reasonable possibility that the event is due to a study procedure. 
Otherwise, the causality should be assessed as Not Related.
10.2.4 Start Date
The start date of the AE is the date that the first signs/symptoms were noted by the subject,
investigator, or sub-investigator.
10.2.5 End Date
The end date of the AE is the date at which the subject recovered, the event resolved but with 
sequelae or the subject died.
10.2.6 Pattern of Adverse Event (Frequency)
Episodic AEs (eg, headache) or those which occur repeatedly over a period of consecutive days are 
“intermittent”. All other events are “continuous”.
10.2.7 Action Taken With Study Treatment

Drug withdrawn – a study drug is stopped due to the particular AE.

Dose not changed – the particular AE did not require changing the dose of study drug.

Unknown – only to be used if it has not been possible to determine what action has been taken.

Not applicable – a study drug was stopped for a reason other than the particular AE eg, the 
study has been terminated, the subject died, dosing with study drug had not yet started or 
dosing with study drug was already stopped before the onset of the AE.

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10.2.8 Outcome

Recovered/resolved – subject returned to first assessment status with respect to the AE.

Recovering/resolving – the intensity is lowered by one or more stages: the diagnosis has or 
signs/symptoms have almost disappeared; the abnormal laboratory value improved, but has 
not returned to the normal range or to the baseline value; the subject died from a cause other 
than the particular AE with the condition remaining “recovering/resolving.”

Not recovered/not resolved – there is no change in the diagnosis, signs or symptoms; the 
intensity of the diagnosis, signs/symptoms or laboratory value on the last day of the observed 
study period has become worse than when it started; is an irreversible congenital anomaly; the 
subject died from another cause with the particular AE state remaining “Not recovered/not 
resolved.”

Recovered/ Resolved with sequelae – the subject recovered from an acute AE but was left with 
permanent/significant impairment (eg, recovered from a cardiovascular accident but with 
some persisting paresis).

Fatal – an AE that is considered as the cause of death.

Unknown – the course of the AE cannot be followed up due to hospital change or residence 
change at the end of the subject’s participation in the study.
10.2.9 Collection and Reporting of AEs, SAEs, Special Interest AEs, and Abnormal LFTs
10.2.9.1 Collection Period
Collection of AEs (ie, AEs, SAEs, Special Interest AEs, and Abnormal LFTs) will commence at 
the time the subject signs the informed consent and continue until the end of examination at 
48 hours postdose in Period 2.
10.2.9.2 Reporting AEs
At each study visit, the investigator or sub-investigator will assess whether any subjective AEs 
have occurred. A neutral question, such as “How have you been feeling since your last visit?” may 
be asked. Subjects may report AEs occurring at any other time during the study.
Subjects experiencing an SAE prior to the first exposure to study drug must be monitored until the 
symptoms subside and any clinically relevant changes in laboratory values have returned to 
baseline or there is a satisfactory explanation for the change. Nonserious AEs that begin prior to 
the first exposure to study drug, related or unrelated to the study procedure, need not be 
followed-up for the purposes of the protocol.
All subjects experiencing AEs, whether considered associated with the use of the study drug or 
not, must be monitored until the symptoms subside and any clinically relevant changes in 
laboratory values have returned to baseline or until there is a satisfactory explanation for the 
changes observed. All AEs will be documented in the AE page of the eCRF, whether or not the 

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investigator concludes that the event is related to the drug treatment. The following information 
will be documented for each event:

Event term.

Start and end date and time.

Pattern of AE (frequency).

Severity/Intensity.

Investigator’s or sub-investigator’s opinion of the causal relationship between the event and 
administration of study drug(s).

Investigator’s or sub-investigator’s opinion of the causal relationship to study procedure(s), 
with a description of the suspected procedure.

Action taken with the study drug(s).

Outcome of event.

Seriousness.

Special Interest AEs.

Timing of occurrence (after administration of study drug[s]).
10.2.9.3 Reporting SAEs
When an SAE occurs through the AE collection period it should be reported according to the 
procedure outlined below:
An SAE should be reported by the investigator or sub-investigator to the Sponsor within 
1 business day of the first onset or notification of the SAE, along with any relevant information. 
The investigator should submit a detailed SAE Form to the Sponsor within 10 calendar days. The 
information should be completed as fully as possible but contain, at a minimum:

A short description of the event and the reason why the event is categorized as serious.

Subject identification number.

Investigator’s or sub-investigator’s name.

Name of the study drug(s).

Causality assessment.
Any SAE spontaneously reported to the investigator or sub-investigator following the AE 
collection period should be reported to the Sponsor if considered related to study participation.
SAE Follow-Up
If information is not available at the time of the first report becomes available at a later date, the 
investigator or sub-investigator should complete a follow-up SAE form copy or provide other 

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written documentation and promptly submit to the Sponsor. Copies of any relevant data from the 
hospital notes (eg, ECGs, laboratory tests, discharge summary, postmortem results) should be sent 
to the addressee, if requested.
All SAEs should be followed up until resolution or permanent outcome of the event.
10.2.9.4 Reporting Special Interest AEs
When a special interest AE (refer to Section 10.1.2) occurs through the AE collection period, it 
should be reported by the investigator or sub-investigator to the Sponsor within 1 business day of 
the first onset or notification of the event, along with any relevant information. The investigator 
should also submit a Special Interest AE Form to the Sponsor within 10 business days. 
Additionally, the investigator should submit the original copy of the Special Interest AE Form to 
the Sponsor.
The special interest AEs should be record as AEs in the eCRF.
10.2.9.5 Reporting of Abnormal LFTs
If a subject is noted to have ALT or AST >3 ×ULN and total bilirubin >2 ×ULN for which an 
alternative etiology has not been identified, the event should be recorded as an SAE and reported 
as per Section 10.2.9.3. The investigator or sub-investigator must report to the study monitor and 
evaluate relevant subject details and possible alternative etiologies, such as acute viral hepatitis A 
or B or other acute liver disease, or medical history/concurrent medical conditions. Follow-up 
laboratory tests as described in Section 9.2.8 must also be performed.
10.2.10Safety Reporting to Investigators, IRBs, and Regulatory Authorities
The Sponsor will be responsible for reporting all suspected unexpected serious adverse reactions 
(SUSARs) and any other applicable SAEs to regulatory authorities, investigators and IRBs, and 
the head of the study site. Relative to the first awareness of the event by/or further provision to the 
Sponsor or Sponsor’s designee, SUSARs will be submitted within 7 days for fatal and 
life-threatening events and 15 days for other serious events, unless otherwise required by national 
regulations. The Sponsor will also prepare an expedited report for other safety issues where these 
might materially alter the current benefit-risk assessment of an investigational medicinal product 
or that would be sufficient to consider changes in the investigational medicinal products 
administration or in the overall conduct of the trial. The study site also will forward a copy of all 
expedited reports to his or her IRB.

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11.0
STATISTICAL METHODS
11.1
Statistical and Analytical Plans
A statistical analysis plan (SAP) will be prepared and finalized prior to database lock. This 
document will provide further details regarding the definitions of analysis variables, and analysis 
methodologies to address all study objectives.
After the databases of the pilot study of Study 1 and Study 2 are locked for all the subjects’ data, 
statistical analysis will be performed on available data. In the case that the pivotal study is
implemented, statistical analysis will also be performed on data from the pivotal study after the 
database of the pivotal study of Study 1 is locked for all of the subjects’ data.
11.1.1 Analysis Sets
In this study, two analysis sets are defined: the safety analysis set and PK analysis set. The 
definition of each analysis set will be described in the SAP.
The Sponsor will verify the validity of the definitions of the analysis sets and the rules for handling 
data in consultation with a medical expert, as needed. The Sponsor will address all remaining 
uncertainties not specified at planning, and will finalize the SAP prior to the database lock.
11.1.1.1 Safety Analysis Set
The safety analysis set will be defined as all subjects who received at least one dose of study drug.
11.1.1.2 PK Analysis Set
The PK analysis set will be defined as all subjects who received at least one dose of study drug, 
who had no major protocol deviation, and whose pharmacokinetic data are evaluable.
11.1.2 Analysis of Demography and Other Baseline Characteristics
Demographics and other baseline characteristics will be summarized using the safety analysis set 
and PK analysis set.
11.1.3 PK Analysis
11.1.3.1 PK Endpoints and Its Analytical Methods
The primary endpoint of the study is:
Study 1:
PK (plasma concentration)

AUClast and Cmax of TAK-438F.

AUClast and Cmax of unchanged aspirin.
The secondary endpoints of the study are:

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Study 1:
PK (plasma concentration)

AUC∞, tmax, MRT∞,ev, and λz of TAK-438F.

AUC∞, tmax, MRT∞,ev, and λz of unchanged aspirin.
Study 2:
PK (plasma concentration)

AUC∞, AUCt, AUClast, Cmax, tmax and t1/2z of TAK-438F and its metabolites (M-I, M-II, M-III, 
and M-IV-Sul).

AUC∞, AUCt, AUClast, Cmax, tmax and t1/2z of unchanged aspirin and its metabolite (salicylic 
acid).
PK (urine concentration)

Aet, fe,t and CLR of TAK-438F and its metabolites (M-I, M-II, M-III, and M-IV-Sul).

Aet, fe,t and CLR of unchanged aspirin and its metabolites (salicylic acid and salicyluric acid).
Analytical methods:
The following analyses will be performed using the PK analysis set.
1) Plasma concentrations
Study 1:
At each time point scheduled for blood sampling, descriptive statistics of plasma 
concentrations of TAK-438F and unchanged aspirin will be provided for each study 
medication (ie, TAK-438ASA tablet [as a fixed dose combination] or concomitant 
administration of TAK-438 tablet and aspirin enteric-coated tablet [as a free combination], the 
same hereinafter). Case plots and mean plots with standard deviations (SD) will be provided 
for each study medication. Descriptive statistics of PK parameters will be provided for each 
study medication. Additionally, descriptive statistics will be provided for AUClast and Cmax
ratios (TAK-438ASA tablet [as a fixed dose combination]/concomitant administration of 
TAK-438 tablet and aspirin enteric-coated tablet [as a free combination]).
Testing for bioequivalence:
For log-transformed (natural log) AUClast and Cmax of TAK-438F and unchanged aspirin (ie, 
the primary endpoint of the study), the two-sided 90% CI of the difference in the least square
means between the study medications (TAK-438ASA tablet [as a fixed dose combination] −
concomitant administration of TAK-438 tablet and aspirin enteric-coated tablet [as a free 
combination]) will be provided using the analysis of variance (ANOVA) model. The same 
analyses will be performed for untransformed AUClast and Cmax.
The same analyses will also be performed for AUC∞, tmax, MRT∞,ev, and λz (ie, the secondary 
endpoint of the study) to provide additional information.

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Study 2:
At each time point scheduled for blood sampling, descriptive statistics will be provided for the 
plasma concentrations of TAK-438F and its metabolites (M-I, M-II, M-III, and M-IV-Sul), and 
of unchanged aspirin and its metabolite (salicylic acid) for each dosing condition of 
TAK-438ASA tablet (fasted [without breakfast] condition or fed [30 minutes after starting
breakfast] condition, the same hereinafter). Case plots and mean plots with SD will be 
provided for each dosing condition. Descriptive statistics of PK parameters will be provided 
for each dosing condition.
Testing of food effect:
For log-transformed (natural log) AUC∞, AUCt, AUClast, and Cmax of TAK-438F and 
unchanged aspirin (ie, the secondary endpoint of the study), the two-sided 90% and 95% CI of 
the difference in the least square means between the dosing conditions of TAK-438ASA tablet 
(fed [30 minutes after starting breakfast] condition −fasted [without breakfast] condition) will 
be provided using the ANOVA model.
2) Urinary concentrations (Study 2 only)
For Aet, fe,t and CLR of TAK-438F and its metabolites (M-I, M-II, M-III, and M-IV-Sul), and 
of unchanged aspirin and its metabolites (salicylic acid and salicyluric acid) (ie, the secondary 
endpoint of the study), descriptive statistics will be provided for each dosing condition.
11.1.3.2 Methods of Data Conversion and Handling of Missing Data
For plasma concentrations and laboratory test results, values below the lower limit of 
quantification will be treated as zero. The details will be provided in the SAP.
11.1.4 Safety Analysis
11.1.4.1 Safety Endpoints and Analytical Methods
Safety endpoints will be the following: 
TEAEs, clinical laboratory tests, vital signs, weight, and 12-lead ECG.
Analytical methods:
The following analyses will be performed using the safety analysis set.
1) TEAEs
A TEAE is defined as an AE with a date of onset that occurs on or after the start of study drug
administration. The analyses of TEAEs will be conducted for the following. TEAEs will be 
coded using the MedDRA dictionary and tabulated by system organ class (SOC) and PT for 
each study medication (in Study 1) or for each dosing condition (in Study 2):

The frequency of all TEAEs

The frequency of drug-related TEAEs

The frequency of TEAEs by intensity

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
The frequency of drug-related TEAEs by intensity

The frequency of serious TEAEs
2) Clinical laboratory tests
For continuous variables, descriptive statistics of observed values and changes from baseline 
will be provided for each evaluation point for each study medication (in Study 1) or for each
dosing condition (in Study 2). Case plots of observed values will be provided for each study 
medication (in Study 1) or for each dosing condition (in Study 2).
For categorical variables, shift tables showing the number of subjects in each category at 
baseline and each post-baseline scheduled evaluation point will be provided for each study 
medication (in Study 1) or for each dosing condition (in Study 2).
3) Vital signs and weight
For continuous variables, descriptive statistics of observed values and changes from baseline 
will be provided for each evaluation point for each study medication (in Study 1) or for each 
dosing condition (in Study 2). Case plots of observed values will be provided for each study 
medication (in Study 1) or for each dosing condition (in Study 2).
4) Other safety parameters
12-lead ECG parameters will be summarized as follows:
For continuous variables, descriptive statistics of observed values and changes from baseline 
will be provided for each evaluation point for each study medication (in Study 1) or for each 
dosing condition (in Study 2). Case plots of observed values will be provided for each study 
medication (in Study 1) or for each dosing condition (in Study 2).
For categorical variables, shift tables showing the number of subjects in each category at 
baseline and each post-baseline scheduled evaluation point will be provided for each study 
medication (in Study 1) or for dosing condition (in Study 2).
11.2
Interim Analysis and Criteria for Early Termination
After the completion of the pilot study, an analysis will be performed on data obtained from the 
pilot study together with that from Study 2 to determine whether the results may warrant further 
analysis in the pivotal study. On the basis of bioequivalence evaluation in the pilot study, the 
Sponsor will determine entry into the pivotal study after discussion(s) with the medical experts, 
and will promptly notify the investigator. Refer to Section 6.2 for the procedures for proceeding to 
the pivotal study.
11.3
Determination of Sample Size
Study 1:
Planned number of subjects is 12 per sequence (total of 24 subjects) in the pilot study, and a 
maximum of 202 per sequence (total of 404 subjects) in the pivotal study. Statistical basis for the 
sample size is presented below.

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Assuming a root mean square error of 0.20 for PK parameters in the pilot study, the power of two 
one-sided t-tests to verify the bioequivalence [H0: ln(μ)≤ln(θ1), ln(μ)≥ln(θ2); H1: 
ln(θ1)<ln(μ)<ln(θ2); where μ=μt/μs, μt is the mean for TAK-438ASA tablet, μs is the mean for the 
concomitant administration of TAK-438 tablet and aspirin enteric-coated tablet, θ1=0.80, and 
θ2=1.25] at a one-sided significance level of 5% and μ=0.95 to 1.05 would be 89% to 96% with a 
sample size of 12 subjects per sequence (total of 24 subjects).
In the case that the pivotal study will be implemented, the number of subjects will be recalculated 
based on the results from the pilot study. Assuming a maximal root mean square error of 0.57 for 
PK parameters in the pivotal study, which is based on the results from preceding studies of 
TAK-438 and the bioequivalence study of another combination tablet using the same aspirin 
enteric-coated tablet (AG-1749ASA/CPH-001), two one-sided t-tests with a one-sided 
significance level of 5% and μ=0.90 to 1.10 would need a maximum of 202 subjects per sequence
(total of 404 subjects) to provide 90% power to verify the bioequivalence.
Study 2:
Planned number of subjects is 6 per sequence (total of 12 subjects) to evaluate the PK and safety of 
TAK-438ASA. This sample size has not been determined by statistical considerations.

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12.0
QUALITY CONTROL AND QUALITY ASSURANCE
12.1
Study-Site Monitoring Visits
Monitoring visits to the study site will be made periodically during the study to ensure that all 
aspects of the protocol are followed. Source documents will be reviewed for verification of data 
recorded on the eCRFs. Source documents are defined as original documents, data, and records. 
The investigator and study site guarantee access to source documents by the Sponsor or its 
designee (contract research organization [CRO]) and by the IRB.
All aspects of the study and its documentation will be subject to review by the Sponsor or the 
Sponsor’s designee, including but not limited to the Investigator’s Binder, trial drug, subject 
medical records, informed consent documentation, and review of eCRFs and associated source 
documents. It is important that the investigator and other study personnel are available during the 
monitoring visits and that sufficient time is devoted to the process.
12.2
Protocol Deviations
The investigator or sub-investigator can deviate and change from the protocol for any medically 
unavoidable reason, for example, to eliminate an immediate hazard to study subjects, without a 
prior written agreement with the Sponsor or a prior approval from IRB. In the event of a deviation 
or change, the investigator should notify the Sponsor and the head of the study site of the deviation 
or change as well as its reason in a written form, and then retain a copy of the written form. When 
necessary, the investigator may consult and agree with the Sponsor on a protocol amendment. If 
the protocol amendment is appropriate, the amendment proposal should be submitted to the head 
of the study site as soon as possible and an approval from IRB should be obtained.
The investigator or sub-investigator should document all protocol deviations.
12.3
Quality Assurance Audits and Regulatory Agency Inspections
The study site also may be subject to quality assurance audits by the Sponsor or designees. In this 
circumstance, the Sponsor-designated auditor will contact the site in advance to arrange an 
auditing visit. The auditor may ask to visit the facilities where laboratory samples are collected, 
where the medication is stored and prepared, and any other facility used during the study. In 
addition, there is the possibility that this study may be inspected by regulatory agencies, including 
those of foreign governments (eg, the Food and Drug Administration [FDA], the United Kingdom 
Medicines and Healthcare products Regulatory Agency [MHRA], the Pharmaceuticals and 
Medical Devices Agency of Japan [PMDA]). If the study site is contacted for an inspection by a 
regulatory body, the Sponsor should be notified immediately. The investigator and the head of the 
study site guarantees access for quality assurance auditors to all study documents as described in 
Section 12.1.

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13.0
ETHICAL ASPECTS OF THE STUDY
This study will be conducted with the highest respect for the individual participants (ie, subjects) 
according to the protocol, the ethical principles that have their origin in the Declaration of 
Helsinki, and the International Council for Harmonisation of Technical Requirements for 
Pharmaceuticals for Human Use (ICH) Harmonised Tripartite Guideline for GCP. Each 
investigator will conduct the study according to applicable local or regional regulatory 
requirements and align his or her conduct in accordance with the “Responsibilities of the 
Investigator” that are listed in Appendix A.
13.1
IRB Approval
IRBs must be constituted according to the applicable local requirements of each participating 
region. The Sponsor or designee will require documentation noting all names and titles of 
members who make up the respective IRB. If any member of the IRB has direct participation in 
this study, written notification regarding his or her abstinence from voting must also be obtained.
The Sponsor or designee will supply relevant documents for submission to the respective IRB for 
the protocol’s review and approval. This protocol, the Investigator’s Brochure, a copy of the 
informed consent form, and, if applicable, subject recruitment materials and/or advertisements and 
other documents required by all applicable laws and regulations, must be submitted to a central or 
local IRB for approval. The IRB’s written approval of the protocol and subject informed consent 
must be obtained and submitted to the Sponsor or designee before commencement of the study. 
The IRB approval must refer to the study by exact protocol title, number, and version date; identify 
versions of other documents (eg, informed consent form) reviewed; and state the approval date. 
The Sponsor will notify study site once the Sponsor has confirmed the adequacy of study site 
regulatory documentation. Until the site receives notification no protocol activities, including 
screening, may occur.
Study sites must adhere to all requirements stipulated by their respective IRB. This may include 
notification to the IRB regarding protocol amendments, updates to the informed consent form, 
recruitment materials intended for viewing by subjects, local safety reporting requirements, 
reports and updates regarding the ongoing review of the study at intervals specified by the 
respective IRB, and submission of the investigator’s final status report to IRB. All IRB approvals 
and relevant documentation for these items must be provided to the Sponsor or its designee.
Subject incentives should not exert undue influence for participation. Payments to subjects must 
be approved by the IRB and Sponsor.
13.2
Subject Information, Informed Consent, and Subject Authorization
Written consent documents will embody the elements of informed consent as described in the
Declaration of Helsinki and the ICH Guidelines for GCP and will be in accordance with all 
applicable laws and regulations. The informed consent form describes the planned and permitted 
uses, transfers, and disclosures of the subject’s personal and personal health information for 
purposes of conducting the study. The informed consent form further explains the nature of the 
study, its objectives, and potential risks and benefits, as well as the date informed consent is given. 

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The informed consent form will detail the requirements of the participant and the fact that he is 
free to withdraw at any time without giving a reason and without prejudice to his further medical 
care.
The investigator is responsible for the preparation, content, and IRB approval of the informed 
consent form. The informed consent form must be approved by both the IRB and the Sponsor prior 
to use.
The informed consent form must be written in a language fully comprehensible to the prospective 
subject. It is the responsibility of the investigator or sub-investigator to explain the detailed 
elements of the informed consent form to the subject. Information should be given in both oral and 
written form whenever possible and in the manner deemed appropriate by the IRB.
The subject must be given ample opportunity to: (1) inquire about details of the study, and (2) 
decide whether or not to participate in the study. If the subject determines he will participate in the 
study, then the informed consent form must be signed and dated by the subject at the time of 
consent and prior to the subject entering into the study. The subject should be instructed by the 
investigator or sub-investigator to sign using their legal names, not nicknames, using blue or black 
ballpoint ink. The investigator or sub-investigator must also sign and date the informed consent 
form prior to subject entering into the study.
Once signed, the original informed consent form will be stored in the investigator’s site file. The 
investigator or sub-investigator must document the date the subject signs the informed consent in 
the subject’s medical record. Copies of the signed informed consent form shall be given to the 
subject.
All revised informed consent forms must be reviewed and signed by relevant subjects in the same 
manner as the original informed consent. The date the revised consent was obtained should be 
recorded in the subject’s medical record, and the subject should receive a copy of the revised 
informed consent form.
13.3
Subject Confidentiality
The Sponsor and designees affirm and uphold the principle of the subject’s right to protection 
against invasion of privacy. Throughout this study, a subject’s source data will only be linked to 
the Sponsor’s clinical study database or documentation via a unique identification number. As 
permitted by all applicable laws and regulations, limited subject attributes, such as sex, age, or date 
of birth may be used to verify the subject and accuracy of the subject’s unique identification 
number.
To comply with ICH Guidelines for GCP and to verify compliance with this protocol, the Sponsor 
requires the investigator to permit its monitor or designee’s monitor, representatives from any 
regulatory authority (eg, FDA, MHRA, PMDA), the Sponsor’s designated auditors, and the 
appropriate IRBs to review the subject’s original medical records (source data or documents), 
including, but not limited to, laboratory test result reports, ECG reports, admission and discharge 
summaries for hospital admissions occurring during a subject’s study participation, and autopsy 

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reports. Access to a subject’s original medical records requires the specific authorization of the 
subject as part of the informed consent process (refer to Section 13.2).
Copies of any subject source documents that are provided to the Sponsor must have certain 
personally identifiable information removed (ie, subject name, address, and other identifier fields 
not collected on the subject’s eCRF).
13.4
Publication, Disclosure, and Clinical Trial Registration Policy
13.4.1 Publication and Disclosure
The investigator is obliged to provide the Sponsor with complete test results and all data derived 
by the investigator from the study. During and after the study, only the Sponsor may make study 
information available to other study investigators or to regulatory agencies, except as required by 
law or regulation. Except as otherwise allowable in the clinical study site agreement, any public 
disclosure (including publicly accessible websites) related to the protocol or study results is the 
sole responsibility of the Sponsor.
The Sponsor may publish any data and information from the study (including data and information 
generated by the investigator) without the consent of the investigator. The investigator or 
sub-investigator needs to obtain a prior written approval from the Sponsor to publish any 
information from the study externally, such as to a professional association.
13.4.2 Clinical Trial Registration
In order to ensure that information on clinical trials reaches the public in a timely manner and to 
comply with applicable laws, regulations and guidance, Takeda will, at a minimum, register all 
interventional clinical trials it sponsors anywhere in the world on ClinicalTrials.gov and/or other 
publicly accessible websites before start of study, as defined in Takeda Policy/Standard. Takeda 
contact information, along with facility name, investigator’s city, state (for Americas 
investigators), country, and recruiting status will be registered and available for public viewing.
13.4.3 Clinical Trial Results Disclosure
Takeda will post the results of clinical trials on ClinicalTrials.gov or other publicly accessible 
websites, as required by Takeda Policy/Standard, applicable laws and/or regulations.
13.5
Insurance and Compensation for Injury
Each subject in the study must be insured in accordance with the regulations applicable to the 
study site where the subject is participating. If a local underwriter is required, then the Sponsor or 
Sponsor’s designee will obtain clinical study insurance against the risk of injury to study subjects. 
Refer to the study site agreement regarding the Sponsor’s policy on subject compensation and 
treatment for injury. If the investigator or sub-investigator has questions regarding this policy, he 
or she should contact the Sponsor or Sponsor’s designee.

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14.0
ADMINISTRATIVE AND REFERENCE INFORMATION
14.1
Administrative Information
14.1.1 Study Contact Information
A separate contact information list (Protocol Annex 1) will be provided to the study site.
14.1.2 Investigator Agreement
A separate agreement will be provided to the study site.
14.1.3 Study-Related Responsibilities
A separate contact information list (Protocol Annex 1) will be provided to the study site.
14.1.4 List of Abbreviations
AE
adverse event
ALP
alkaline phosphatase
ALT
alanine aminotransferase
AST
aspartate aminotransferase
BMI
body mass index
BUN
blood urea nitrogen
CYP
cytochrome P450
eCRF
electronic case report form
FDA
Food and Drug Administration
GCP
Good Clinical Practice
GGT
gamma-glutamyl transferase
HBsAg
hepatitis B virus surface antigen
HCV
hepatitis C virus
HIV
human immunodeficiency virus
ICH
International Council for Harmonisation of Technical Requirements for Pharmaceuticals 
for Human Use
INR
international normalized ratio
MedDRA
Medical Dictionary for Regulatory Activities
MHRA
Medicines and Healthcare products Regulatory Agency
PMDA
Pharmaceuticals and Medical Devices Agency of Japan
PPI
proton pump inhibitor
SAE
serious adverse event
SUSAR
suspected unexpected serious adverse reaction
TAK-438F
TAK-438 free base

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15.0
DATA HANDLING AND RECORDKEEPING
The full details of procedures for data handling will be documented in the Data Management Plan. 
AEs, medical history, and concurrent conditions will be coded using the MedDRA. Drugs will be 
coded using the World Health Organization Drug Dictionary.
15.1
eCRFs
Completed eCRFs are required for each subject who signs an informed consent.
The Sponsor or its designee will supply study sites with access to eCRFs. The Sponsor will make 
arrangements to train appropriate site staff in the use of the eCRF. These forms are used to transmit 
the information collected in the performance of this study to the Sponsor and regulatory 
authorities. eCRFs must be completed in English. Data are transcribed directly onto eCRFs.
After completion of the entry process, computer logic checks will be run to identify items, such as 
inconsistent dates, missing data, and questionable values. Queries may be issued by Takeda 
personnel (or designees) and will be answered by the study site.
Corrections are recorded in an audit trail that captures the old information, the new information, 
identification of the person making the correction, the date the correction was made, and the reason 
for change.
The investigator must review the eCRFs for completeness and accuracy and must sign and date the 
appropriate eCRFs as indicated. Furthermore, the investigator must retain full responsibility for 
the accuracy and authenticity of all data entered on the eCRFs.
The following data will not be recorded in the eCRFs:

Laboratory results

Measurement results of drug concentrations
After the lock of the clinical study database, any change of, modification of, or addition to the data 
on the eCRFs should be made by the investigator or sub-investigator with use of change and 
modification records of the eCRFs. The investigator must review the data change for completeness 
and accuracy, and must e-sign.
eCRFs will be reviewed for completeness and acceptability at the study site during periodic visits 
by the Sponsor or its designee. The Sponsor or its designee will be permitted to review the 
subject’s medical and hospital records pertinent to the study to ensure accuracy of the eCRFs. The 
completed eCRFs are the sole property of the Sponsor and should not be made available in any 
form to third parties, except for authorized representatives of appropriate governmental health or 
regulatory authorities, without written permission of the Sponsor.
15.2
Record Retention
The investigator and the head of the study site agree to keep the records stipulated in Section 15.1
and those documents that include (but are not limited to) the study-specific documents, the 
identification log of all participating subjects, medical records, all original signed and dated 

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informed consent forms, electronic copy of eCRFs, including the audit trail, and detailed records 
of drug disposition to enable evaluations or audits from regulatory authorities, the Sponsor or its 
designees.
The investigator and the head of the study site are required to retain relevant essential documents 
until the day specified as 1 or 2 below, whichever comes later. However, if the Sponsor requests a 
longer time period for retention, the head of the study site should discuss how long and how to 
retain those documents with the Sponsor.
1. The day on which marketing approval for the study drug is obtained (or the day 3 years after 
the date of notification in the case that the investigation is discontinued.)
2. The day 3 years after the date of early termination or completion for the study.
In addition, the investigator and the head of the study site should retain the relevant essential 
documents until the receipt of a Sponsor-issued notification that states the retention is no longer 
required.

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16.0
REFERENCES
1. The Japanese Society of Gastroenterology. Evidence-based Clinical Practice Guidelines for 
Peptic Ulcer 2015 (2nd Edition). Nankodo; 2015.
2. Partial Revision of the Guideline for Bioequivalence Studies of Generic Products, PFSB
Notification No. 0229-10 (29 February 2012).
3. Enforcement Regulation on the Law for Securing a Stable Supply of Safe Blood Products, 
Ministry of Health and Welfare Ordinance No. 22 (25 June 1956).
4. Japan Society for the Study of Obesity. Diagnostic Criteria for Obesity 2011. Journal of Japan 
Society for the Study of Obesity 2011 (Extra Edition).
5. General Considerations for Clinical Trials, Pharmaceutical Safety Bureau Notification No. 380 
(21 April 1998).