A Phase 3 Multicenter, Randomized, Double-blind, Placebo-controlled, Clinical Study to Assess the Efficacy and Safety of Linzagolix in Subjects With Moderate to Severe Endometriosis-associated Pain.
Phase: PHASE3
Conditions: Endometriosis
Sponsor: Kissei Pharmaceutical Co., Ltd.

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OBSEVA CONFIDENTIAL 
CLINICAL STUDY PROTOCOL 
 
Protocol Number: 
18-OBE2109-002 
Investigational Medicinal 
Product: 
Linzagolix (OBE2109) 
Study Title: 
A Phase 3 multicenter, randomized, double-blind, placebo-
controlled, clinical study to assess the efficacy and safety of 
linzagolix in subjects with moderate to severe endometriosis-
associated pain. 
Short Study Title: 
A phase 3 study to confirm the efficacy and safety of 
linzagolix to treat endometriosis-associated pain. 
Study Name: 
Edelweiss 2 
Version number: 
Version 4.0 
Date: 
31 August 2020 
Replacing:  
Version 3.0 – 25 June 2019 
Study Sponsor: 
 
ObsEva S.A. 
  
 
Clinical Trial Director: 
 
 
 
 
Medical Responsible: 
 
  
 
CRO 
 
 
CRO Project Director: 
  
  
 
 

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OBSEVA CONFIDENTIAL 
 
VERSION HISTORY 
Amendment 
Number 
Amendment 
Date 
General / Country-Specific/ 
Site-Specific 
Amended Protocol 
version and date 
01 
March 28, 2019 
General 
V2.0 – March 28, 2019 
02 
June 25, 2019 
General 
V3.0 – June 25, 2019 
03 
August 31, 2020 
General 
V4.0 – August 31, 2020 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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OBSEVA CONFIDENTIAL 
 
 
CONFIDENTIAL AND PROPRIETARY 
This protocol contains confidential and proprietary information about an investigational drug and is 
provided by ObsEva S.A., Plan-les-Ouates, Geneva, Switzerland, for the exclusive use of the 
Investigators of this clinical study and their Health Authorities/IRBs/IECs. This confidential 
information may not be disclosed to any other person without prior written consent of ObsEva S.A. 
Note: Other ObsEva or delegate personnel who may be contacted by study site personnel for this study 
are listed in a separate document, which will be updated on a regular basis when necessary. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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OBSEVA CONFIDENTIAL 
SPONSOR 
AND 
CONTRACT 
RESEARCH 
ORGANIZATION(S) 
SIGNATORY APPROVAL PAGE 
The below signatories have read this trial protocol and agree with its principles. They agree to carry out 
the clinical trial in compliance with this protocol, with ICH Good Clinical Practice (ICH GCP) and the 
applicable regulatory requirements. 
Sponsor: 
ObsEva S.A., 
 
 
Signature 
ate of signature 
 
(Clinical Trial Director) 
 
 
Signature 
Date of signature 
 
 
(Medical Responsible) 
 
 
 
Contract Research Organization(s): 
 
 
 
 
Signature 
 
Date of signature 
 
 
 
(Project Director) 
 
 
 
 

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OBSEVA CONFIDENTIAL 
INVESTIGATOR ENDORSEMENT PAGE 
I, the undersigned, am responsible for the conduct of the study at this site and agree to the following: 
 
I understand and will conduct the study according to the protocol, any approved protocol 
amendments, ICH GCP and all applicable regulatory authority requirements and national laws. 
 
I will not deviate from the protocol without prior written permission from the sponsor and prior 
review and written approval from the Institutional Review Board or Independent Ethics 
Committee, except where necessary to prevent any immediate danger to the subject. 
 
I have read and understand fully the Investigator Brochure (IB) for linzagolix, and I am familiar 
with the Investigational Medicinal Product (IMP) and its use according to this protocol. 
 
I have sufficient time to properly conduct and complete the trial within the agreed trial period, 
and I have available an adequate number of qualified staff and adequate facilities for the 
foreseen duration of the trial to conduct the trial properly and safely. 
 
I will ensure that any staff at my site(s) who are involved in the study conduct are adequately 
trained regarding the IMP, the protocol and their responsibilities. In the case of delegating any 
of my study responsibilities I will provide the sponsor with a Delegation of Activities certificate. 
 
I understand that some regulatory authorities require sponsors of clinical studies to obtain and 
supply, when required, details about the Investigators’ ownership interests in the sponsor or the 
Investigational Medicinal Product and information regarding any financial ties with the sponsor. 
The sponsor will use any such information that is collected solely for the purpose of complying 
with regulatory requirements. I therefore agree to supply the sponsor with any necessary 
information regarding ownership interest and financial ties (including those of my spouse and 
dependent children), and to provide updates as necessary. 
 
 
 
 
 
 
Signature 
 
Date of signature 
PI Name: 
Institution: 
 
 
 
 

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OBSEVA CONFIDENTIAL 
1 TABLE OF CONTENTS  
1 
TABLE OF CONTENTS ........................................................................................................ 6 
2 
LIST OF FIGURES ............................................................................................................. 11 
3 
LIST OF ABBREVIATIONS ................................................................................................. 12 
4 
SYNOPSIS ....................................................................................................................... 17 
5 
BACKGROUND INFORMATION........................................................................................ 30 
5.1 
INTRODUCTION TO LINZAGOLIX .......................................................................................... 30 
5.2 
ENDOMETRIOSIS .................................................................................................................. 30 
5.3 
CONVENTIONAL TREATMENT OF ENDOMETRIOSIS ............................................................. 30 
5.4 
SUMMARY OF NON-CLINICAL STUDIES ................................................................................ 31 
5.4.1 
Non-Clinical Pharmacology .................................................................................................. 31 
5.4.2 
Non-Clinical Pharmacokinetics and Toxicology.................................................................... 32 
5.4.3 
Non-clinical summary .......................................................................................................... 33 
5.5 
SUMMARY OF CLINICAL STUDIES ......................................................................................... 33 
5.5.1 
Pharmacokinetics/Pharmacodynamics ................................................................................ 33 
5.5.2 
Efficacy ................................................................................................................................. 35 
5.5.3 
Safety  .................................................................................................................................. 35 
5.6 
RATIONALE FOR THE CURRENT STUDY ................................................................................ 36 
5.7 
SUMMARY OF OVERALL RISKS AND BENEFITS ..................................................................... 37 
6 
OBJECTIVES .................................................................................................................... 38 
6.1 
EFFICACY OBJECTIVES .......................................................................................................... 38 
6.1.1 
Primary ................................................................................................................................. 38 
6.1.2 
Secondary ............................................................................................................................ 38 
6.2 
SAFETY OBJECTIVES .............................................................................................................. 39 
6.3 
EXPLORATORY OBJECTIVES .................................................................................................. 39 
7 
ENDPOINTS .................................................................................................................... 39 
7.1 
EFFICACY ENDPOINTS .......................................................................................................... 39 
7.1.1 
Primary ................................................................................................................................. 39 
7.1.2 
Secondary ............................................................................................................................ 39 
7.2 
SAFETY ENDPOINTS .............................................................................................................. 41 
7.3 
EXPLORATORY ENDPOINTS .................................................................................................. 42 
8 
STUDY DESIGN................................................................................................................ 42 
9 
STUDY POPULATION ....................................................................................................... 44 
9.1 
SUBJECTS .............................................................................................................................. 44 
9.1.1 
Description of the target population ................................................................................... 44 
9.1.2 
Number of subjects .............................................................................................................. 44 
9.1.3 
Study region/location .......................................................................................................... 44 
9.2 
ENTRY CRITERIA ................................................................................................................... 44 
9.2.1 
Inclusion Criteria .................................................................................................................. 44 

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OBSEVA CONFIDENTIAL 
9.2.2 
Exclusion Criteria.................................................................................................................. 45 
10 
STUDY PROCEDURES AND ASSESSMENTS ....................................................................... 48 
10.1 
GENERAL INSTRUCTIONS ..................................................................................................... 48 
10.2 
OUTLINE OF STUDY PROCEDURES AND ASSESSMENTS ....................................................... 50 
10.2.1 
Screening Period – Screening visit ....................................................................................... 50 
10.2.2 
Treatment period ................................................................................................................. 53 
10.2.3 
Follow-up period without treatment for subjects not entering the extension study .......... 58 
10.3 
EFFICACY OBSERVATIONS AND MEASUREMENTS ............................................................... 61 
10.3.1 
Modified Biberoglu and Behrman questionnaire ................................................................ 62 
10.3.2 
Daily diary ............................................................................................................................ 62 
10.3.3 
Outcome rating scales assessed at site visits ....................................................................... 64 
10.4 
SAFETY OBSERVATIONS AND MEASUREMENTS ................................................................... 68 
10.4.1 
Adverse Events ..................................................................................................................... 68 
10.4.2 
Physical Examination ........................................................................................................... 68 
10.4.3 
Vital signs ............................................................................................................................. 69 
10.4.4 
Transvaginal ultrasound ....................................................................................................... 69 
10.4.5 
Endometrial biopsies ........................................................................................................... 69 
10.4.6 
Bone mineral density and DXA ............................................................................................ 71 
10.4.7 
Bone markers ....................................................................................................................... 71 
10.4.8 
Laboratory parameters ........................................................................................................ 72 
10.4.9 
Electrocardiogram ................................................................................................................ 72 
10.4.10 
Columbia-Suicide Severity Rating Scale (C-SSRS) ................................................................. 72 
10.5 
LINZAGOLIX AND KP017 PLASMA LEVELS ............................................................................ 72 
10.6 
CONCOMITANT MEDICATIONS AND THERAPIES ................................................................. 73 
10.6.1 
Permitted Medicines ............................................................................................................ 73 
10.6.2 
Prohibited Medicines ........................................................................................................... 74 
10.6.3 
Non-Drug Therapies ............................................................................................................. 74 
10.7 
SUBJECT COMPLETION AND WITHDRAWAL ........................................................................ 75 
10.7.1 
Subject Completion .............................................................................................................. 75 
10.7.2 
Subject Withdrawal .............................................................................................................. 75 
10.7.3 
Subject Replacement ........................................................................................................... 77 
11 
INVESTIGATIONAL MEDICINAL PRODUCT ....................................................................... 77 
11.1 
DESCRIPTION OF INVESTIGATIONAL MEDICINAL PRODUCTS .............................................. 77 
11.2 
DOSAGE AND ADMINISTRATION.......................................................................................... 78 
11.3 
PACKAGING AND LABELLING ............................................................................................... 79 
11.4 
PREPARATION, HANDLING AND STORAGE .......................................................................... 80 
11.5 
IMP ACCOUNTABILITY .......................................................................................................... 81 
11.6 
ASSIGNMENT TO TREATMENT GROUPS .............................................................................. 82 
11.7 
ASSESSMENT OF INVESTIGATIONAL MEDICINAL PRODUCT COMPLIANCE.......................... 82 

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OBSEVA CONFIDENTIAL 
11.8 
METHOD OF BLINDING ........................................................................................................ 82 
11.9 
EMERGENCY UNBLINDING ................................................................................................... 83 
11.10 
TREATMENT OF OVERDOSE AND MISUSE............................................................................ 83 
11.11 
OTHER SUPPLIES TO BE USED IN THE STUDY ....................................................................... 83 
12 
ADVERSE EVENTS AND SERIOUS ADVERSE EVENTS ........................................................ 83 
12.1 
ADVERSE EVENTS ................................................................................................................. 84 
12.1.1 
Definitions ............................................................................................................................ 84 
12.1.2 
Abnormal laboratory findings and other objective measurements..................................... 86 
12.1.3 
Baseline Medical Conditions ................................................................................................ 86 
12.1.4 
Exacerbation of endometriosis ............................................................................................ 86 
12.1.5 
Adverse Events of Special Interest ....................................................................................... 86 
12.2 
PROCEDURES FOR ELICITING, RECORDING AND REPORTING ADVERSE EVENTS ................. 87 
12.2.1 
Eliciting Adverse Events ....................................................................................................... 87 
12.2.2 
Recording of Adverse Events in the eCRF ............................................................................ 87 
12.2.3 
Reporting of Adverse Events ................................................................................................ 87 
12.3 
SERIOUS ADVERSE EVENTS .................................................................................................. 88 
12.3.1 
Definitions ............................................................................................................................ 88 
12.3.2 
SAE Urgent Reporting Procedure ......................................................................................... 89 
12.4 
REPORTING TO THE INSTITUTIONAL REVIEW BOARDS AND REGULATORY AUTHORITIES .. 90 
12.5 
REPORTING PERIOD ............................................................................................................. 90 
12.6 
PREGNANCY AND IN UTERO DRUG EXPOSURE .................................................................... 91 
13 
DATA ANALYSIS AND STATISTICS .................................................................................... 92 
13.1 
TEST OF HYPOTHESES .......................................................................................................... 92 
13.2 
SAMPLE SIZE ......................................................................................................................... 93 
13.3 
RANDOMIZATION................................................................................................................. 93 
13.4 
ANALYSIS SETS ..................................................................................................................... 93 
13.5 
DATA ANALYSIS .................................................................................................................... 94 
13.5.1 
Baseline Assessment ............................................................................................................ 95 
13.5.2 
Primary Efficacy Analysis ...................................................................................................... 95 
13.5.3 
Secondary Efficacy Analysis ................................................................................................. 96 
13.5.4 
Additional Efficacy Analysis .................................................................................................. 99 
13.5.5 
Safety Analysis ..................................................................................................................... 99 
13.5.6 
Pharmacokinetic analysis methodology ............................................................................ 100 
13.5.7 
Pharmacodynamic analysis methodology ......................................................................... 100 
13.5.8 
Missing Data....................................................................................................................... 101 
13.6 
STUDY SPECIFIC DATA ANALYSIS ........................................................................................ 101 
13.6.1 
Responder Threshold Analysis ........................................................................................... 101 
13.6.2 
End-of-Treatment Period Analysis ..................................................................................... 101 
13.6.3 
Treatment Free Follow-Up Period Analysis ....................................................................... 101 

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OBSEVA CONFIDENTIAL 
14 
STUDY ADMINISTRATION ............................................................................................. 102 
14.1 
REGULATORY AND ETHICAL CONSIDERATIONS ................................................................. 102 
14.1.1 
Informed Consent .............................................................................................................. 102 
14.1.2 
Regulatory Authority Approval .......................................................................................... 102 
14.1.3 
Institutional Review Board Requirements / Research Ethics Boards ................................. 102 
14.1.4 
End of the study ................................................................................................................. 102 
14.2 
INVESTIGATOR RESPONSIBILITIES ...................................................................................... 103 
14.3 
DATA MANAGEMENT ......................................................................................................... 103 
14.4 
STUDY MONITORING ......................................................................................................... 103 
14.5 
DATA MONITORING COMMITTEE ...................................................................................... 103 
14.6 
SUBJECT CONFIDENTIALITY ................................................................................................ 104 
14.7 
QUALITY ASSURANCE ......................................................................................................... 104 
14.8 
PROTOCOL DEVIATIONS ..................................................................................................... 104 
14.9 
STUDY OR SITE DISCONTINUATION ................................................................................... 104 
14.10 
RETENTION OF ESSENTIAL STUDY DOCUMENTS ................................................................ 105 
14.11 
PUBLICATION POLICY ......................................................................................................... 105 
 
 

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15 
APPENDICES ................................................................................................................. 106 
APPENDIX A. SCHEDULE OF STUDY ASSESSMENTS – SCREENING AND TREATMENT PERIODS ............ 107 
APPENDIX B. SCHEDULE OF STUDY ASSESSMENTS – FOLLOW-UP PERIOD ......................................... 112 
APPENDIX C. MODIFIED BIBEROGLU & BEHRMAN SYMPTOM SEVERITY SCALE* ............................... 115 
APPENDIX D. ENDOMETRIOSIS HEALTH PROFILE QUESTIONNAIRE (EHP-30) ..................................... 117 
APPENDIX E. PROMIS FATIGUE – SHORT FORM 6A ........................................................................... 122 
APPENDIX F. HEALTH-RELATED PRODUCTIVITY QUESTIONNAIRE (HRPQ) ......................................... 123 
APPENDIX G. HEALTH RESOURCE UTILIZATION QUESTIONNAIRE (HRUQ) .......................................... 125 
APPENDIX H. PATIENT GLOBAL IMPRESSION OF CHANGE (PGIC) ....................................................... 130 
APPENDIX I. POST-TREATMENT PATIENT GLOBAL IMPRESSION OF CHANGE (PPGIC) ....................... 131 
APPENDIX J. PATIENT GLOBAL IMPRESSION OF SEVERITY (PGIS) ...................................................... 132 
APPENDIX K. SUBJECT SURGERY INTENTION QUESTIONNAIRE (SSIQ) ................................................ 133 
APPENDIX L. PHYSICIAN SURGERY INTENTION QUESTIONNAIRE (PSIQ) ............................................ 134 
APPENDIX M. EQ-5D-5L ...................................................................................................................... 135 
APPENDIX N. LABORATORY PARAMETERS ......................................................................................... 138 
APPENDIX O. ANALGESIC CHANGE DURING TREATMENT PERIOD ...................................................... 139 
APPENDIX P. STRONG CYP3A4 INDUCERS AND INHIBITORS .............................................................. 141 
APPENDIX Q. REFERENCE LIST ............................................................................................................ 143 
APPENDIX R. BASELINE C-SSRS .......................................................................................................... 145 
APPENDIX S. C-SSRS ALREADY ENROLLED SUBJECTS ......................................................................... 148 
APPENDIX T. C-SSRS SINCE LAST VISIT ............................................................................................... 151 
 
 

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OBSEVA CONFIDENTIAL 
2 LIST OF FIGURES 
FIGURE 1 : STUDY DESIGN ............................................................................................................................................ 43 
FIGURE 2 : SCHEDULE OF VISITS .................................................................................................................................... 50 
FIGURE 3 : BIOPSY PROCESS FOR MONTH 6 STUDY VISIT .................................................................................................... 70 
FIGURE 4 : BIOPSY PROCESS FOR THE FOLLOW-UP PERIOD VISITS .......................................................................................... 70 
FIGURE 5 : LINZAGOLIX/PLACEBO KIT DESIGN ................................................................................................................... 80 
 

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OBSEVA CONFIDENTIAL 
3 LIST OF ABBREVIATIONS 
ABT 
Add-Back Therapy 
AE 
Adverse Event 
Al 
Aluminum 
ALT 
ALanine amino Transferase 
APTT 
Activated Partial Thromboplastin Time 
AMH 
Anti-Müllerian Hormone 
AST 
ASpartate amino Transferase 
AUC 
Area Under the Curve 
AUC (24hr) 
Area Under the plasma concentration time Curve from time 0 to 24hr post-
dose 
AUC0-∞ 
Area Under the Curve from time 0 to infinite time 
AUC0-t 
Area Under the Curve from time 0 to the last measurable time 
AUCτ 
Area Under the Curve to the end of the dosing period 
BMD 
Bone Mineral Density 
BMI 
Body Mass Index 
BP 
Blood Pressure 
Bpm 
Beats Per minute 
°C 
Degree Celsius 
CDF 
Cumulative Distribution Function 
CK 
Creatine Kinase 
ClinRO 
Clinician Reported Outcome 
Cm 
Centimeter(s) 
COC 
Combined Oral Contraceptive 
CRA 
Clinical Research Associate 
CRO 
Contract Research Organization 
C-SSRS 
Columbia-Suicide Severity Rating Scale 

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OBSEVA CONFIDENTIAL 
CTx 
C-terminal telopeptide  
CV 
Coefficient of Variation 
CYP 
CYtochrome P 
DMC 
Data Monitoring Committee 
dPGIS 
Patient Global Impression of Severity – daily recall  
DXA 
Dual-energy X-ray Absorptiometry 
DYS 
Dysmenorrhea 
E2 
Estradiol 
EAP 
Endometriosis-Associated Pain 
ECG 
ElectroCardioGram 
eCRF 
Electronic Case Report Form 
eDiary 
Electronic Diary 
EHP-30 
Endometriosis Health Profile – 30 
ePRO 
Electronic Patient Reported Outcome 
EQ-5D-5L 
EuroQol 5 Dimension 5 Level questionnaire 
EU 
European Union 
FAS 
Full Analysis Set 
FDA 
Food and Drug Administration 
FU 
Follow-Up 
FSH 
Follicle-Stimulating Hormone 
G 
Gram(s) 
GCP 
Good Clinical Practice 
γGT 
Gamma-Glutamyl Transferase 
GGT 
Gamma-Glutamyl Transpeptidase 
GMP 
Good Manufacturing Practice 
hGnRH 
human Gonadotropin Releasing Hormone 
HDL 
High Density Lipoprotein 

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OBSEVA CONFIDENTIAL 
HIV 
Human Immunodeficiency Virus 
Hr 
hour 
HRPQ 
Health Related Productivity Questionnaire 
HRUQ 
Health Resource Utilization Questionnaire 
IB 
Investigator Brochure 
ICF 
Informed Consent Form 
ICH 
International Conference on Harmonization 
IMP 
Investigational Medicinal Product 
INN 
International Nonproprietary Name 
INR 
International Normalized Ratio 
IRB 
Institutional Review Board 
IUD 
Intra-Uterine Device 
IWRS 
Interactive Web Response System 
Kg 
Kilogram(s) 
L 
Liter(s) 
LDH 
Lactate DeHydrogenase 
LDL 
Low Density Lipoprotein 
LEEP 
Loop Electrosurgical Excision Procedure 
LFT 
Liver Function Test 
LH 
Luteinizing Hormone 
LOQ 
Limit Of Quantification 
mB&B 
Modified Biberoglu & Behrman 
MCH 
Mean Corpuscular Haemoglobin 
MCHC 
Mean Corpuscular Haemoglobin Concentration 
MCV 
Mean Corpuscular Volume 
Mg 
Milligram(s) 
Min 
Minute(s) 

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OBSEVA CONFIDENTIAL 
mL 
Milliliter(s) 
MME 
Morphine Milligram Equivalent 
mmHg 
millimeter of mercury 
mPGIS 
Patient Global Impression of Severity – monthly recall  
msec 
Millisecond 
nmol 
Nanomole(s) 
NETA 
NorEThisterone Acetate 
NMPP 
Non-Menstrual Pelvic Pain 
NOAEL 
No Observed Adverse Effect level 
NRS 
Numeric Rating Scale 
NSAID 
Non Steroidal Anti-Inflammatory Drug 
OAT3 
Organic Anion Transporter 3 
OBE2109 
(2-Hydroxyethyl)trimethylammonium-3-[2-fluoro-5-(2,3-difluoro-6-
methoxybenzyloxy)-4-methoxyphenyl]-2,4-dioxo-1,2,3,4-
tetrahydrothieno[3,4-d]pyrimidine-5-carboxylate 
P1NP 
Procollagen type 1 N-terminal Propeptide  
P4 
Progesterone 
PAP 
PAPanikolaou test 
PD 
PharmacoDynamics 
PDF 
Probability Density Function 
PGIC 
Patient Global Impression of Change 
PPGIC 
Post-treatment Patient Global Impression of Change 
PGIS 
Patient Global Impression of Severity 
PK 
Pharmacokinetic 
PP 
Per Protocol 
PSF 
Pregnancy Surveillance Form 
PSIQ 
Pysician Surgery Intention Question 
PT 
Prothrombin Time 

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OBSEVA CONFIDENTIAL 
PVC/Al 
PolyVinyl Chloride/Aluminum 
QD 
Once daily (from the Latin Quaque Die)  
QoL 
Quality of Life 
QTc 
QT interval corrected for heart rate  
QTcF 
QT interval corrected for heart rate (QTc) using Fridericia's correction 
formula 
RBC 
Red Blood Cell 
REB 
Research Ethics Board 
ROC 
Receiver Operating Characteristic 
SAE 
Serious Adverse Event 
SAP 
Statistical Analysis Plan 
SERM 
Selective Estrogen Receptor Modulator 
SIN 
Subject Identification Number 
SPRM 
Selective Progesterone Receptor Modulator 
SHBG 
Sex Hormone-Binding Globulin 
SLE 
Systemic Lupus Erythematosus 
SSIQ 
Subject Surgery Intention Question 
SUSAR 
Suspected Unexpected Serious Adverse Reaction  
T1/2 
Elimination half-life 
TEAE(s) 
Treatment Emergent Adverse Event(s) 
TVUS 
TransVaginal UltraSound 
ULN 
Upper Limit of Normal 
US/USA 
United States/United States of America 
VAS 
Visual Analogue Scale 
VRS 
Verbal Rating Scale 
WBC 
White Blood Cell 
WHO 
World Health Organization 

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OBSEVA CONFIDENTIAL 
4 SYNOPSIS 
Study Title: A Phase 3, multicenter, randomized, double-blind, placebo-controlled, clinical study to 
assess the efficacy and safety of linzagolix in subjects with moderate to severe endometriosis-
associated pain. 
Code/Name ObsEva Investigational Drug: linzagolix (OBE2109) Phase of Development: 3 
Objectives: 
The primary objective of this study is to demonstrate the efficacy and safety of linzagolix 
administered orally once daily for up to 3 months at a dose of 75 mg alone or of 200 mg in 
combination with add-back hormone replacement therapy (ABT: estradiol (E2) 1 mg / norethisterone 
acetate (NETA) 0.5 mg) versus placebo, while under randomized treatment, in the management of 
moderate to severe endometriosis-associated pain (EAP) in women with surgically confirmed 
endometriosis. The two co-primary efficacy endpoints will be clinically meaningful reduction over 
the last 28 days of randomized treatment up to the Month 3 visit, along with a stable or decreased 
use of analgesics for EAP, for 1) dysmenorrhea (DYS) and for 2) non-menstrual pelvic pain (NMPP) .  
Secondary objectives include evaluation of persistence of efficacy over the last 28 days of 
randomized treatment up to the Month 6 visit, evaluation of pain associated with sexual intercourse 
(dyspareunia) and defecation (dyschezia), difficulty of doing daily activities, analgesic use, 
assessment of subject perception of severity, change in uterine bleeding, Quality of Life (QoL) 
questionnaires, pharmacoeconomic burden of endometriosis by assessing changes in patient 
productivity, assessment of endometriosis related number of non-study health visits, number of days 
in hospital and type of medical procedures performed during the Treatment Period. 
Safety and tolerability objectives include assessment of bone mineral density (BMD), endometrial 
health, cardiac safety including QT interval prolongation, standard laboratory safety parameters, 
gynecological assessments and adverse event (AE) frequency including specific hypoestrogenic AEs. 
Exploratory objectives include assessment of bone turnover markers and collection of 
pharmacokinetic (PK) and pharmacodynamic (PD) data of linzagolix for a separate modelling 
exercise. 
Endpoints: 
Efficacy endpoints  
 
Primary efficacy endpoints:  
The two co-primary, composite, efficacy endpoints are clinically meaningful reduction from 
baseline to the last 28 days preceding the Month 3 visit (the 4-week period preceding Month 3 
visit) or, for subjects who discontinue randomized treatment prior to the Month 3 visit, to the last 
28 days of randomized treatment,  , along with a stable or decreased use of analgesics for EAP, 
in the mean daily assessment of 1) DYS and of 2) NMPP, both measured on a Verbal Rating 
Scale (VRS) using an electronic diary (eDiary).. 

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OBSEVA CONFIDENTIAL 
 
 
Secondary efficacy endpoints:  
 
Ranked secondary efficacy endpoints (in the order of the endpoints to be tested): 
 
Change from baseline to Month 6 in DYS (VRS) 
 
Change from baseline to Month 6 in NMPP (VRS) 
 
Change from baseline to Month 6 in dyschezia (Numeric Rating Scale - NRS) 
 
Change from baseline to Month 6 in overall pelvic pain (NRS) 
 
Change from baseline to Month 6 in the interference of pain with the ability to perform 
daily activities, measured using the pain dimension of the Endometriosis Health 
Profile-30 (EHP-30)  
 
Change from baseline to Month 6 in dyspareunia (VRS) 
 
No analgesics use for EAP during the preceding 4-week period at Month 6 
 
No opiate use for EAP during the preceding 4-week period at Month 6 
 
Additional secondary efficacy endpoints : 
 
Clinically meaningful reduction at scheduled visits other than Month 3 for DYS and 
NMPP  
 
Change from baseline to each scheduled assessment in the mean pelvic pain scores for 
DYS, NMPP and overall pelvic pain, during the previous 4-week period assessed on the 
NRS and VRS 
 
Change from baseline to each scheduled assessment in the number of days with 
moderate to severe pelvic pain during the previous 4-week period assessed on the VRS 
 
Change from baseline to each scheduled assessment in the mean worst pelvic pain score 
defined as the mean of the 5 highest daily pain scores reported during the previous 4-
week period assessed on the NRS 
 
Change from baseline to each scheduled assessment in the mean of daily dyspareunia 
scores reported during the previous 4-week period on the dyspareunia VRS  
 
Change from baseline to each scheduled assessment in the mean of daily dyschezia 
scores reported during the previous 4-week period assessed on the dyschezia NRS 
 
Change from baseline to each scheduled assessment in non-opioid, opioid and combined 
analgesic use for EAP during the previous 4-week period based on pill count in the 
eDiary 
 
Change from baseline to each scheduled assessment in opioid analgesic use for EAP as 
reported in the eDiary during the previous 4-week period based on morphine milligram 
equivalent (MME) 

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 
Change from baseline to each scheduled assessment in the number of days of analgesic 
use (including any class) for EAP during the previous 4-week period as assessed in the 
eDiary 
 
Change from baseline to each scheduled assessment in the number of days of opioid 
analgesic use for EAP during the previous 4-week period as assessed in the eDiary 
 
Change from baseline to each scheduled assessment in the number of pelvic pain-free 
days (assessed on the VRS) during the previous 4-week period  
 
Change from baseline to each scheduled assessment in ability to perform daily activities 
during the previous 4-week period, as assessed in the eDiary (daily function NRS) 
 
Change from baseline to each scheduled assessment in the number of days with no 
difficulty in doing daily activities due to EAP during the previous 4-week period as 
assessed in the eDiary (daily function NRS) 
 
Change from baseline to each scheduled assessment in the number of days when 
dyspareunia was a problem during the previous 4-week period (including days when 
sexual intercourse was avoided because of anticipation of pain) as assessed on the 
dyspareunia VRS 
 
Change from baseline to each scheduled assessment in the number of days when sexual 
intercourse was avoided because of anticipation of pain during the previous 4-week 
period as assessed on the dyspareunia VRS 
 
Change from baseline to each scheduled assessment in the number of days with uterine 
bleeding (including spotting) during the previous 4-week period measured by eDiary 
 
Change from baseline to each scheduled assessment in the number of days when school 
or work was missed due to EAP in the previous 4-week period as reported in the eDiary 
 
Change from baseline to each scheduled assessment in the number of days when the 
subject had to go to bed or lie down due to EAP in the previous 4-week period as 
reported in the eDiary 
 
 
 
Change from baseline to each scheduled assessment in the Pain, Control and 
powerlessness, Emotional well-being, Social support, Self-image dimensions and the 
Modular sexual relationship questionnaire of EHP-30 scores 
 
Change from baseline to each scheduled assessment in the Health Related Productivity 
Questionnaire (HRPQ) scores 
 
Number of non-study endometriosis related health visits, number of days in hospital and 
type of procedures performed based on Health Resource Utilization Questionnaire 
(HRUQ) at each scheduled assessment 
 
Change from baseline to each scheduled assessment in the Physician/Subject Surgery 
Intention Question (PSIQ/SSIQ) 

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 
Change from baseline to each scheduled assessment in the PROMIS Fatigue – Short 
Form 6a 
 
Change from baseline to each scheduled assessment in the EuroQoL 5-Dimension 5-
Level (EQ-5D-5L) questionnaire 
 
Response at each scheduled assessment according to Patient Global Impression of 
Change (PGIC) (and Post-treatment Patient Global Impression of Change, PPGIC) 
 
Change from baseline to each scheduled assessment in the monthly PGIS (mPGIS) score 
Safety endpoints 
 
Change from baseline to each scheduled assessment in BMD measured by dual-energy 
X-ray absorptiometry (DXA) of lumbar spine (L1-L4), femoral neck, and total hip 
 
Incidence and severity of treatment emergent adverse events (TEAEs) 
 
Incidence and severity of hypoestrogenic TEAEs (hot flush) 
 
Time to the first post-treatment menses 
 
Changes in clinical laboratory assessments (hematology, biochemistry, coagulation 
parameters, hormones, lipids and urinalysis) from baseline to each scheduled assessment 
 
Any pathological changes from baseline in the endometrium as assessed by histology 
from endometrial biopsies 
 
Changes from baseline to each scheduled assessment in any other safety parameter 
including weight, vital signs, electrocardiogram (ECG), gynecological assessments and 
endometrial thickness 
Exploratory endpoints 
 
Change from baseline in bone turnover markers at each scheduled assessment 
 
PK and PD of linzagolix 
Study Design: This is a prospective, randomized, double-blind, placebo-controlled study to 
demonstrate the efficacy and safety of linzagolix administered orally once daily at doses of 75 mg 
alone and 200 mg in combination with low dose ABT (E2 1 mg/NETA 0.5 mg) versus placebo in the 
management of moderate to severe EAP in women with surgically confirmed endometriosis. 
The study starts with an approximately 3-month screening period during which subjects will receive 
no study drug. Eligibility will be confirmed based on data collected during the screening period. After 
randomization, a 6-month Treatment Period will follow. Subjects will be randomized to one of the 
three treatment groups: 
1. Linzagolix 75 mg  
2. Linzagolix 200 mg combined with ABT  
3. Placebo  

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Randomization will be conducted via an interactive web response system (IWRS) in a 1:1:1 ratio. There 
will be no stratification. 
At 6 months, BMD change will be assessed via DXA measurement. Eligible subjects who have 
completed the 6-month treatment period may enter a separate extension study for 6 additional months 
of active treatment (no placebo control). In this extension study, subjects who previously received 
placebo will be randomly switched to one of the two active treatments (75 mg alone or 200 mg + 
ABT). Subjects who received active treatment will continue with the same treatment. 
Subjects who decline to participate to or do not qualify for the extension study and who were exposed 
to at least 3 months of treatment will enter a 6-month drug-free follow-up. At the end of the 6-month 
follow-up period, subjects with a BMD decrease from baseline of >1.5% for lumbar spine and >2.5% 
for total hip will have an additional DXA scan 6 months later. Subjects who discontinue treatment 
prior to Month 3 will not enter the follow-up period.  
The main analysis will be performed after 6 months of treatment and will include all of the subjects’ 
data up to Month 6. 
The study will last on average 15 months; 3-month Screening Period, 6-month Treatment Period and 
6-month Follow-up (with 1 month being defined as 28 days/4 weeks). The duration excludes any 
washout period. 
All subjects will receive once daily either linzagolix 75 mg alone or 200 mg combined with ABT or 
placebo for 6 months. Linzagolix or its corresponding placebo will be supplied as tablets for oral 
administration. ABT or its corresponding placebo will be supplied as capsules for oral administration.  
Linzagolix/placebo treatments will be provided in monthly treatment kits, packaged, labelled and 
administered in the same manner to protect the blinded nature of the trial. ABT/placebo treatments 
will be supplied as 3-monthly kits, packaged, labelled and administered in the same manner to protect 
the blinded nature of the trial. Blinded treatment kit numbers corresponding to each subject’s 
randomized treatment will be provided through an IWRS. 
Study Population: The target population will be premenopausal women aged 18 to 49 years inclusive 
at screening, with surgically and, if available, histologically confirmed pelvic endometriosis and with 
moderate to severe EAP. They must not be planning to become pregnant and must agree to use double 
non-hormonal barrier contraception from screening until 3 months after the end of treatment. From 3 
months after the end of treatment to the end of the drug-free follow-up period, contraception is still 
mandatory but hormonal contraception is allowed. 
Four hundred and fifty (450) randomized subjects are planned in total (approximately 150 subjects per 
group). It is expected that the screen failure rate will be around 70%. Therefore, approximately 1500 
subjects will be screened in order to randomize 450 subjects into the study.  
The study will be conducted in approximately 130 investigational sites in the Unites States (US) and 
Canada. Additional sites will be identified, qualified and activated in case of recruitment issues. 
Recruitment will be competitive between countries and sites. 
 

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Eligibility Criteria:  
Inclusion Criteria 
To be eligible for inclusion into this study, the subject must fulfill all of the following criteria: 
1. The subject must provide written informed consent prior to any study related procedures. 
2. The subject must be a female subject aged 18 years to 49 years inclusive. 
3. The subject must have had her most recent surgical and – if available – histological diagnosis 
of pelvic endometriosis (laparoscopy, laparotomy, vaginal fornix or other biopsy) up to 10 years 
before screening. 
4. The subject must agree to the washout intervals for prohibited therapies (if applicable). 
5. The subject must agree to switch from her usual analgesic rescue medication to only those 
permitted by the protocol during the Screening, Treatment and Follow-up Period. 
6. The subject has moderate to severe EAP during the screening period defined as: 
a. At the screening visit, a score of at least 2 for DYS and at least 2 for NMPP for the 
previous month assessed with the modified Biberoglu & Behrman (mB&B) scale. 
b. Over two full menstrual cycles (i.e. from day 1 of the first menstruation going over two 
spontaneous menstrual cycles up to the day before the next menstruation i.e. the third 
menstruation) finishing just before the baseline visit: 
i. Mean overall pelvic pain scores of at least 4 on the 0–10 NRS over the 5 days 
with the highest score for each cycle separately, i.e. required for both cycles; 
ii. At least two days with “moderate” or “severe” pain on the 0–3 VRS for pelvic 
pain over the days with uterine bleeding for each cycle separately, i.e. required 
for both cycles; 
iii. At least two days with “moderate” or “severe” pain on the 0–3 VRS for pelvic 
pain over the days without uterine bleeding for each cycle separately, i.e. 
required for both cycles. 
7. The subject is compliant with eDiary completion i.e. has completed at least 75% of days during 
the screening period. 
8. The subject has regular menstrual cycles and the total length of the two screening menstrual 
cycles should be between 42 and 76 days inclusive. 
9. The subject has a Body Mass Index (BMI) ≥ 18 kg/m2 at the screening visit. 
10. If of childbearing potential, the subject agrees to use one of the following birth control methods 
during the Screening Period, the entire Treatment Period of the study and until 3 months after 
the end of treatment: 
a. Sexual abstinence, if this is the subject's habitual practice and/or the subject is routinely 
abstinent from heterosexual intercourse, 
b. Partner with a vasectomy with confirmed azoospermia, 

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c. Double non-hormonal barrier contraception such as condom or diaphragm each 
combined with spermicide. 
11. If of non-childbearing potential, the subject must have had tubal ligation sterilization at least 
two months before the screening visit. 
12. The subject is ≥ 40 years of age at the screening visit has a normal mammogram within 1 year 
before randomization. 
13. The subject must be able to communicate well with the Investigator and research staff and to 
comply with the requirements of the study protocol. 
Exclusion Criteria 
To be eligible for inclusion in this study the subject must not meet any of the following criteria: 
1. The subject is pregnant or breast feeding or is planning a pregnancy within the duration of the 
Treatment Period of the study. 
2. The subject is less than 6 months postpartum or 3 months post-abortion/miscarriage at the time 
of entry into the screening period. 
3. The subject has a surgical history of: 
a. Hysterectomy,  
b. Bilateral oophorectomy, 
c. Vagotomy, bowel resection or any surgical procedure (including gastric surgery) that 
might interfere with gastrointestinal motility, pH, or absorption, 
d. Any major abdominal surgery (including laparotomy for endometriosis) within 6 
months or any interventional surgery for endometriosis performed within a period of 2 
months before screening, or the subject is scheduled for a surgical abdominal procedure 
during the course of the study. 
4. The subject had a tubal sterilization which was performed with ESSURE™. 
5. The subject had endometrial ablation resulting in amenorrhea. 
6. The subject has at least one ovarian endometrioma with a diameter of 7 cm or greater. 
7. The subject is likely to require treatment during the study OR received treatment within a 
specified period prior to screening with any of the medications listed below: 
a. 
Gonadotropin releasing hormone (GnRH) antagonists 
3 months 
b. 
GnRH agonist injections/3-month depot injections 
3/6 months 
c. 
Danazol 
3 months 
d. 
Oral contraceptives and other sex hormones 
1 month 
e. 
Depot contraceptives 
10 months 
f. 
Selective Progesterone Receptor Modulators (SPRMs), Selective 
Estrogen Receptor Modulators (SERMs) and aromatase inhibitors 
3 months 
g. 
Long acting narcotics (i.e. requiring less than once daily dosing) 
1 day 

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h. 
Systemic glucocorticoid treatments for acute diseases (not depot) 
1 month 
i. 
Medical (prescribed) marijuana 
1 week 
j. 
In situ copper intra-uterine device (IUD) 
1 day 
k. 
In situ IUD with progestogen 
1 month 
8. The subject is likely to use cannabinoids during the study washout, screening or treatment 
period. 
9.  The subject has required more than 2 weeks of continuous use of a narcotic analgesics for 
treatment of EAP within 6 months prior to Screening. 
10. The subject received strong CYP3A4 inducers or inhibitors that (might potentially) interact 
with ABT within 1 month prior to randomization. 
11. The subject has a contra-indication to ABT including: 
a. Active deep vein thrombosis, pulmonary embolism, or history of these conditions; 
b. Active or recent (e.g. within the past year) arterial thromboembolic disease (e.g. stroke, 
myocardial infarction); 
c. Known, suspected, or history of breast cancer; 
d. Known or suspected estrogen-dependent neoplasia;  
e. Known protein C, protein S, or antithrombin deficiency, or other known thrombophilia 
disorders, including Factor V Leiden; 
f. Migraine with aura; 
g. History of porphyria; 
h. Known hypersensitivity to the ingredients. 
12. The subject has a history of or current systemic glucocorticoid therapy for treatment of chronic 
diseases (e.g. Systemic Lupus Erythematosus (SLE), rheumatic arthritis). Inhaled 
glucocorticoids for e.g. asthma are not considered systemic glucocorticoids. 
13. The subject did not respond to prior treatment with GnRH agonists or GnRH antagonists for 
endometriosis. 
14. The subject has alanine aminotransferase (ALT), aspartate aminotransferase (AST), total 
bilirubin levels or gamma-glutamyl transpeptidase (GGT) level ≥ 2 times the upper limit of 
normal and indicative of potential liver damage at Screening or Day 1 (subjects with 
abnormalities at Day 1 will be withdrawn from study at reception of the results). 
15. The subject has clinically significant abnormal ECG, or ECG with QT interval corrected for 
heart rate (QTc) using Fridericia's correction formula (QTcF) > 450 msec at Screening or Day 
1 (prior to dosing). 
16. The subject has a known positive human immunodeficiency virus (HIV) or viral Hepatitis 
serology. 
17. The subject has abnormal uterine bleeding of undiagnosed cause. 

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18. The subject had/has clinically significant findings from a Papanikolaou (PAP) smear test 
performed within the past 12 months or at the screening visit which will require surgical 
intervention (e.g. Loop electrosurgical excision procedure (LEEP) or cervical conization). 
19. The subject has chronic pelvic pain that, in the opinion of the Investigator, is not caused by 
endometriosis and requires chronic analgesic or other chronic therapy which would interfere 
with the assessment of EAP (e.g., interstitial cystitis, presumptive adenomyosis, fibroids, non-
endometriosis-related pelvic adhesive disease, post-tubal ligation or irritable bowel syndrome).  
20. The subject has any other clinically significant gynecological condition identified during 
screening transvaginal ultrasound (TVUS) or endometrial biopsy which might interfere with 
the study efficacy and safety objectives (e.g. endometritis, endometrial hyperplasia). However, 
uterine fibroids (as long as uterus size ≤ 12 weeks, i.e. equivalent gestational weeks) and 
adenomyosis are allowed provided they do not interfere with the assessment of EAP (see 
previous criterion). 
21. The subject has any known condition, including findings in the medical history or in the 
screening assessments, which in the opinion of the Investigator constitutes a risk or a 
contraindication to the participation of the subject in the trial or that could interfere with the 
trial objectives, conduct or evaluation. 
22. The subject has a history of, or known, osteoporosis, hyperparathyroidism or other metabolic 
bone disease. 
a. Screening DXA results of the lumbar spine (L1–L4), femoral neck, or total hip BMD 
showing a Z-score ≤ –1.5  
b. Any condition that would interfere with obtaining adequate DXA measurements (e.g. 
weight [> 300 pounds or 136 kg], history of spinal surgery, spinal hardware, severe 
scoliosis) 
c. Intercurrent bone disease 
d. History of hip fracture 
e. History of pathologic or compression fractures 
f. History of bilateral hip replacement 
23. The subject has a mental condition rendering her unable to understand the nature, scope and 
possible consequences of the study, or evidence of an uncooperative attitude. 
24. The subject has current problem with alcohol or drug abuse (including painkiller abuse).  
25. The subject has been administered with any experimental drug in the 12 weeks before screening 
and/or has been randomized in Edelweiss 3 (Phase III) study protocol No. 18-OBE2109-003. 
26. The subject has calcium level above the upper limit of normal range at screening, which is 
confirmed on repeat fasting testing at Screening. 
27. The subject has a history of, or active malignancy (with or without systemic chemotherapy) 
(except treated basal carcinoma of the skin which is not an exclusion criterion). 
28. The subject has a history of attempted suicide and/or a history of, or known major psychiatric 
disorders that are not well controlled.  

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Investigational Medicinal Product(s) (IMP): the term “Investigational Medicinal Product” (IMP) 
will refer to the ObsEva investigational drug linzagolix 75 mg tablets and 200 mg tablets, the ABT 
(E2 1 mg/NETA 0.5 mg) capsules or their matching placebos.  
Data Analysis and Statistics 
Descriptive statistics will be performed on relevant screening and baseline data (i.e. data collected 
prior to the treatment administration) and on demographic characteristics for each treatment group and 
overall. There will be no formal comparison of baseline data, that is, no statistical hypothesis testing. 
All statistical hypothesis tests and confidence intervals will be two sided. To maintain an overall type 
I error rate of 0.05, as there are two linzagolix versus placebo comparisons, Bonferoni corrected p-
values will be produced (raw p-values will be multiplied by two prior to comparing to 0.05), along 
with corresponding 97.5% confidence intervals.  
Each linzagolix group will need to demonstrate a statistically significant difference for both co-primary 
endpoints in order for the group to be considered more efficacious than placebo, thus maintaining the 
overall type I error rate of 0.05.  
For each linzagolix group that is statistically significantly more efficacious than placebo for the co-
primary endpoints, a fixed-sequence testing strategy shall be used within the group to test the ranked 
secondary endpoints, so as to maintain the family-wise type I error rate. 
Primary Efficacy Analysis 
The primary efficacy analysis aims to estimate the effect of linzagolix versus placebo on DYS and 
NMPP over the last 28 days up to and including the Month 3 visit or, for subjects who discontinue 
randomized treatment prior to the Month 3 visit, over the last 28 days of randomized treatment. Use 
of analgesic medication for EAP will be included in the responder definition. A responder for the co-
primary endpoints needs to demonstrate both a reduction in pain (DYS or NMPP, depending on the 
endpoint) and a stable or decreased use of analgesics for EAP. Anyone who does not meet both of 
these criteria will be defined as a non-responder. 
For each of the co-primary endpoints, the criterion for defining a subject as a responder over the last 
28 days of randomized treatment up to the Month 3 visit will include a reduction of X or greater from 
baseline in pain, where X will be determined using appropriate anchors as described below, as well as 
a stable or decreased use of analgesics for EAP. 
Mean pelvic pain scores for DYS and for NMPP will be calculated by averaging over the 
corresponding 28 calendar days immediately prior to and including the day of the Month 3 visit. DYS 
will use days with uterine bleeding, defined as those days on which the subject records any uterine 
bleeding or spotting in the subject eDiary; NMPP will use days with no uterine bleeding. If a subject's 
mean score for DYS is undefined numerically because her daily eDiary reports indicate that she did 
not experience uterine bleeding on any days during the 28 calendar day time period, then the mean 
score for DYS will be set equal to zero (which reflects the absence of any DYS during that reporting 
time period). For subjects who discontinue treatment prior to Month 3, the last available observations 
prior to discontinuation will be used, in order to estimate the treatment effect of while under treatment, 
that is the 28 calendar days immediately prior to and including the last dose date. The baseline mean 
overall pelvic pain scores for DYS and NMPP will be calculated by averaging over the two complete 

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menstrual cycles during screening, which may not be exactly 28 days each. For both DYS and NMPP, 
responses of "No pain," "Mild pain," "Moderate pain," and "Severe pain" will be assigned a score of 
0, 1, 2, and 3, respectively. 
For the assessment of a stable or decreased use of analgesics for EAP, the analgesic use for any defined 
period will be based on the mean of the total pill count for each class of rescue analgesics 
(endometriosis-associated). The total pill count for each class of rescue analgesic is the sum of the pill 
count of the corresponding class of rescue analgesic, as reported in the eDiary during the time period 
of interest. The baseline analgesic use will be calculated as the mean of daily pill count of analgesics 
over the two complete menstrual cycles during screening. For purposes of determining a stable or 
decreased use of analgesics, the averaging will be done over the same calendar days as used for the 
pelvic pain scores. The evaluation of a stable or decreased use of analgesics will be done according to 
a pre-defined set of rules. 
The analysis of each co-primary endpoint will be conducted using a logistic regression model, with 
treatment group as the main effect (three values) and including the baseline pain score as a covariate. 
Individual linzagolix versus placebo treatment group comparisons will be made using the same logistic 
regression model. 
An additional analysis of the co-primary endpoints will be conducted to estimate the effect of treatment 
policy rather than that of while on treatment. A reference based multiple imputation approach will be 
used for subjects who discontinue the study prior to Month 3. Further details will be provided in the 
Statistical Analysis Plan (SAP). 
Responder Thresholds analysis:  
For each of the co-primary endpoints, the criterion for defining a subject as a responder over the last 
28 days of randomized treatment up to the Month 3 visit will be a reduction of X or greater from 
baseline in pain. The threshold for response in the responder analysis (i.e., the value of X) will be 
chosen to represent a clinically meaningful reduction in pain and may not be the same for each 
endpoint. The threshold will be determined based on separate analyses of overall mean change using 
the mPGIS at Month 3 as an anchor. A 2-point improvement in the mPGIS will be used to define 
responders for the primary analysis. Response categories of “very mild” and “mild” will be collapsed 
into one category prior to the analyses. Monthly questions specific to DYS, NMPP, overall pelvic pain, 
dyschezia, dyspareunia and daily function will be used as separate anchors, PGIC as an anchor, 
Cumulative Distribution Function (CDF) and Probability Density Function (PDF) curves, and 
Receiver Operating Characteristic (ROC) analyses will be used as supportive analyses. The thresholds 
have been estimated in an analysis of DYS and NMPP data from the Phase 2b Edelweiss study and 
will be re-estimated in this study, calculated based on the blinded Month 3 data. The final responder 
thresholds, taking into account the previous estimates from phase 2b, will be included in the final SAP 
prior to breaking the blind after Month 6. Based on the results from the Phase 2b Edelweiss study, it 
is expected that the responder thresholds will be in the range of a 0.7 to 1.25 point (40% to 50%) 
reduction in pain in the 4-point VRS for a 2-point improvement, and of a 0.25 to 0.75 point (20% to 
30%) reduction in pain in the 4-point VRS for a 1-point improvement. The numerical thresholds for 
DYS are expected to be larger than those for NMPP.    
 

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Secondary Efficacy Analysis 
In order to estimate the treatment effect of while under treatment, endpoints that are collected daily 
using the eDiary will be based on the 28 calendar days immediately prior to and including the day of 
the corresponding visit, or the 28 calendar days immediately prior to and including the last dose date 
for subjects who discontinue treatment prior to the visit in question. Corresponding baseline values 
will be calculated based on the two complete menstrual cycles during screening, which may not be 
exactly 28 days each. 
The value for other endpoints is defined as the value at the corresponding visit, or the last completed 
assessment prior to and including the last dose date for subjects who discontinue treatment prior to the 
visit in question. 
All secondary efficacy endpoints will be summarized by descriptive statistics for each treatment group, 
for each time point, including summaries of change from baseline when applicable. As with the 
primary analysis, individual linzagolix versus placebo treatment group comparisons will be made. 
In general, between-group comparisons for continuous endpoints will be analyzed via analysis of co-
variance, with the baseline value as a covariate. Between-group comparisons for binary endpoints will 
be analyzed via logistic regression. Between-group comparisons for ordinal categorical data will be 
analyzed using a Mantel-Haenszel test, or using Koch’s method when there is also a baseline covariate. 
Full details describing the derivation and analyses of each secondary endpoint will be provided in the 
SAP. 
Safety analysis 
The safety and tolerability profile will be assessed versus baseline conditions and differences between 
treatment groups and descriptive statistics will be produced for both values and change from baseline, 
where applicable.  
Extent of exposure and compliance will be evaluated.  
Concomitant medications will be summarized using the World Health Organization (WHO) Drug 
Dictionary with frequencies and percentages for each treatment group. All medications administered 
between the date of the first dose and the end of the study will be included. 
An analysis of the TEAEs will be done. AEs will be summarized using the Medical Dictionary for 
Regulatory Activities (MedDRA) tabulated by preferred term and system organ class. TEAEs will be 
summarized with frequencies and percentages for each treatment group. Tabulations by severity and 
drug-relatedness will also be made. 
Laboratory parameters values will be summarized for each visit for each treatment group including 
within-group changes from baseline.  
BMD values and corresponding Z-scores will be summarized at baseline and at Month 6 for each 
treatment group, using the observed data. The within-group percent changes from baseline for BMD 
values will also be summarized, including 2-sided 95% confidence intervals. Categorical summaries 
of percent change from baseline will also be produced. The percent changes from baseline to Month 6 
will be compared between each of the linzagolix groups and the placebo group via analysis of co-

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variance with treatment group as the main effect (three values) and including the baseline as a 
covariate. 
Pharmacokinetic and pharmacodynamic analyses 
Plasma concentrations of linzagolix and pharmacodynamic parameters, such as for example estradiol 
and other hormones, will be summarized by time point for each treatment group, and listed for each 
subject by visit day and dose regimen. Where appropriate, changes from baseline will be presented. 
PK/PD analyses will be reported separately. 

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5 BACKGROUND INFORMATION 
5.1 INTRODUCTION TO LINZAGOLIX 
Linzagolix is a new, orally active, non-peptide gonadotropin releasing hormone (GnRH) antagonist. It 
has been shown to significantly reduce endometriosis-associated pain (EAP) in women with surgically 
confirmed endometriosis at once daily doses between 50 and 200 mg with a good safety and tolerability 
profile. It is being developed for the long-term treatment of moderate to severe EAP. 
5.2 ENDOMETRIOSIS 
Endometriosis is an estrogen-dependent gynecological condition, defined as the presence of 
endometrium-like tissue outside the uterus. It is one of the most common gynecological diseases (1). 
The condition is predominantly found in women in their reproductive years and disappears 
spontaneously after menopause. A chronic, inflammatory reaction, induced by the ectopic endometrial 
cells, results in a variety of pain symptoms including dysmenorrhea (DYS), dyspareunia, chronic pelvic 
pain, dysuria and dyschezia (2, 3). 
5.3 CONVENTIONAL TREATMENT OF ENDOMETRIOSIS 
The principal objective in treating endometriosis is symptom-relief management. Treatment options for 
women with EAP are diverse and consist of analgesic therapies, hormonal therapies, conservative or 
minimal invasive surgery, or a combination of these (3). Hormonal therapies aim at inhibition of 
ovulation, prevention of cyclic endometrium growth, and abolition of menstruation through 
achievement of a stable steroid hormone milieu, based on the concept that the response of the eutopic 
and ectopic endometrium is substantially similar (4, 5). 
Combined oral contraceptives (COCs), although not approved for the treatment of EAP, are often used 
as initial therapy. Their intake results in anovulation, reduction of menstrual blood flow, decidualization 
of endometriotic lesions, down regulation of cell proliferation and enhanced apoptosis in the 
endometrium (6). However, over time many women on COCs no longer have adequate pain relief and 
require second-line therapy (7).  
Progestin monotherapy can be efficacious for the reduction in EAP as it induces anovulation and a 
hypoestrogenic state via suppression of pituitary gonadotropin release. Progestins also have direct 
effects on the endometrium, causing decidualization of eutopic and ectopic endometrium leading to 
atrophy of the endometriotic implants (8). However, progestin monotherapy is often associated with 
breakthrough bleeding, alterations in mood, weight gain, and breast tenderness (9). 
Other therapies with proven efficacy for the treatment of EAP are often limited by undesirable side 
effects. For example, GnRH agonists lead through a constant stimulation of the GnRH receptor at the 
pituitary level to its desensitization and ultimately to suppression of ovulation and reduced serum 
estrogen levels; thus their use is associated with significant hypoestrogenic side-effects. Short-term 
effects include menopausal symptoms such as hot flush, vaginal dryness, loss of libido and emotional 
lability and their long-term use is limited to 6 months without hormonal add-back therapy (ABT) by 

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substantial bone mineral density (BMD) reduction (10). In addition, GnRH-agonists are administered 
as depot products which lack flexibility in case of side effects. 
For longer term use of GnRH-analogues, concurrent treatment with add-back (progestin and/or estrogen) 
hormone replacement therapy has been shown to be effective in reducing associated BMD loss (11). 
ABT is generally recommended as part of initial treatment with GnRH agonists to minimize side effects.  
Randomized trial data comparing 12-month GnRH agonist treatment with and without ABT showed 
durable suppression of endometriosis symptoms and minimal impact on BMD with the addition of daily 
5 mg norethisterone acetate (NETA) alone or in combination with estrogen (11). ABT is considered 
mandatory for women requiring GnRH agonist retreatment / treatment expected to go beyond 6 months. 
In a prospective cohort study comparing four different regimens of ABT, the add-back regimen 
containing 1 mg estradiol (E2) and 0.5 mg NETA demonstrated the best efficacy in terms of quality of 
life, hypoestrogenism-associated symptoms, and BMD (12).  
GnRH antagonists are a new potential treatment option that is hypothesized to allow dose-dependent 
control of E2 levels reducing endometriosis implants and EAP (12). Partial or complete suppression of 
E2 is possible depending on the dose (13). Partial suppression with elagolix 150 mg once daily was 
demonstrated to reduce EAP significantly while having limited impact on BMD and therefore allowing 
for up to 2 years administration (14). A higher dose of elagolix 200 mg twice a day for 6 months led to 
nearly full suppression of E2, better reduction of EAP but significant reduction of BMD which limits 
treatment to 6 months (14). 
Linzagolix is a new, orally active, non-peptide GnRH antagonist. In a Phase 2b placebo-controlled dose-
ranging study, 75 mg linzagolix given once daily for 6 months partially suppressed E2 and significantly 
decreased EAP with limited effect on BMD. A dose of 200 mg given once daily for 6 months suppressed 
E2 to menopausal levels (< 20 pg/mL), significantly decreased EAP, with better efficacy for some 
symptoms such as DYS and dyspareunia, but as expected, significantly reduced BMD at 6 months.  
Daily doses of 75 and 200 mg linzagolix have been chosen to be developed further for the treatment of 
EAP in order to provide dosing optionality to achieve both partial and complete E2 suppression. 
However, due to the significant BMD loss observed with 200 mg linzagolix, this dose will be developed 
in combination with concomitant estrogen/progestogen ABT. 
The purpose of this study is to evaluate the safety, tolerability and efficacy of linzagolix in women with 
EAP. It is a Phase 3, randomized, double-blind, placebo-controlled study to demonstrate the superior 
efficacy of once daily oral 75 mg linzagolix and of once daily oral 200 mg linzagolix in combination 
with ABT on the reduction of EAP in women with surgically confirmed endometriosis. 
5.4 SUMMARY OF NON-CLINICAL STUDIES 
5.4.1 
Non-Clinical Pharmacology 
Linzagolix shows potent affinity for the GnRH receptors in different species particularly the human 
GnRH (hGnRH) receptor and acts as an antagonist in vitro (hGnRH Ki=27.4nM). The affinity of KP017, 
the main metabolite of linzagolix, to the hGnRH receptor was shown to be 4.4 fold lower (Ki=127 nM). 
Specific effects on the endometrium were observed during in vivo studies, with linzagolix acting through 
suppression of estrogen dependent endometrial proliferation in a rat autograft endometriosis model. 

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Safety pharmacology studies, including a comprehensive set of cardiovascular ion channels, did not 
show any adverse effects on the central nervous, respiratory or cardiovascular system at exposures 
significantly exceeding those that would be used in a clinical setting. 
5.4.2 
Non-Clinical Pharmacokinetics and Toxicology  
5.4.2.1 
Pharmacokinetics 
Linzagolix was rapidly and completely absorbed after oral dosing with exposures increasing in a 
generally dose-proportional manner. The volumes of distribution and plasma clearance were low. 
Linzagolix is highly bound to plasma proteins (>95%) across a range of species with no concentration 
dependent changes. In human plasma, the major binding protein for linzagolix was albumin. It does not 
exhibit blood partitioning.  
Tissue distribution of radiolabeled linzagolix was widespread; there was no indication of unusual 
distribution or accumulation to tissues. Radioactivity was also detected in fetal tissues and milk.  
The major route of biotransformation of linzagolix was the oxidative O-demethylation to KP017 
(produced via CYP2C9 metabolism) which was observed in hepatocytes of all tested species. The in 
vivo metabolic pathway of linzagolix in mice, rats and monkeys was comparable to the in vitro data. 
Excretion of radioactivity from radiolabeled linzagolix was predominantly via feces in both rats and 
monkeys. 
Pharmacokinetic (PK) interaction studies in vitro indicated that drugs possibly co-administered in 
clinical settings (non steroidal anti-inflammatory drugs - NSAIDs) did not affect the plasma protein 
binding of linzagolix.  
5.4.2.2 
Toxicology 
Overall, the toxicological profile of linzagolix from repeated-dose toxicity studies was dominated by 
the consequences of its pharmacological activity as a GnRH receptor antagonist. During pivotal 
toxicology studies, dose levels of 200 and 10 mg/kg/day linzagolix were shown to be the no observed 
adverse effect level (NOAEL) in the main toxicology species rat (26-week daily oral administration) 
and monkey (39-week daily oral administration), respectively, and resulted in therapeutic indices (based 
on total / unbound exposure) for a human dose of 200 mg/day of 6.7 / 4.6 and 0.8 / 3.6, respectively.  
Reproductive toxicity studies, especially fertility studies and embryo-foetal development studies in 
rabbits, were limited in dose by the anti-GnRH effects of linzagolix preventing conception or leading to 
total litter loss. The effects of linzagolix on conception were reversible, and rabbit embryo-foetal studies 
showed expected pharmacological activity and no adverse reprotoxic/teratogenic effect. 
No effect on pre- and postnatal development of the offspring exposed during embryo-fetal development 
and lactation was recorded. 
Linzagolix was not genotoxic nor phototoxic. 
A 26-week carcinogenicity study in transgenic TgRasH2 mice showed no evidence of any linzagolix-
induced carcinogenicity. 

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5.4.3 
Non-clinical summary 
Taken together, the data in the nonclinical package have shown linzagolix to be an orally available, 
potent, selective GnRH receptor antagonist. Anti-GnRH effects have been demonstrated in a range of 
pharmacology studies, both in vitro and in vivo, and these also dominate the findings in the toxicology 
studies. Toxicology evaluation in mice, rats, dogs and monkeys confirmed exaggerated pharmacological 
activity but no overt toxicity. No genotoxicity or unexpected reproduction toxicology findings in rats 
and rabbits were seen.  
In conclusion, the nonclinical package supports clinical long-term dosing regimens up to 200 mg per 
day. 
5.5 SUMMARY OF CLINICAL STUDIES 
The efficacy, safety and PK of linzagolix were investigated by the originator company (Kissei 
Pharmaceutical Co., LTD. from Japan) in two Phase 1 studies (Study KLH1101 and KLH1103) in 
Japanese and/or Caucasian volunteers in single and multiple doses up to 400 mg, and in three Phase 2a 
studies (Studies KLH1201, KLH1202 and KLH1203) in Japanese endometriosis patients at doses up to 
200 mg daily for up to 12 weeks. An additional Phase 2b study (KLH1204) has been performed in Japan. 
Its objective was to assess the efficacy and safety of daily doses of linzagolix 25 mg, 50 mg, 75 mg and 
100 mg for up to 24 weeks in Japanese subjects with EAP. Overall, 455 subjects were randomized. 
The PK and PD of linzagolix have been further investigated in six Phase 1 studies investigating the use 
of estrogen/progestin ABT, potential drug-drug interactions, bioequivalence of forumulations and the 
effect of linzagolix on the QT interval.  
The efficacy and safety of linzagolix are being investigated in US and European patients with moderate 
to severe EAP in a dose-ranging Phase 2b study at doses from 50 to 200 mg daily for up to 12 months 
(study 15-OBE2109-001).  
In addition to the endometriosis indication, two placebo-controlled Phase 3 studies (16-OBE2109-008 
and 16-OBE2109-009) assessing the efficacy and safety of linzagolix in subjects with heavy menstrual 
bleeding associated with uterine fibroids are on going. A total of 500 subjects per study are planned to 
be enrolled in the USA and Europe. Daily doses of 100 and 200 mg of linzagolix are administered with 
or without ABT (E2 1mg/NETA 0.5mg) for up to 52 weeks.  
5.5.1 
Pharmacokinetics/Pharmacodynamics 
Linzagolix was evaluated in a Phase 1 single/repeated-dose study (Study KLH1101) in which Japanese 
and Caucasian pre- and post-menopausal women received single doses of linzagolix from 12.5 to 700 
mg and repeated once daily doses of 100 to 400 mg once daily for 7 days under fed and fasted conditions. 
Linzagolix was safe and well-tolerated, showed linear PK, a half-life of about 15–20 hours, and little 
difference between pre- and post-menopausal women or between Japanese and Caucasian women. There 
was a dose-dependent suppression of luteinizing hormone (LH), follicle-stimulating hormone (FSH) 
and E2. 
Study 17-OBE2109-001 evaluated the tolerability and PK of a single supra-therapeutic dose of 700 mg 
linzagolix, and effects of therapeutic and supratherapeutic doses of linzagolix on the QTc interval (QT 
interval corrected for heart rate). Subjects received a 200 mg dose of linzagolix (therapeutic target 

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exposure), a 700 mg dose of linzagolix (supratherapeutic target exposure), a 400 mg dose of 
moxifloxacin (positive control), and placebo with an appropriate washout. Linzagolix at 700 mg was 
well tolerated. A borderline effect of linzagolix on the heart rate corrected QT interval was identified 
with prolongations exceeding the threshold of concern by less than 2 msec. The categorical data for QTc 
showed no values greater than 480 msec and no changes greater than 30 msec following administration 
of the supratherapeutic and therapeutic doses. Thus, based on the magnitude of the QTc prolongation, 
the observed effects are not considered to be clinically significant. 
The open-label study, KLH1103, assessed the absorption, metabolism, and excretion of linzagolix in 6 
women of non-childbearing potential. Linzagolix was the predominant component in plasma and all 
plasma metabolites were present at less than 10% of the total drug related exposure. Similarly, 
unchanged linzagolix was also a major component in urine and feces. Linzagolix was eliminated in urine 
(52%) and, to a lesser extent, in feces (38%). 
Study 16-OBE2109-011 assessed the pharmacodynamics (PD) and safety of linzagolix alone and 
combined with E2/ NETA add-back hormone replacement therapy on E2 levels and vaginal bleeding. 
In this single-center, open-label, randomized, parallel-group study, 76 healthy premenopausal women 
were randomized to linzagolix (100 mg), linzagolix/ E2/ NETA (100 mg/0.5 mg/0.1 mg), linzagolix/ 
E2/ NETA (100 mg/1 mg/0.5 mg), linzagolix (200 mg) or linzagolix/E2/NETA (200 mg/1 mg/0.5 mg) 
once daily for 6 weeks. The study showed that ABT may be needed to prevent adverse bone impact in 
subjects treated at 200 mg. 
A single-center, open-label, randomized, parallel-group study (study 17-OBE2109-008) in 32 healthy 
pre-menopausal women was performed to assess whether co-administration of ABT following 4 weeks 
of high-dose linzagolix administration alone would result in improved bleeding patterns compared to 
combined linzagolix/ABT administration. Subjects were randomized to once daily linzagolix 
(200 mg)/ABT for 10 weeks or linzagolix (200 mg) for 4 weeks followed by once daily linzagolix 
(200 mg)/ABT for 6 weeks. Starting the administration of linzagolix and hormonal ABT together 
provided better bleeding control than delaying the ABT treatment start for 4 weeks. 
In a drug-drug interaction study with women of child bearing potential (Study 16-OBE2109-005), 
linzagolix did not induce CYP3A4 and there was no clinically significant food effect. In another drug-
drug interaction study (Study 17-OBE2109-006) the OATP1B1/1B3 inhibitor rifampicin (600 mg single 
dose) had no clinically relevant effects on the PK of linzagolix. Additional drug-drug interaction studies 
(Studies 18-OBE2109-006 and 18-OBE2109-007) showed linzagolix to have no effect on OAT3 
substrate benzylpenicillin and to increase the exposure to CYP2C8 substrate repaglinide. Linzagolix is 
considered to be a weak inhibitor of the CYP2C8 enzyme. 
A single-center, open-label, randomized, two-period cross-over study in 20 healthy pre-menopausal 
women (Study 17-OBE2109-004) aimed to demonstrate the bioequivalence of linzagolix formulation A 
(reference formulation), used in Phase 2b Edelweiss study 15-OBE2109-001, and formulation B (test 
formulation) planned to be used in the current Phase 3 study. After single oral administration of 
linzagolix, the test formulation was found to be bioequivalent to the reference formulation for Cmax 
and area under the curves (AUCs) of linzagolix and KP017 (metabolite). A single administration of 
linzagolix formulations A and B to healthy female participants was safe and well tolerated. 

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5.5.2 
Efficacy 
The clinical efficacy of linzagolix has been investigated in five Phase 2 studies. 
In a Phase 2 clinical study conducted in Japan in patients with endometriosis (Study KLH1201), 50 or 
200 mg linzagolix was orally administered once daily for 8 weeks. Linzagolix improved endometriosis 
symptoms and continuously suppressed E2 in a dose-dependent manner. 
In a Phase 2 clinical study conducted in Japan in patients with endometriosis (Study KLH1202), 50, 
100, or 200 mg linzagolix or placebo was orally administered once daily for 12 weeks. Linzagolix 
significantly reduced endometriosis pain symptoms compared with placebo. 
In a Phase 2 clinical study conducted in Japan in patients with endometriosis (Study KLH1203), 75 or 
150 mg linzagolix was orally administered once daily for 8 weeks. Linzagolix improved endometriosis 
symptoms and continuously suppressed E2 in a dose-dependent manner. 
A Phase 2b study (KLH1204) conducted in Japan assessed the efficacy and safety of once daily doses 
of linzagolix 25 mg, 50 mg, 75 mg and 100 mg for up to 24 weeks in subjects with EAP. There was a 
dose dependent improvement of EAP, with significant improvement compared to placebo at the 75 and 
100 mg doses. 
In an ongoing Phase 2b study conducted in US and Europe in patients with endometriosis (Study 15-
OBE2109-001, also known as Edelweiss), doses of 50, 75, 100, 200 mg linzagolix or placebo were 
administered orally, once daily for up to 52 weeks. Linzagolix significantly decreased EAP after 12 
weeks at doses of 75, 100 and 200 mg and the effects were maintained or increased at 24 weeks. 
5.5.3 
Safety 
More than 1,500 subjects were exposed to different doses (25, 50, 75, 100, 200, 400 mg) of linzagolix 
from 12 completed and 3 ongoing clinical studies. Ongoing studies include two Phase 3 studies for the 
indication of heavy menstrual bleeding associated with uterine fibroids. 
Repeated once daily dosing at up to 700 mg linzagolix was safe and well-tolerated by premenopausal 
healthy volunteers. In endometriosis patients, doses up to 200 mg once daily for up to 24 weeks of 
treatment were well tolerated. 
Hepatic impairment had no relevant effect on total plasma linzagolix exposure. In women with severe 
hepatic impairment (Child-Pugh C), 2- to 3-fold unbound mean exposures were recorded. In hepatic 
impaired subjects, a single dose of 200 mg was well tolerated. 
Renal impairment had no relevant effect on total plasma linzagolix exposure. In women with severe 
renal impairment (eGFR <30 mL/min/1.73 m2) or end-stage renal disease, approximately 2-fold 
unbound mean exposures were recorded. In renal impaired subjects, a single dose of 200 mg was well 
tolerated. 
The expected side effects of linzagolix are disturbances of the menstrual cycle and hypoestrogenic 
adverse events (AEs) (metrorrhagia and hot flush). 
In the Phase 2b Edelweiss trial, changes from baseline to week 24 in BMD were measured by dual-
energy X-ray absorptiometry (DXA) scan, using central reading. Partial E2 suppression achieved with 
linzagolix 75 mg was associated with a mean percent change from baseline in spine BMD (the site of 

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greatest bone loss) of ‐0.8% (95% CI ‐1.57, ‐0.03) after 6 months of treatment, while achieving 
improvement of the conditions in the majority of patients. As expected, full E2 suppression with 
linzagolix 200 mg lowers BMD by more than 2.5%, which indicates the need for a low dose ABT for 
use beyond 6 months. 
In multiple-dose studies, a dose-dependent occurrence of hot flush was observed (14.63%, 27.27%, 
27.8%, 30% and 40.7% at 50 mg, 75 mg, 100 mg, 150 mg and 200 mg linzagolix, respectively). In the 
Phase 2b Edelweiss trial, a moderate proportion of patients reported a dose-dependent increase in hot 
flush (at week 12, placebo: 10.9% reporting at least one hot flush; 75mg: 18.4%; 200 mg: 42.1% - at 
week 24, 75 mg: 19.0%; 200 mg: 45.6%).  
Anticipated adverse events (AE) are events that were not necessarily observed with linzagolix but can 
be anticipated based on the drug’s pharmacological action and/or class effects, such as: increase in liver 
function test parameters, headache, dizziness, nausea, hyperhidrosis, blood cholesterol increased, low 
density lipoprotein increased and BMD loss. 
In few subjects, an increase in transaminase values exceeding 3>ULN (Upper Limit of Normal) was 
observed under treatment, most often the increase in transaminase values was reversible and decreased 
spontaneously under treatment up to normal. These increased transaminase values were not associated 
with increased bilirubin values. 
A borderline effect of linzagolix on the heart rate corrected QT interval was identified with 
prolongations exceeding the threshold of concern by less then 2 msec. The categorical data for QTc 
showed no values greater than 480 msec and no changes greater than 30 msec following the 
supratherapeutic and therapeutic doses. Thus, based on the magnitude of the QTc prolongation, the 
observed effects are not considered to be clinically significant. 
The vast majority of related AEs were reported as being of “mild” or “moderate” intensity; only very 
few related events were reported as being of “severe” intensity. 
5.6 RATIONALE FOR THE CURRENT STUDY 
Linzagolix has been shown to suppress LH and E2 dose dependently and to significantly reduce EAP in 
women with moderate to severe EAP with a good safety and tolerability profile.  
In the dose-ranging study (15-OBE2109-001), daily doses of 75, 100 and 200 mg linzagolix for 12 
weeks significantly reduced EAP compared to placebo, whereas daily doses of 50 mg led to a reduction 
which was not significantly different than placebo. The effects of daily doses of 75, 100 and 200 mg 
were maintained or increased at 24 weeks. For overall pelvic pain, 49%, 62%, 56% and 56% of subjects 
responded (30% reduction in pelvic pain) to the doses of 50, 75, 100 and 200 mg linzagolix compared 
to 35% in placebo. For DYS, 43%, 68%, 69%, 79% of subjects responded to the dose of 50 mg, 75 mg, 
100 mg and 200 mg, respectively, compared to 29% in placebo. For NMPP, 37%, 46%, 59%, 62% and 
48% of subjects responded to the doses of 50, 75, 100 and 200 mg linzagolix, respectively, compared 
to 37% in placebo. Suppression of E2 was dose dependent with partial suppression achieved with once 
daily 75 mg dose and complete suppression with once daily 200 mg dose. Mean percent (95% CI, P 
value) BMD changes for lumbar spine from baseline to week 24 in the 50, 75, 100 and 200 mg dose 
groups were 0.137% (-0.83, -1.11, P=.777), 0.798% (-1.57, -0.03, P=.042), -1.365% (-2.14, -0.59, 
P<.001), -2.602% (-3.56, -1.65, P<.001). BMD of femoral neck and total hip showed a similar pattern 
but with generally smaller changes from baseline.  

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Based on the clinically and statistically very significant results of the dose-ranging study, two doses 
have been chosen for Phase 3 confirmatory registration studies: 75 mg alone and 200 mg in combination 
with hormone ABT (E2 1 mg/NETA 0.5 mg).  
The two doses are chosen to provide two different long-term treatment options for women suffering 
from endometriosis: one dose providing a significant pain control for the majority of patients whilst 
maintaining E2 at levels above 20 pg/mL, which will mitigate a major impact on bone mineral density 
and one high dose requiring administration with hormone ABT (E2 1 mg/NETA 0.5 mg) achieving a 
better symptom control for some patients by providing complete E2 suppression but limiting the impact 
on bone mineral density due to the addition of ABT. 
The study is double-blind and placebo-controlled which is considered the gold standard to prove efficacy 
of new medicines, in particular if potential advantages over alternative therapies lie in areas other than 
efficacy (15).  For this reason, a placebo-controlled study is required by some regulatory authorities to 
support the registration of a product. In this study, the placebo control is restricted to 6 months after 
which all subjects will be offered active treatment (while maintaining the double-blind) for a further 6 
months in a separate extension study. Of note, all subjects are allowed to use rescue analgesics for 
endometriosis-associated pain during the study. All subjects will enter a 6-month post-treatment follow-
up, except for subjects who discontinued treatment prior to completing 3 months of treatment; those 
subjects will be directly discontinued from the study.  
5.7 SUMMARY OF OVERALL RISKS AND BENEFITS 
Endometriosis is an underserved gynecologic condition and one of the most common gynecological 
diseases (1). It is characterized by pain symptoms including DYS, dyspareunia, chronic pelvic pain, 
dysuria and dyschezia. Medical options are still limited and new treatment options are warranted. 
Linzagolix is a new oral GnRH antagonist which has been shown significantly to reduce EAP via dose 
dependent suppression of LH, FSH and E2. This has included clinically meaningful improvements in 
DYS, NMPP, dyschezia and dyspareunia. Efficacy compared to placebo was demonstrated at daily 
doses of 75–200 mg for 3 months and maintenance of effect has been shown up to 6 months. 
Linzagolix was well-tolerated at these doses. The most commonly reported AEs in the Phase 2 studies 
were headache and hot flush which are related to the biological activity of linzagolix.  
Eleven pregnancies have been observed in the Phase 2 studies. No fetal or newborn abnormalities were 
reported in any of these pregnancies. 
There were no clinically relevant findings in laboratory measurements, vital signs or electrocardiogram 
(ECG) recordings. The administration of linzagolix results in infrequent, transient, moderate and not 
dose-related increases in transaminase levels which were not associated with any change in bilirubin 
levels. A borderline increase in QTc interval was observed in healthy volunteers which was not 
considered clinically significant. Nevertheless, all subjects in the current study will be monitored 
monthly with ECG. 
A modest degree of BMD loss has been seen in linzagolix-treated subjects with doses below 100 mg 
QD. Clinically significant BMD loss was observed with a dose of 200 mg QD at 6 months of treatment 
and requires combined use of ABT to mitigate BMD loss. The BMD loss will be monitored during the 
study and subjects who experience more than 8% confirmed BMD loss or a Z-score ≤ -2.5 will be 

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discontinued from treatment and will not be eligible to enter the extension study. In addition, subjects 
will be provided with vitamin D and calcium supplements which they will be recommended to take. 
In conclusion, linzagolix has a favorable benefit/risk ratio and represents a potentially useful therapy for 
treating EAP. 
The overall benefit/risk of this study was re-evaluated by ObsEva in light of the COVID-19 pandemic 
and evolving regulatory guidance. 
The trial was not completely stopped; rather, ObsEva implemented a temporary hold on recruitment in 
order to ensure patient safety.  Therefore, ObsEva believes the hold had no potential effect on the 
benefit/risk balance for subjects. 
Respecting national recommendations, as the COVID-19 pandemic situation improves and after careful 
assessment of risks and benefits, the Sponsor will decide on a site by site basis, when to resume screening 
and randomization for this study. 
For randomized subject who could not attend her visits due to quarantine, travel restrictions, site closure 
or other unforeseen reasons, remote study visits and shipment of materials and study drugs from site to 
subject were setup, whenever feasible, based on local restrictions related to the pandemic. Sites 
scheduled telephone calls to subjects as replacement for on-site visits, to ensure continuity in patient’s 
safety monitoring, treatment and study data collection.  
 
6 OBJECTIVES 
6.1 EFFICACY OBJECTIVES 
6.1.1 
Primary 
The primary objective of this study is to demonstrate the efficacy and safety of linzagolix administered 
orally once daily for up to 3 months at a dose of 75 mg alone or of 200 mg in combination with ABT 
(E2 1 mg / NETA 0.5 mg) versus placebo, while under randomized treatment, in the management of 
moderate to severe EAP in women with surgically confirmed endometriosis. The two co-primary 
efficacy endpoints will be clinically meaningful reduction over the last 28 days of randomized treatment 
up to the Month 3 visit along with a stable or decreased use of analgesics for EAP for 1) DYS and for 
2) NMPP. 
6.1.2 
Secondary 
Secondary objectives include evaluation of persistence of efficacy over the last 28 days of randomized 
treatment up to the Month 6 visit, evaluation of pain associated with sexual intercourse (dyspareunia) 
and defecation (dyschezia), difficulty of doing daily activities, analgesic use, assessment of subject 
perception of severity, change in uterine bleeding, Quality of Life (QoL) questionnaires, 
pharmacoeconomic burden of endometriosis by assessing changes in patient productivity, assessment 

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of endometriosis related number of non-study health visits, number of days in hospital and type of 
medical procedures performed during the Treatment Period. 
6.2 SAFETY OBJECTIVES 
Safety and tolerability objectives include assessment of BMD, endometrial health, cardiac safety 
including QT interval prolongation, standard laboratory safety parameters, gynecological assessments 
and AE frequency including specific hypoestrogenic AEs. 
6.3 EXPLORATORY OBJECTIVES 
Exploratory objectives include assessment of bone turnover markers and collection of PK and PD data 
of linzagolix for a separate modelling exercise 
7 ENDPOINTS 
7.1 EFFICACY ENDPOINTS 
7.1.1 
Primary 
The two co-primary, composite, efficacy endpoints are clinically meaningful reduction from baseline to 
the last 28 days preceding the Month 3 visit (the 4-week period preceding Month 3 visit) or, for subjects 
who discontinue randomized treatment prior to the Month 3 visit, to the last 28 days of randomized 
treatment, along with a stable or decreased use of analgesics for EAP, in the mean daily assessment of 
1) DYS and of 2) NMPP measured on a Verbal Rating Scale (VRS) using an electronic diary (eDiary). 
7.1.2 
Secondary 
7.1.2.1 
Ranked secondary efficacy endpoints 
Ranked secondary efficacy endpoints (in the order of the endpoints to be tested) are: 
 
Change from baseline to Month 6 in DYS (VRS) 
 
Change from baseline to Month 6 in NMPP (VRS) 
 
Change from baseline to Month 6 in dyschezia (Numeric Rating Scale - NRS) 
 
Change from baseline to Month 6 in overall pelvic pain (NRS) 
 
Change from baseline to Month 6 in the interference of pain with the ability to perform daily 
activities, measured using the pain dimension of the Endometriosis Health Profile-30 (EHP-
30)  
 
Change from baseline to Month 6 in dyspareunia (VRS) 
 
No analgesics use for EAP during the preceding 4-week period at Month 6 

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 
No opiate use for EAP during the preceding 4-week period at Month 6 
7.1.2.2 
Additional secondary efficacy endpoints 
Additional secondary efficacy endpoints include: 
 
Clinically meaningful reduction at scheduled visits other than Month 3 for DYS and NMPP  
 
Change from baseline to each scheduled assessment in the mean pelvic pain scores for DYS, 
NMPP and overall pelvic pain, during the previous 4-week period assessed on the NRS and 
VRS 
 
Change from baseline to each scheduled assessment in the number of days with moderate to 
severe pelvic pain during the previous 4-week period assessed on the VRS 
 
Change from baseline to each scheduled assessment in the mean worst pelvic pain score 
defined as the mean of the 5 highest daily pain scores reported during the previous 4-week 
period assessed on the NRS 
 
Change from baseline to each scheduled assessment in the mean of daily dyspareunia scores 
reported during the previous 4-week period on the dyspareunia VRS  
 
Change from baseline to each scheduled assessment in the mean of daily dyschezia scores 
reported during the previous 4-week period assessed on the dyschezia NRS 
 
Change from baseline to each scheduled assessment in non-opioid, opioid and combined 
analgesic use for EAP during the previous 4-week period based on pill count in the eDiary 
 
Change from baseline to each scheduled assessment in opioid analgesic use for EAP as 
reported in the eDiary during the previous 4-week period based on morphine milligram 
equivalent (MME) 
 
Change from baseline to each scheduled assessment in the number of days of analgesic use 
(including any class) for EAP during the previous 4-week period as assessed in the eDiary 
 
Change from baseline to each scheduled assessment in the number of days of opioid analgesic 
use for EAP during the previous 4-week period as assessed in the eDiary 
 
Change from baseline to each scheduled assessment in the number of pelvic pain-free days 
(assessed on the VRS) during the previous 4-week period  
 
Change from baseline to each scheduled assessment in ability to perform daily activities 
during the previous 4-week period, as assessed in the eDiary (daily function NRS) 
 
Change from baseline to each scheduled assessment in the number of days with no difficulty 
in doing daily activities due to EAP during the previous 4-week period as assessed in the 
eDiary (daily function NRS) 
 
Change from baseline to each scheduled assessment in the number of days when dyspareunia 
was a problem during the previous 4-week period (including days when sexual intercourse was 
avoided because of anticipation of pain) as assessed on the dyspareunia VRS 

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 
Change from baseline to each scheduled assessment in the number of days when sexual 
intercourse was avoided because of anticipation of pain during the previous 4-week period as 
assessed on the dyspareunia VRS 
 
Change from baseline to each scheduled assessment in the number of days with uterine 
bleeding (including spotting) during the previous 4-week period measured by eDiary 
 
Change from baseline to each scheduled assessment in the number of days when school or 
work was missed due to EAP in the previous 4-week period as reported in the eDiary 
 
Change from baseline to each scheduled assessment in the number of days when the subject 
had to go to bed or lie down due to EAP in the previous 4-week period as reported in the eDiary 
 
Change from baseline to each scheduled assessment in the Pain, Control and powerlessness, 
Emotional well-being, Social support, Self-image dimensions and the Modular sexual 
relationship questionnaire of EHP-30 scores 
 
Change from baseline to each scheduled assessment in the Health Related Productivity 
Questionnaire (HRPQ) scores 
 
Number of non-study endometriosis related health visits, number of days in hospital and type 
of procedures performed based on Health Resource Utilization Questionnaire (HRUQ) at each 
scheduled assessment 
 
Change from baseline to each scheduled assessment in the Physician/Subject Surgery Intention 
Question (PSIQ/SSIQ) 
 
Change from baseline to each scheduled assessment in the PROMIS Fatigue – Short Form 6a 
 
Change from baseline to each scheduled assessment in the EuroQoL 5-Dimension 5-Level 
(EQ-5D-5L) questionnaire 
 
Response at each scheduled assessment according to Patient Global Impression of Change 
(PGIC) (and Post-treatment Patient Global Impression of Change, PPGIC) 
 
Change from baseline to each scheduled assessment in the monthly PGIS (mPGIS) score 
7.2 SAFETY ENDPOINTS 
 
Change from baseline to each scheduled assessment in BMD measured by DXA of lumbar spine 
(L1-L4), femoral neck, and total hip 
 
Incidence and severity of treatment emergent adverse events (TEAEs) 
 
Incidence and severity of hypoestrogenic TEAEs (hot flush) 
 
Time to the first post-treatment menses 
 
Changes in clinical laboratory assessments (hematology, biochemistry, coagulation parameters, 
hormones, lipids and urinalysis) from baseline to each scheduled assessment 
 
Any pathological changes from baseline in the endometrium as assessed by histology from 
endometrial biopsies 

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 
Changes from baseline to each scheduled assessment in any other safety parameter including 
weight, vital signs, ECG, gynecological assessments and endometrial thickness 
7.3 EXPLORATORY ENDPOINTS 
 
Change from baseline in bone turnover markers at each scheduled assessment 
 
PK and PD of linzagolix 
8 STUDY DESIGN 
This is a prospective, randomized, double-blind, placebo-controlled study to demonstrate the efficacy 
and safety of linzagolix administered orally once daily at doses of 75 mg alone and 200 mg in 
combination with low dose ABT (E2 1 mg/NETA 0.5 mg) versus placebo in the management of 
moderate to severe EAP in women with surgically confirmed endometriosis. 
The study starts with an approximately 3-month screening period during which subjects will receive 
no study drug. Eligibility will be confirmed based on data collected during the screening period. After 
randomization, a 6-month Treatment Period will follow. Subjects will be randomized to one of the 
three treatment groups: 
1. Linzagolix 75 mg  
2. Linzagolix 200 mg combined with ABT  
3. Placebo  
Randomization will be conducted via an interactive web response system (IWRS) in a 1:1:1 ratio. There 
will be no stratification. 
At 6 months, BMD change will be assessed via DXA measurement. Eligible subjects who have 
completed the 6-month treatment period may enter a separate extension study for 6 additional months 
of active treatment (no placebo control). In this extension study, subjects who previously received 
placebo will be randomly switched to one of the two active treatments (75 mg alone or 200 mg + 
ABT). Subjects who received active treatment will continue with the same treatment. 
Subjects who decline to participate to or do not qualify for the extension study and who were exposed 
to at least 3 months of treatment will enter a 6-month drug-free follow-up. At the end of the 6-month 
follow-up period, subjects with a BMD decrease from baseline of >1.5% for lumbar spine and/or 
>2.5% for total hip will have an additional DXA scan 6 months later. Subjects who discontinue 
treatment prior to Month 3 will not enter the follow-up period.  
The main analysis will be performed after 6 months of treatment and will include all of the subjects’ 
data up to Month 6. 
The study will last on average 15 months; 3-month Screening Period, 6-month Treatment Period and 
6-month Follow-up (with 1 month being defined as 28 days/4 weeks). The duration excludes any 
washout period. 

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It is expected that only few subjects will have to enter the second 6-month follow-up period to have 
a DXA scan.  
A schematic of the study design is shown in Figure 1. 
 
Figure 1 : Study design 
 
All subjects will receive once daily either linzagolix 75 mg alone (with ABT placebo) or linzagolix 
200 mg combined with low dose ABT, or placebo (linzagolix placebo with ABT placebo) for 6 months. 
ABT is a combination of estradiol (E2) 1 mg and norethisterone acetate (NETA) 0.5 mg. Linzagolix 
or its corresponding placebo will be supplied as tablets for oral administration. ABT or its 
corresponding placebo will be supplied as capsules for oral administration.  
Linzagolix/placebo treatments will be provided in monthly treatment kits, packaged, labelled and 
administered in the same manner to protect the blinded nature of the trial.  
ABT/placebo treatments will be supplied as 3-monthly kits, packaged, labelled and administered in the 
same manner to protect the blinded nature of the trial. 
Blinded treatment kit numbers corresponding to each subject’s randomized treatment will be provided 
through an IWRS. 

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9 STUDY POPULATION 
9.1 SUBJECTS 
9.1.1 
Description of the target population 
The target population will be premenopausal women aged 18 to 49 years inclusive at screening, with 
surgically and, if available, histologically confirmed pelvic endometriosis and with moderate to severe 
EAP. 
They must not be planning to become pregnant and must agree to use double non-hormonal barrier 
contraception from screening until 3 months after the end of treatment. From 3 months after the end of 
treatment to the end of the drug-free follow-up period, contraception is still mandatory but hormonal 
contraception is allowed. 
9.1.2 
Number of subjects 
Four hundred and fifty (450) randomized subjects are planned in total (approximately 150 subjects per 
group). It is expected that the screen failure rate will be around 70%. Therefore, approximately 1500 
subjects will be screened in order to randomize 450 subjects into the study.  
9.1.3 
Study region/location 
The study will be conducted in approximately 130 investigational sites in the Unites States (US) and 
Canada. Additional sites will be identified, qualified and activated in case of recruitment issues. 
Recruitment will be competitive between countries and sites. 
The COVID-19 situation has had a negative impact on the recruitment rate in our Phase 3 clinical trials. 
Therefore the Company may consider opening new sites outside the US and Canada. 
9.2 ENTRY CRITERIA 
9.2.1 
Inclusion Criteria 
1. The subject must provide written informed consent prior to any study related procedures. 
2. The subject must be a female subject aged 18 years to 49 years inclusive. 
3. The subject must have had her most recent surgical and – if available – histological diagnosis 
of pelvic endometriosis (laparoscopy, laparotomy, vaginal fornix or other biopsy) up to 10 
years before screening. 
4. The subject must agree to the washout intervals for prohibited therapies (if applicable). 
5. The subject must agree to switch from her usual analgesic rescue medication to only those 
permitted by the protocol during the Screening, Treatment and Follow-up Period. 
6. The subject has moderate to severe EAP during the screening period defined as: 

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a. At the screening visit, a score of at least 2 for DYS and at least 2 for NMPP for the 
previous month assessed with the modified Biberoglu & Behrman (mB&B) scale. 
b. Over two full menstrual cycles (i.e. from day 1 of the first menstruation going over 
two spontaneous menstrual cycles up to the day before the next menstruation i.e. the 
third menstruation) finishing just before the baseline visit: 
i. Mean overall pelvic pain scores of at least 4 on the 0–10 NRS over the 5 days 
with the highest score for each cycle separately, i.e. required for both cycles; 
ii. At least two days with “moderate” or “severe” pain on the 0–3 VRS for pelvic 
pain over the days with uterine bleeding for each cycle separately, i.e. required 
for both cycles; 
iii. At least two days with “moderate” or “severe” pain on the 0–3 VRS for pelvic 
pain over the days without uterine bleeding for each cycle separately, i.e. 
required for both cycles. 
7. The subject is compliant with eDiary completion i.e. has completed at least 75% of days during 
the screening period. 
8. The subject has regular menstrual cycles and the total length of the two screening menstrual 
cycles should be between 42 and 76 days inclusive. 
9. The subject has a Body Mass Index (BMI) ≥ 18 kg/m2 at the screening visit. 
10. If of childbearing potential, the subject agrees to use one of the following birth control methods 
during the Screening Period, the entire Treatment Period of the study and until 3 months after 
the end of treatment: 
a. Sexual abstinence, if this is the subject's habitual practice and/or the subject is 
routinely abstinent from heterosexual intercourse, 
b. Partner with a vasectomy with confirmed azoospermia, 
c. Double non-hormonal barrier contraception such as condom or diaphragm each 
combined with spermicide. 
11. If of non-childbearing potential, the subject must have had tubal ligation sterilization at least 
two months before the screening visit. 
12. The subject is ≥ 40 years of age at the screening visit has a normal mammogram within 1 year 
before randomization. 
13. The subject must be able to communicate well with the Investigator and research staff and to 
comply with the requirements of the study protocol. 
9.2.2 
Exclusion Criteria 
To be eligible for inclusion in this study the subject must not meet any of the following criteria: 
1. The subject is pregnant or breast feeding or is planning a pregnancy within the duration of the 
Treatment Period of the study. 

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2. The subject is less than 6 months postpartum or 3 months post-abortion/miscarriage at the time 
of entry into the screening period. 
3. The subject has a surgical history of: 
a. Hysterectomy,  
b. Bilateral oophorectomy, 
c. Vagotomy, bowel resection or any surgical procedure (including gastric surgery) that 
might interfere with gastrointestinal motility, pH, or absorption, 
d. Any major abdominal surgery (including laparotomy for endometriosis) within 6 
months or any interventional surgery for endometriosis performed within a period of 
2 months before screening, or the subject is scheduled for a surgical abdominal 
procedure during the course of the study. 
4. The subject had a tubal sterilization which was performed with ESSURE™. 
5. The subject had endometrial ablation resulting in amenorrhea. 
6. The subject has at least one ovarian endometrioma with a diameter of 7 cm or greater. 
7. The subject is likely to require treatment during the study OR received treatment within a 
specified period prior to screening with any of the medications listed below: 
a. GnRH antagonists 
3 months 
b. GnRH agonist injections/3-month depot injections 
3/6 months 
c. Danazol 
3 months 
d. Oral contraceptives and other sex hormones 
1 month 
e. Depot contraceptives 
10 months 
f. Selective Progesterone Receptor Modulators (SPRMs), 
Selective Estrogen Receptor Modulators (SERMs) and 
aromatase inhibitors 
3 months 
g. Long acting narcotics (i.e. requiring less than once daily 
dosing) 
1 day 
h. Systemic glucocorticoid treatments for acute diseases 
(not depot) 
1 month 
i. 
Medical (prescribed) marijuana 
1 week 
j. 
In situ copper intra-uterine device (IUD) 
1 day 
k. In situ IUD with progestogen 
1 month 
8.  The subject is likely to use cannabinoids during the study washout, screening or treatment 
period. 
9.  The subject has required more than 2 weeks of continuous use of a narcotic analgesics for 
treatment of EAP within 6 months prior to Screening. 
10. The subject received strong CYP3A4 inducers or inhibitors that (might potentially) interact 
with ABT within 1 month prior to randomization. 

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11. The subject has a contra-indication to ABT including: 
a. Active deep vein thrombosis, pulmonary embolism, or history of these conditions; 
b. Active or recent (e.g. within the past year) arterial thromboembolic disease (e.g. stroke, 
myocardial infarction); 
c. Known, suspected, or history of breast cancer; 
d. Known or suspected estrogen-dependent neoplasia;  
e. Known protein C, protein S, or antithrombin deficiency, or other known thrombophilia 
disorders, including Factor V Leiden; 
f. Migraine with aura; 
g. History of porphyria; 
h. Known hypersensitivity to the ingredients. 
12. The subject has a history of or current systemic glucocorticoid therapy for treatment of chronic 
diseases (e.g. Systemic Lupus Erythematosus (SLE), rheumatic arthritis). Inhaled 
glucocorticoids for e.g. asthma are not considered systemic glucocorticoids. 
13. The subject did not respond to prior treatment with GnRH agonists or GnRH antagonists for 
endometriosis. 
14. The subject has alanine aminotransferase (ALT), aspartate aminotransferase (AST), total 
bilirubin levels or gamma-glutamyl transpeptidase (GGT) level ≥ 2 times the upper limit of 
normal and indicative of potential liver damage at Screening or Day 1 (subjects with 
abnormalities at Day 1 will be withdrawn from study at reception of the results). 
15. The subject has clinically significant abnormal ECG, or ECG with QTc using Fridericia's 
correction formula (QTcF) > 450 msec at Screening or Day 1 (prior to dosing). 
16. The subject has a known positive human immunodeficiency virus (HIV) or viral Hepatitis 
serology. 
17. The subject has abnormal uterine bleeding of undiagnosed cause. 
18. The subject had/has clinically significant findings from a Papanikolaou (PAP) smear test 
performed within the past 12 months or at the screening visit which will require surgical 
intervention (e.g. Loop electrosurgical excision procedure (LEEP) or cervical conization). 
19. The subject has chronic pelvic pain that, in the opinion of the Investigator, is not caused by 
endometriosis and requires chronic analgesic or other chronic therapy which would interfere 
with the assessment of EAP (e.g., interstitial cystitis, presumptive adenomyosis, fibroids, non-
endometriosis-related pelvic adhesive disease, post-tubal ligation or irritable bowel 
syndrome).  
20. The subject has any other clinically significant gynecological condition identified during 
screening transvaginal ultrasound (TVUS) or endometrial biopsy which might interfere with 
the study efficacy and safety objectives (e.g. endometritis, endometrial hyperplasia). However, 
uterine fibroids (as long as uterus size ≤ 12 weeks, i.e. equivalent gestational weeks) and 
adenomyosis are allowed provided they do not interfere with the assessment of EAP (see 
previous criterion). 

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21. The subject has any known condition, including findings in the medical history or in the 
screening assessments, which in the opinion of the Investigator constitutes a risk or a 
contraindication to the participation of the subject in the trial or that could interfere with the 
trial objectives, conduct or evaluation. 
22. The subject has a history of, or known, osteoporosis, hyperparathyroidism or other metabolic 
bone disease. 
a. Screening DXA results of the lumbar spine (L1–L4), femoral neck, or total hip BMD 
showing a Z-score ≤ –1.5  
b. Any condition that would interfere with obtaining adequate DXA measurements (e.g. 
weight [> 300 pounds or 136 kg], history of spinal surgery, spinal hardware, severe 
scoliosis) 
c. Intercurrent bone disease 
d. History of hip fracture 
e. History of pathologic or compression fractures 
f. History of bilateral hip replacement 
23. The subject has a mental condition rendering her unable to understand the nature, scope and 
possible consequences of the study, or evidence of an uncooperative attitude. 
24. The subject has current problem with alcohol or drug abuse (including painkiller abuse).  
25. The subject has been administered with any experimental drug in the 12 weeks before screening 
and/or has been randomized in Edelweiss 3 (Phase III) study protocol No. 18-OBE2109-003. 
26. The subject has calcium level above the upper limit of normal range at screening, which is 
confirmed on repeat fasting testing at Screening. 
27. The subject has a history of, or active malignancy (with or without systemic chemotherapy) 
(except treated basal carcinoma of the skin which is not an exclusion criterion). 
28. The subject has a history of attempted suicide and/or a history of, or known major psychiatric 
disorders that are not well controlled. 
10 STUDY PROCEDURES AND ASSESSMENTS 
10.1 GENERAL INSTRUCTIONS 
Before the start of the study, each subject will be provided with a subject information leaflet giving 
details on the Investigational Medicinal Product (IMP), study procedures and potential risks and they 
will also be informed verbally by the Investigator or legally acceptable designee of the overall 
requirements of the study. They will be instructed that they can obtain further information from the 
Investigator at any time and that they are free to withdraw their consent and to discontinue their 
participation in the project at any time without prejudice. 

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If the subject is willing to participate in the study, she will be requested to give written informed consent 
prior to conducting any of the study screening procedures, after being given sufficient time to consider 
her participation and the opportunity to ask for further details. One original copy of the consent form 
will be signed and personally dated by both the subject and the Investigator or legally acceptable 
designee. The original signed copy will be kept in the confidential investigator file and a copy will be 
given to the subject. 
The subject will be asked if she authorizes the Investigator to notify her general practitioner of her 
participation in the trial. 
Upon signature of the Informed Consent Form (ICF), each subject will be assigned a Subject 
Identification Number (SIN) through an IWRS. SINs will be made of 6 digits, as follows: 
 
1st, 2nd and 3rd digits: site identifier (100 to 999) 
 
4th, 5th and 6th digits: subject number (001 to 999) 
During the whole study, the subject will be identified using the SIN for all documentation and 
discussion. The SIN assigned to a subject in this way must only be used for that subject. 
Should a subject drop out from the study, the SIN will not be re-allocated. 
Screen failures may be re-screened at a later date with the Sponsor’s approval if it is believed that the 
reason for excluding them initially is no longer applicable. Any re-screened subject will be assigned a 
new SIN through an IWRS and all the screening information will be collected again. All screening 
procedures should be repeated except endometrial biopsy collection (if done during the preceding 6 
months of re-screening), PAP smear (if done during the preceding 12 months of re-screening), DXA (if 
done during the preceding 3 months of randomization) and mammogram (if done during the preceding 
12 months of randomization). 
An electronic Case Report Form (eCRF) will be completed for all subjects who signed the ICF.  
For screen failed subjects, the following information will be collected at a minimum: Informed Consent, 
Demographics, AEs and reason for screen failure. 
When a subject has been found to be eligible for the study, she will be randomized to one of the three 
treatment groups in a 1:1:1 ratio (approximately 150 subjects per treatment group) as shown in Figure 
1. 
Randomization will be done according to a computer-generated list. Treatment assignments will be 
obtained via IWRS according to the randomization list. The subject will be allocated a randomization 
number and treatment kit numbers via IWRS. The randomization number allocated to the subject will 
allow any unblinded study personnel to identify the treatment group to which the subject is randomized.  
Treatment kits will be dispensed to the subjects as follows: 
- 
on Day 1 and Month 3 visits, subject will receive two kits, one for linzagolix/placebo (monthly 
kit) and one for the ABT/placebo (3-monthly kit).  
- 
On Month 1, Month 2, Month 4 and Month 5 visits, subject will receive one kit only, for 
linzagolix/placebo.  

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The treatment kit numbers for linzagolix/placebo and ABT/placebo will refer to unique kits present at 
site and corresponding to the randomization allocation.  
10.2 OUTLINE OF STUDY PROCEDURES AND ASSESSMENTS 
All post-baseline visits should take place at the end of the defined period (i.e. Month 1 visit should be 
scheduled at the end of Month 1, Month 2 visit should be scheduled at the end of Month 2, etc.). One 
month is defined as 28 days/4 weeks. Post-baseline visit dates are calculated from Day 1 visit date :  
- 
Month 1 (Day 29), Month 2 (Day 57), Month 3 (Day 85), Month 4 (Day 113), Month 5 
(Day 141) and Month 6 (Day 169) for the Treatment Period,  
- 
Month 1 FU (Day 197), Month 2 FU (Day 225), Month 3 FU (Day 253), Month 4 FU (Day 
281), Month 5 FU (Day 309) and Month 6 FU (Day 337) for the Follow-up Period. 
A window of ± 3 days is allowed for each visit scheduled during the treatment period. A window of ± 7 
days/1 week is allowed for each visit scheduled during the follow-up period. The visit schedule is 
illustrated in Figure 2 below:  
 
Figure 2 : Schedule of Visits 
 
The timing of events is shown in the Schedule of Assessments (Appendix A and Appendix B). 
10.2.1 Screening Period – Screening visit  
The subject will be informed of the study objectives and overall requirements, and written informed 
consent will be obtained before performing any study-specific procedures that are not standard of care. 
The subject will be considered as included into the study after the ICF is signed and dated by the subject 
and the Investigator or legally acceptable designee. 

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For subjects who require washout for oral contraceptives, or other sex hormones, or GnRH 
antagonists/agonists (provided that the reason for discontinuing the previous GnRH-antagonist is not 
lack of efficacy), a period of up to 3 months will be allowed between signing the ICF and starting the 
collection of pain assessments in eDiary during the screening period. The screening period must cover 
two full menstrual cycles and will last about 3 months. During the screening period, the subject will be 
seen up to three times if not all screening assessments could be performed at the first screening visit 
(e.g. the endometrial biopsy must be performed after day 7 of the menstrual cycle). 
During the screening period the following study screening assessments will be completed (see Schedule 
of Assessments in Appendix A): 
- 
Demographic data, height and weight 
- 
Medical and surgical history including concomitant diseases (and especially presence of 
rectovaginal endometriosis and adenomyosis), previous medication, obstetric/gynecological 
history and history of endometriosis including diagnosis and previous treatments for 
endometriosis. 
- 
Assessment of DYS, dyspareunia and NMPP with the mB&B scale (see Appendix C). Answers 
will be captured in eCRF. 
- 
Completion of the paper C-SSRS questionnaire “Baseline” version specific for subjects under 
screening (see Appendix R) 
- 
ECG 
- 
Physical examination 
- 
Vital signs (blood pressure (BP) and heart rate) 
- 
Urine pregnancy test  
- 
TVUS of uterus and ovaries to measure endometrial thickness, to rule out any clinically 
significant gynecological conditions which might interfere with the study efficacy and safety 
objectives and to confirm that the subject has no ovarian endometrioma ≥ 7 cm in diameter 
- 
Gynecological examination, including the mB&B scale (see Appendix C) clinical signs 
reporting (pelvic tenderness and pelvic induration) 
- 
Endometrial biopsy (should be performed at least 7 days after the first day of menstruation and 
sent for central assessment). If no tissue is available, the biopsy should be repeated as soon as 
possible in the following days. In case of multiple (at least two including the initial one) and 
unsuccessful attempts to get sufficient endometrial tissue, the subject is allowed to be 
randomized without any screening endometrial biopsy under the following conditions: 
a. the investigator confirms and documents in source that the subject has no signs of 
suspected endometrium malignancy (e.g. abnormal bleeding profile).  
b. The investigator and subject agree that at end of treatment all necessary actions will be 
taken to get a sufficient endometrium sample (e.g. short anaesthesia, if necessary). 
c. The medical monitor of the study approves the inclusion of the subject. 

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The endometrial biopsy is not required for subjects having performed an endometrial biopsy 
within the past 6 months of the screening visit, which shows no endometrium hyperplasia of 
any type or adenocarcinoma and for which slides are available for current study assessment 
through retrospective central laboratory reading. 
- 
PAP smear 
A screening PAP smear is not required for subjects in whom a PAP smear was performed within 
the 12 months prior to the screening visit and which results indicate no clinically significant 
abnormalities requiring surgical intervention (e.g. LEEP or cervical conization) and are 
available for source document verification.  
- 
Manual breast examination by palpation (and mammography if applicable: subject ≥ 40 years 
of age at screening should have performed a mammogram within 12 months before 
randomization) 
- 
Blood samples for haematology, coagulation parameters, chemistry and lipids assessments 
- 
Urinary protein dipstick. 
- 
Contraception dispensing and counselling 
- 
BMD assessed by DXA for femoral neck, hip and spine. The DXA scans will be read centrally. 
To avoid unnecessary exposure to X-ray it is recommended to perform this procedure towards 
the end of the screening period (when all other Inclusion/Exclusion criteria are already met), 
but at least 2 weeks prior to the baseline visit to allow enough time to get the DXA results for 
eligibility confirmation at the time of the baseline visit at the latest. 
The subject will receive double barrier contraception (condoms with spermicide) if requested. If the 
subject is at risk for acquiring HIV, she must be instructed to use double non-hormonal barrier 
contraception without spermicides (eg: condoms and diaphragms). 
In addition, a limited quantity (as per Investigator’s judgement) of permitted analgesics will be 
provided/prescribed to the subject at the screening visit to cover the screening period. 
The subject will be given an eDiary with a user manual to take home and will be trained by the 
Investigator or delegate on how to use and complete it correctly. Subject eDiary completion should be 
started on the day of screening visit (after completion of washout period when applicable). The eDiary 
should be completed daily, in the evening at approximately the same time, for use of provided/prescribed 
analgesics, uterine bleeding (including start of menstruation), pelvic pain, dyspareunia, dyschezia and 
daily function. The eDiary screening assessments should cover at least two full menstrual cycles (from 
day 1 of the first menstruation going over two spontaneous menstrual cycles up to the day before the 
next menstruation i.e. the third menstruation).  
A daily alarm will be set up in the eDiary to remind the patient to complete her daily questions. In 
addition, appropriate email alerts will be sent to the site staff and to the operational team in case of 
missed diary entries. eDiary compliance will be checked remotely on an ongoing basis by the operational 
team. 
Any concomitant medications taken after signature of informed consent will be recorded in the eCRF 
(excluding any provided/prescribed analgesics used for EAP which will be recorded daily in the eDiary). 

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Any AE occurring after signature of informed consent will be recorded in the eCRF. 
The subject will be asked to return to the site and bring her eDiary between the first and seventh day 
(inclusive) of her next menstrual period (the period after the 2 screening full menstrual cycles) for the 
Day 1 visit. Final assessment of her eligibility will be performed, including calculation of the baseline 
scores for pelvic pain collected via the eDiary. The baseline mean pelvic pain scores will be calculated 
using the data collected during the screening period over two full, spontaneous menstrual cycles.  
If for logistical reasons beyond her control, the subject is unable to come to the clinic for Day 1 within 
the acceptable time window (1st to 7th day inclusive of the cycle) then the subject will be allowed to start 
Day 1 in the following cycle (again on the 1st to 7th day of the cycle). In this case, the eligibility 
assessments should be assessed based on the first two cycles only. However, the eDiary recording should 
be continued daily during the third cycle. 
Note that in exceptional cases, the Day 1 visit may occur between Day 8 and Day 12 of the third or 
fourth cycle but only upon prior approval by the sponsor. In that case, the subject should do a urine 
pregnancy test at her home 1 week after the Day 1 visit to ensure she is not pregnant. The subject should 
communicate (e.g., via phone) results of the test to the site for recording into the source medical file. 
10.2.2 Treatment period 
From Day 1 to Month 6, the subject should record daily in her eDiary, at approximately the same time 
each evening, the following questionnaires: IMP intake, use of provided/prescribed analgesics, uterine 
bleeding, pelvic pain, dyspareunia, dyschezia and daily function.  
During the entire treatment period, the subject will be asked to bring her eDiary and her IMP kits at each 
visit to the site.  
10.2.2.1 
Baseline visit: Day 1 
If the subject has successfully completed all screening assessments and is between the first and seventh 
day (inclusive) of her menstruation, she will go to the investigational site for the following evaluations 
and tests before drug administration: 
- 
eDiary eligibility data review 
- 
ePRO and ClinRO completion, ideally before any other procedures or assessments: EHP-
30, HRPQ, HRUQ, PSIQ, SSIQ, PROMIS, EQ-5D-5L, specific monthly severity questions, 
mPGIS (anchors must be completed last) 
- 
Completion of the paper C-SSRS questionnaire “Baseline” version, if not already completed 
during screening period (see Appendix R) 
- 
Screening DXA results review 
- 
Screening lab results review 
- 
Screening endometrial biopsy results review (randomization will not be postponed if the 
results of the endometrial biopsy performed during the screening period are not available 
on Day 1) 

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- 
Previous and concomitant treatments recording 
- 
AE recording 
- 
ECG 
- 
Vital signs (BP and heart rate) 
- 
Urine pregnancy test 
- 
Urinary protein dipstick 
- 
Fasting (overnight) blood samples for haematology, coagulation parameters, chemistry, 
lipids, glucose, hormones and bone biomarkers, prior to the first administration of study 
treatment, and after confirmation of the subject’s eligibility (considering the invasive nature 
of this procedure). 
Upon confirmation of inclusion/exclusion criteria, the subject will be randomized to one of the three 
treatment groups and will be provided with the study drugs (1 kit of linzagolix/placebo and 1 kit of 
ABT/placebo) and provided/prescribed with permitted analgesics as well as vitamin D and calcium 
supplements. The subject will be instructed on how to take the study drugs and analgesics, and advised 
to take the provided vitamin D and calcium daily. The subject will be provided/prescribed as necessary 
with analgesics and vitamin D/calcium supplements at each subsequent visit to cover requirements until 
the end of the follow-up period. 
The subject will take her first dose of study medication at the study site. The exact time of dosing 
(hour/minute) will be recorded in eCRF. 
After drug administration, the following procedures will be performed: 
- 
ECG at about the same time as but before the post-dose PK sample 
- 
Post-dose PK sample taken at least 1.5 h after treatment administration. The exact time of 
dosing and of PK sampling (hour/minute) will be recorded in the eCRF. 
- 
Contraception dispensing (if applicable) and counselling 
The subject will receive double barrier contraception (condoms with spermicide) if requested. If the 
subject is at risk for acquiring HIV, she will be instructed to use double non-hormonal barrier 
contraception without spermicides (condoms and diaphragms). 
Upon completion of the visit, the subject will be provided with emergency contact phone numbers and 
will be scheduled for her next visits.  
For the whole duration of the treatment period, the subject will take her daily dose of study medication 
at home except on the day of study visits where she will take her daily dose at site. 
10.2.2.2 
Study visits: Month 1 (Day 29 -3/+2 days) and Month 2 (Day 57 ± 3 days) 
The following tests and evaluations will be performed : 
- 
eDiary completion compliance check  

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- 
ePRO and ClinRO completion, ideally before any other procedures or assessments:  
 
at Month 1 visit: EHP-30, HRPQ, HRUQ, PROMIS, EQ-5D-5L, mPGIS, PGIC 
 
at Month 2 visit: HRPQ, HRUQ, mPGIS, PGIC 
with mPGIS and PGIC completed last. 
- 
Concomitant treatments recording 
- 
AE recording 
- 
Completion of the paper C-SSRS questionnaire (version for “already enrolled subjects” (see 
Appendix S) for patients responding to the C-SSRS for the first time during the study, or 
version “since last study visit” (see Appendix T) for patients for whom the C-SSRS was 
completed at the previous study visit) 
- 
IMP accountability based on blisters 
- 
ECG (at about the same time as but before the PK sample) 
- 
Vital signs (BP and heart rate) 
- 
Urine pregnancy test 
- 
Urinary protein dipstick 
- 
Blood samples for haematology, coagulation parameters, chemistry, lipids, hormones 
(overnight fasting required at Month 1 visit only) 
- 
Pre-dose PK sample (the time of study medication administration on previous 4 days and time 
of PK sampling will be recorded) 
- 
Contraception dispensing (if applicable) and counselling 
- 
Dispensing via IWRS of one new kit of linzagolix/placebo 
The subject will take her daily dose of study medication at the study site from the newly dispensed 
linzagolix/placebo kit, and from the ABT/placebo kit dispensed at the baseline visit. 
10.2.2.3 
Study visit: Month 3 (day 85 ± 3 days) 
The following tests and evaluations will be performed: 
- 
eDiary completion compliance check 
- 
ePRO and ClinRO completion, ideally before any other procedures or assessments: EHP-30, 
HRPQ, HRUQ, PROMIS, EQ-5D-5L, specific monthly severity questions, mPGIS, PGIC 
completion (anchors must be completed last) 
- 
Concomitant treatments recording 
- 
AE recording 

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- 
Completion of the paper C-SSRS questionnaire (version for “already enrolled subjects” (see 
Appendix S) for patients responding to the C-SSRS for the first time during the study, or version 
“since last study visit” (see Appendix T) for patients for whom the C-SSRS was completed at 
the previous study visit) 
- 
IMP accountability based on blisters 
- 
ECG (at about the same time as but before the PK sample) 
- 
Physical examination 
- 
Vital signs (BP and heart rate) 
- 
Urine pregnancy test 
- 
Gynecological examination 
- 
TVUS of the uterus 
- 
Urinary protein dipstick 
- 
Fasting (overnight) blood samples for haematology, coagulation parameters, chemistry, lipids, 
hormones and bone biomarkers 
- 
Pre-dose PK samples (the time of dose administration on previous 4 days and time of PK 
sampling will be recorded) 
- 
Contraception dispensing (if applicable) and counselling 
- 
Dispensing via IWRS of one new kit of linzagolix/placebo and one new kit of ABT/placebo 
The subject will take her daily dose of study medication at the study site from the newly dispensed kits. 
10.2.2.4 
Study visits: Month 4 (day 113 ± 3 days) and Month 5 (day 141 ± 3 days) 
The following tests and evaluations will be performed: 
- 
eDiary completion compliance check  
- 
ePRO and ClinRO completion, ideally before any other procedures or assessments: HRPQ, 
HRUQ, mPGIS, PGIC completion (mPGIS and PGIC must be completed last) 
- 
Concomitant treatments recording 
- 
AE recording 
- 
Completion of the paper C-SSRS questionnaire (version for “already enrolled subjects” (see 
Appendix S) for patients responding to the C-SSRS for the first time during the study, or version 
“since last study visit” (see Appendix T) for patients for whom the C-SSRS was completed at 
the previous study visit) 
- 
IMP accountability based on blisters 
- 
ECG (at about the same time as but before the PK sample) 

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- 
Vital signs (BP and heart rate) 
- 
Urine pregnancy test  
- 
Urinary protein dipstick 
- 
Blood samples for haematology, coagulation parameters, chemistry, lipids, hormones 
- 
Pre-dose PK samples (the time of dose administration on previous 4 days and time of PK 
sampling will be recorded) 
- 
Contraception dispensing (if applicable) and counselling 
- 
Dispensing via IWRS of one new kit of linzagolix/placebo 
The subject will take her daily dose of study medication at the study site from the newly dispensed 
linzagolix/placebo kit, and from the ABT/placebo kit dispensed at the Month 3 visit. 
At Month 5 visit, the subject will be informed of the possibility to enter the extension study at Month 6 
(if eligible) and will be provided with a copy of the subject information sheet to read prior to the Month 
6 visit. 
10.2.2.5 
Study visit: Month 6 (day 169 ± 3 days) 
The following tests and evaluations will be performed : 
- 
eDiary completion compliance check  
- 
ePRO and ClinRO completion, ideally before any other procedures or assessments: EHP-30, 
HRPQ, HRUQ, PSIQ, SSIQ, PROMIS, EQ-5D-5L, specific monthly severity questions, 
mPGIS, PGIC completion (anchors must be completed last) 
- 
Concomitant treatments recording 
- 
AE recording 
- 
Completion of the paper C-SSRS questionnaire (version for “already enrolled subjects” (see 
Appendix S) for patients responding to the C-SSRS for the first time during the study, or version 
“since last study visit” (see Appendix T) for patients for whom the C-SSRS was completed at 
the previous study visit) 
- 
Final IMP accountability based on blisters 
- 
ECG (at about the same time as but before the PK sample) 
- 
Physical examination, including weight recording 
- 
Vital signs (BP and heart rate) 
- 
Urine pregnancy test  
- 
Gynecological examination 
- 
Manual breast examination (by palpation) 

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- 
TVUS of uterus  
- 
Urinary protein dipstick 
- 
Fasting (overnight) blood samples for haematology, coagulation parameters, chemistry, lipids, 
hormones and bone biomarkers 
- 
Pre-dose PK samples (the time of dose administration on previous 4 days and time of PK 
sampling will be recorded) 
- 
Endometrial biopsy, unless the endometrium thickness in TVUS is ≤ 5 mm, in which case no 
endometrial biopsy will be necessary (see section 10.4.5). Appropriate photo documentation of 
the endometrium thickness is mandatory.  
- 
BMD assessed by DXA for femoral neck, hip and spine. DXA can be performed up to 10 days 
prior to the study visit which allows to get the DXA results ideally at the time of the Month 6 
study visit at the latest, knowing that subjects who experience more than 8% BMD loss or a Z-
score ≤ -2.5 will not be eligible to enter the extension study. 
- 
The subject will be verbally asked which treatment she believed she received during the blinded 
Treatment Period. The answer will be recorded in the eCRF. 
- 
Contraception dispensing (if applicable) and counselling 
An additional question will be asked to the subject about the burden of filling in the eDiary (0 = not at 
all a burden, 10 = very much a burden). The answer will be recorded in the eCRF. 
Study visit Month 6 constitutes the end of the Treatment Period. 
The subject – if eligible - will be proposed to enter the extension study. If she is willing to participate, 
she will have to provide written consent. If she does not wish to enter the extension study or if she does 
not qualify for the extension, she will continue in the treatment-free follow-up period. 
10.2.3 Follow-up period without treatment for subjects not entering the extension study  
Up to Month 6 FU visit, the subject will continue to record on her eDiary, daily at approximately the 
same time each evening, her use of provided/prescribed analgesics, uterine bleeding, pelvic pain, 
dyspareunia, dyschezia and daily function.  
The subject will be asked to bring her eDiary at each visit to the site during the entire follow-up period. 
10.2.3.1 
Study visit: Month 1 FU  
M1 FU visit should be scheduled on Day 197 ± 7 days after Day 1 (or 28 days ± 7 days after last IMP 
intake for early discontinued subjects). 
The following tests and evaluations will be performed at Month 1 FU visit: 
- 
eDiary completion compliance check  
- 
ePRO completion, ideally before any other procedures or assessments: mPGIS and PPGIC 

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- 
Concomitant treatments recording 
- 
AE recording 
- 
Completion of the paper C-SSRS questionnaire (version for “already enrolled subjects” (see 
Appendix S) for patients responding to the C-SSRS for the first time during the study, or version 
“since last study visit” (see Appendix T) for patients for whom the C-SSRS was completed at 
the previous study visit) 
- 
ECG 
- 
Vital signs (BP and heart rate) 
- 
Urine pregnancy test and contraception counselling 
- 
Urinary protein dipstick 
- 
Blood samples for haematology, coagulation parameters, chemistry, lipids, hormones 
- 
Endometrial biopsy only if diagnosis at Month 6 was different than “benign endometrium” or if 
no endometrial biopsy was done at Month 6 (see section 10.4.5).  
10.2.3.2 
Study visits: Month 2 FU, Month 4 FU and Month 5 FU 
Month 2 FU visit should be scheduled on Day 225 ± 7 days after Day 1 (or 56 days ± 7 days after last 
IMP intake for early discontinued subjects). 
Month 4 FU visit should be scheduled on Day 281 ± 7 days after Day 1 (or 112 days ± 7 days after last 
IMP intake for early discontinued subjects). 
Month 5 FU visit should be scheduled on Day 309 ± 7 days after Day 1 (or 140 days ± 7 days after last 
IMP intake for early discontinued subjects). 
The following tests and evaluations will be performed at Month 2 FU, Month 4 FU and Month 5 FU 
visits: 
- 
eDiary completion compliance check 
- 
ePRO completion, ideally before any other procedures or assessments: mPGIS and PPGIC 
- 
Concomitant treatments recording 
- 
AE recording 
- 
Completion of the paper C-SSRS questionnaire (version for “already enrolled subjects” (see 
Appendix S) for patients responding to the C-SSRS for the first time during the study, or version 
“since last study visit” (see Appendix T) for patients for whom the C-SSRS was completed at 
the previous study visit) 
- 
Urine pregnancy test and contraception counselling (at Month 2 FU visit only) 
- 
Endometrial biopsy only if diagnosis at preceding biopsy was different than “benign 
endometrium” or if no endometrial biopsy was done at Month 6 nor at any visit since Month 6 
(see section 10.4.5).  

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10.2.3.3 
Study visit Month 3 FU 
Month 3 FU visit should be scheduled on Day 253 ± 7 days after Day 1 (or 84 days ± 7 days after last 
IMP intake for early discontinued subjects). 
The following tests and evaluations will be performed at Month 3 FU Visit: 
- 
eDiary completion compliance check 
- 
ePRO and ClinRO completion, ideally before any other procedures or assessments: EHP-30, 
HRPQ, HRUQ, PROMIS, EQ-5D-5L, mPGIS, PPGIC completion (mPGIS and PPGIC must be 
completed last) 
- 
Concomitant treatments recording 
- 
AE recording 
- 
Completion of the paper C-SSRS questionnaire (version for “already enrolled subjects” (see 
Appendix S) for patients responding to the C-SSRS for the first time during the study, or version 
“since last study visit” (see Appendix T) for patients for whom the C-SSRS was completed at 
the previous study visit)  
- 
ECG 
- 
Physical examination 
- 
Vital signs (BP and heart rate) 
- 
Urine pregnancy test and contraception counselling 
- 
Gynecological examination 
- 
Manual breast examination (by palpation) 
- 
TVUS of uterus 
- 
Urinary protein dipstick 
- 
Fasting (overnight) blood samples for haematology, coagulation parameters, chemistry, lipids, 
hormones and bone markers. For subjects that do not resume menses at Month 3 FU visit, a 
FSH test should be performed at local laboratory and the subjects should be advised to consult 
for a gynaecological evaluation. 
- 
Endometrial biopsy only if diagnosis at preceding biopsy was different than “benign 
endometrium” or if no endometrial biopsy was done at Month 6 nor at any visit since Month 6 
(see section 10.4.5).  
10.2.3.4 
Study visit: Month 6 FU – End of Follow-up visit 
Month 6 FU visit should be scheduled on Day 337 ± 7 days after Day 1 (or 168 days ± 7 days after last 
IMP intake for early discontinued subjects). 
The following evaluations and tests will be performed at Month 6 FU Visit: 

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- 
ePRO and ClinRO completion, ideally before any other procedures or assessments: EHP-30, 
HRPQ, HRUQ, PROMIS, EQ-5D-5L, mPGIS, PPGIC completion (mPGIS and PPGIC must be 
completed last) 
- 
Collection and deactivation of eDiary 
- 
Concomitant treatments recording 
- 
AE recording 
- 
Completion of the paper C-SSRS questionnaire version “since last study visit” (see Appendix 
T) for patients for whom the C-SSRS was completed at the previous study visit. 
- 
ECG 
- 
Physical examination, including weight recording 
- 
Urine pregnancy test 
- 
TVUS of uterus 
- 
Endometrialm biopsy if no endometrial biopsy was obtained at Month 6 nor at any visit since 
Month 6 (see section 10.4.5). If no tissue is available, the biopsy should be repeated as soon as 
possible in the following days. 
- 
BMD assessed by DXA for femoral neck, hip and spine. This DXA can be performed ±  10 days 
from the Month 6 FU study visit. 
This visit constitutes the end of study participation except for subjects with a BMD decrease from 
baseline > 1.5% for lumbar spine and/or > 2.5% for total hip who should have a repeat DXA scan 6 
months later for a BMD follow-up assessment.  
10.2.3.5 
Study visit: BMD Follow-up visit 
BMD Follow-up visit should be scheduled on Day 505 ± 10 days after Day 1 (or 168 days ± 10 days 
after M6 FU visit). 
This visit is applicable only to subjects with a BMD decrease from baseline > 1.5% for lumbar spine 
and/or > 2.5% for total hip at M6 FU visit. 
BMD will be assessed by DXA for femoral neck, hip and spine.  
Subjects who have ≥ 3% BMD decrease at any site (femoral neck, hip or spine) at this visit should be 
referred to a bone specialist. 
10.3 EFFICACY OBSERVATIONS AND MEASUREMENTS 
All the questionnaires described below except the mB&B scale will be completed in the eDiary by the 
subject and/or the site staff. If the subject forgets to bring her eDiary to one site visit, the completion of 
ePRO and ClinRO will be done on a site back-up device. 

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10.3.1 Modified Biberoglu and Behrman questionnaire 
Endometriosis pain will be assessed at screening by subject using the mB&B scale (see Appendix C). 
10.3.2 Daily diary 
The subject will be given an eDiary with a user manual to take home and will be trained by the 
Investigator or delegate on how to use and complete it correctly. Subject eDiary completion should be 
started on the day of screening visit (after completion of washout period when applicable).  
The eDiary should be completed daily, in the evening at approximately the same time. A daily alarm 
will be set up in the eDiary to remind the patient to complete her daily questions. In addition, appropriate 
email alerts will be sent to the site staff and to the operational team in case of missed diary entries. 
eDiary compliance will be checked remotely on an ongoing basis by a dedicated data management team. 
10.3.2.1 
Pelvic pain 
The subject’s assessment of pelvic pain will be collected daily via the eDiary using an NRS and a VRS. 
NRS: The subject will be asked to rate her worst endometriosis associated pelvic pain in the last 24 
hours on a 0–10 scale with 0 representing no pelvic pain and 10 representing the worst pelvic pain 
imaginable. 
VRS: The subject will be asked to choose the category that best describes her endometriosis associated 
pelvic pain in the last 24 hours: 
0  
No pain. 
1  
Mild pain but I was easily able to do the things I usually do. 
2  
Moderate pain. I had some difficulty doing the things I usually do.  
3  
Severe pain. I had great difficulty doing the things I usually do.  
10.3.2.2 
Daily function (difficulty of doing daily activities) 
The subject will complete a daily questionnaire in the eDiary if she had any difficulty doing her daily 
activities in the last 24 hours on a 0–10 scale (NRS) with 0 representing no difficulty doing daily 
activities and 10 representing inability to do daily activities. 
10.3.2.3 
Uterine bleeding 
The subject will complete a daily questionnaire in the eDiary assessing strength of uterine/vaginal 
bleeding in the last 24 hours. The strength of uterine bleeding will be assessed using the following scale: 
Please choose the category that best describes your vaginal bleeding or spotting in the last 24 hours 

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None 
No bleeding nor spotting 
Spotting 
Blood loss not requiring sanitary protection (except for panty liners) 
Bleeding 
Blood loss requiring sanitary protection (tampons or pads) 
Heavy 
Bleeding 
Heavy blood loss requiring sanitary protection (tampons or pads) for example: 
• 
Need for double protection to manage menstrual bleeding 
• 
Menstrual bleeding accompanied by sensation of “gushing” or 
“flooding” 
• 
Soaking one pad and/or tampon or more per hour for three or more 
consecutive hours 
• 
Needing to change the tampon or pad at night or soiling bedclothes 
Subject will be asked additional questions to identify the first day of her menstrual periods during the 
Screening Period. 
10.3.2.4 
Analgesic use 
The subject will report daily in the eDiary whether she has taken any provided/prescribed analgesic 
(including the dose) for her EAP during the last 24-hour period.  
Analgesic use for any other reason will be reported by the subject to the site staff and recorded in the 
eCRF. 
10.3.2.5 
Dyspareunia (pain associated with sexual intercourse) 
The subject will be asked daily about dyspareunia via the eDiary using a VRS. 
She will be asked to rate how her EAP interfered with sexual intercourse in the last 24 hours, with the 
following response options: 
 
 
 
 
 
 
She will be given as well the option to answer that she was not sexually active for reasons other than 
her endometriosis, in which case no score would be allocated. 
0 
No pain during sexual intercourse. 
1 
I was able to tolerate the pain during sexual intercourse. 
2 
Intercourse was interrupted due to pain.  
3 
I avoided sexual intercourse because of anticipation of pain. 

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10.3.2.6 
Dyschezia (pain associated with defecation) 
Dyschezia will be assessed daily via the eDiary and will be scored by the subject using a 0–10 NRS, 
where 0 represents no pain and 10 represents the worst pain imaginable. 
10.3.2.7 
School or work missed 
The subject will be asked whether she missed school or work in the last 24 hours due to EAP. 
10.3.2.8 
Event cancelled 
The subject will be asked if she had to cancel an event in the last 24 hours due to EAP. 
Following a request from the FDA, this question is removed in protocol version 4.0 to reduce respondent 
burden and maximize the quality and completeness of clinical outcome assessment data. This question 
has been asked only to subjects who were enrolled prior implementation of protocol version 4.0. 
10.3.2.9 
Sleeping or lying down during the day 
The subject will be asked whether she slept or laid down during the day in the last 24 hours due to EAP.  
10.3.2.10  Difficulty sleeping 
The subject will be asked whether she had difficulty sleeping in the last 24 hours due to EAP. 
Following a request from the FDA, this question is removed in protocol version 4.0 to reduce respondent 
burden and maximize the quality and completeness of clinical outcome assessment data. This question 
has been asked only to subjects who were enrolled prior implementation of protocol version 4.0. 
10.3.2.11  Patient Global Impression of Severity – daily recall (dPGIS) 
The subject will record on a daily basis in the eDiary the severity of her endometriosis symptoms 
assessed on a 5-point scale with the following possible answers: no symptoms, very mild, mild, 
moderate, severe (see Appendix J). 
Following a request from the FDA, this assessment is removed in protocol version 4.0 to reduce 
respondent burden and maximize the quality and completeness of clinical outcome assessment data. 
This assessment has been collected only for subjects who were enrolled prior implementation of protocol 
version 4.0. 
10.3.3 Outcome rating scales assessed at site visits 
ePROs are self-administered questionnaires completed by the subject. ePROs completed by the subject 
during the site visit include: specific monthly severity questions (i.e monthly dysmenorrhea question, 
monthly non-menstrual pelvic pain question, monthly overall pelvic pain question, monthly difficulty 
in doing daily activities question, monthly dyschezia question, monthly dyspareunia question), EHP-30, 
HRPQ, SSIQ, PROMIS, EQ-5D-5L, mPGIS and PGIC/PPGIC. 

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ClinROs are questionnaires administered by the site staff to the subject and completed by the site staff 
in the eDiary. ClinROs include monthly dyspareunia question, HRUQ and PSIQ. 
Specific monthly severity questions (monthly dysmenorrhea question, monthly non-menstrual pelvic 
pain question, monthly overall pelvic pain question, monthly difficulty in doing daily activities question, 
monthly dyschezia question, monthly dyspareunia question), mPGIS, and PGIC/PPGIC will be used as 
anchors to estimate meaningful change and deriving responder thresholds. 
During site visits, ePROs and ClinROs should be completed ideally prior to any other study procedures, 
with the anchors being completed last.. Assessments will be performed at the visits as indicated in 
Appendix A and Appendix B.  
Prior to the start of the study, site personnel will be trained on all rating scales (ePROs, ClinROs and 
scales of daily diary) used in this study. The training will be provided at the investigator meeting and/or 
site initiation visit. The objective of this training is to establish uniformity across subjects and sites in 
completion of these rating instruments.  
10.3.3.1 
Endometriosis Health Profile-30 (EHP-30) 
The EHP-30 is a disease-specific self-administered questionnaire used to measure health related quality 
of life in women with endometriosis. The EHP-30 is composed of two parts: a core questionnaire 
containing five scales that are applicable to all women with endometriosis and a modular part containing 
six scales which do not necessarily apply to all women with endometriosis. This study will employ the 
Core EHP-30 and modular section C (Part 2) as outlined in Appendix D. 
10.3.3.2 
PROMIS Fatigue Short Form 6a14 
This questionnaire is composed of six questions to evaluate the severity of fatigue (see Appendix E). 
10.3.3.3 
Health Related Productivity Questionnaire (HRPQ) 
The HRPQ consists of nine questions measuring the impact of EAP and its treatment on work 
productivity and daily activities at home (see Appendix F). 
10.3.3.4 
Health Resource Utilization Questionnaire (HRUQ) 
The HRUQ records use of health resources (emergency room, physician visit, hospitalization, etc.) 
during the study. This includes the number of non-study health visits – the total, the reason, primary 
reason, and type of clinician for the visit; Diagnostic/therapeutic procedures performed (Hysteroscopy, 
SIS, Colposcopy, Biopsy, Ultrasound or Other) and Emergency Room/Outpatient Procedures (see 
Appendix G). 
10.3.3.5 
Patient Global Impression of Change (PGIC) 
The PGIC is used by the subjects to evaluate the change in their endometriosis symptoms since initiation 
of study drug on a 7-point scale with following possible answers: very much improved, much improved, 
minimally improved, no change, minimally worse, much worse, very much worse (see Appendix H). 

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10.3.3.6 
Post-treatment Patient Global Impression of Change (PPGIC) 
Subjects will evaluate the change in their endometriosis symptoms after discontinuation of study drug 
on a 7-point scale with the following possible answers: very much improved, much improved, minimally 
improved, no change, minimally worse, much worse, very much worse (see Appendix I).  
10.3.3.7 
Patient Global Impression of Severity - monthly recall (mPGIS) 
At each study visit from Day 1 to the end of the follow-up period, the subject will be asked to evaluate 
the severity of her endometriosis symptoms over the past 28 days using a 5-point scale with the 
following possible answers: no symptoms, very mild, mild, moderate, severe (see Appendix J). 
10.3.3.8 
Subject Surgery Intention Question (SSIQ) 
The SSIQ evaluates subject willingness to opt for endometriosis-related surgery if current symptoms 
continue (see Appendix K). 
10.3.3.9 
Physician Surgery Intention Question (PSIQ) 
The PSIQ evaluates physician likelihood of recommending endometriosis-related surgery(s) to the 
subject if current symptoms continue (see Appendix L). 
10.3.3.10 EQ-5D-5L 
Subjects’ health related quality of life will be measured using the EQ-5D-5L (see Appendix M). The 
EQ-5D-5L essentially consists of two pages: the EQ-5D descriptive system and the EQ visual analogue 
scale (EQ VAS). 
The descriptive system comprises five dimensions: mobility, self-care, usual activities, pain/discomfort 
and anxiety/depression. Each dimension has five levels: no problems, slight problems, moderate 
problems, severe problems and extreme problems.  
The EQ VAS records the subject’s self-rated health on a vertical VAS, where the endpoints are labelled 
‘The best health you can imagine’ and ‘The worst health you can imagine’.  
10.3.3.11 Specific Monthly severity questions 
The monthly severity questions specific to DYS, NMPP, overall pelvic pain, difficulty in doing daily 
activities, dyschezia and dyspareunia will be used as separate anchors to determine what constitutes a 
meaningful within-patient score change in the respective assessment. 
10.3.3.11.1 
Monthly dysmenorrhea question 
At Day 1, Month 3 and Month 6 study visits, the subject will be asked to evaluate the severity of her 
dysmenorrhea over the past 28 days using a 5-point scale with the following possible answers: no pain, 
very mild, mild, moderate, severe. 
Subject’s answer to the question “How would you describe your menstrual pelvic pain (on any days 
of vaginal bleeding or spotting) over the past 28 days?” will be collected via the eDiary. 

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Not all subjects will have this assessment completed as it was added during the study course as a protocol 
amendment. 
10.3.3.11.2 
Monthly non-menstrual pelvic pain question 
At Day 1, Month 3 and Month 6 study visits, the subject will be asked to evaluate the severity of her 
non-menstrual pelvic pain over the past 28 days using a 5-point scale with the following possible 
answers: no pain, very mild, mild, moderate, severe. 
Subject’s answer to the question “How would you describe your non-menstrual pelvic pain (on any 
days with no vaginal bleeding nor spotting) over the past 28 days?” will be collected via the eDiary. 
Not all subjects will have this assessment completed as it was added during the study course as a protocol 
amendment. 
10.3.3.11.3 
Monthly overall pelvic pain question 
At Day 1, Month 3 and Month 6 study visits, the subject will be asked to evaluate the severity of her 
overall pelvic pain over the past 28 days using a 5-point scale with the following possible answers: no 
pain, very mild, mild, moderate, severe. 
Subject’s answer to the question “How would you describe your overall pelvic pain (menstrual and 
non-menstrual) over the past 28 days?” will be collected via the eDiary. 
Not all subjects will have this assessment completed as it was added during the study course as a protocol 
amendment. 
10.3.3.11.4 
Monthly difficulty in doing daily activities question 
At Day 1, Month 3 and Month 6 study visits, the subject will be asked to evaluate how much has her 
endometriosis-related pain caused her difficulty in performing her daily activities over the past 28 days 
using a 5-point scale with the following possible answers: No difficulty, slight difficulty, mild difficulty, 
moderate difficulty, severe difficulty. 
Subject’s answer to the question “How much has your endometriosis-related pain caused you difficulty 
in performing your daily activities over the past 28 days?” will be collected via the eDiary. 
Not all subjects will have this assessment completed as it was added during the study course as a protocol 
amendment. 
10.3.3.11.5 
Monthly dyschezia question 
At Day 1, Month 3 and Month 6 study visits, the subject will be asked to evaluate the severity of her 
dyschezia over the past 28 days using a 5-point scale with the following possible answers: no pain, very 
mild, mild, moderate, severe. 
Subject’s answer to the question “Overall, how would you describe any endometriosis-related pain 
during defecation (bowel movement) over the past 28 days?” will be collected via the eDiary. 
Not all subjects will have this assessment completed as it was added during the study course as a protocol 
amendment. 

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10.3.3.11.6 
Monthly dyspareunia question 
The question will be administered and completed in the eDiary using the mB&B scale for Deep 
Dyspareunia, at Day 1, Month 3 and Month 6 study visits. 
The subject will first report, directly in the eDiary, if she had any sexual intercourse over the past 28 
days.  
If she didn’t have any sexual intercourse over the past 28 days, she will report whether she avoided 
sexual intercourse mainly because of anticipation of pain during intercourse, with the following possible 
answers: Yes, No. 
If she had any sexual intercourse over the past 28 days, her overall experience of pain with intercourse 
over the previous 28 days will be asked by the site staff and graded using the mB&B scale for Deep 
Dyspareunia: 
None 
 
0 = No symptoms 
Mild 
 
1 = Tolerated discomfort during intercourse 
Moderate 
2 = Interference of usual frequency of sexual intercourse due to pain 
Severe   
3 = Avoids, or wishes to avoid, intercourse because of pain 
Not all subjects will have this assessment completed as it was added during the study course as a protocol 
amendment. 
10.4 SAFETY OBSERVATIONS AND MEASUREMENTS 
10.4.1 Adverse Events 
AE data will be collected continuously during the study as described in Section 12.2. 
AE data will be obtained at scheduled study visits based on physical examination, vital signs, ECG and 
biological laboratory assessments (see flowchart in Appendix A). In addition, subjects will report AEs 
spontaneously and/or through questioning. 
Complete appropriate data on all AEs experienced for the duration of the reporting period will be 
reported on an ongoing basis in the AE pages of the eCRF. 
10.4.2 Physical Examination 
A complete physical examination, i.e. examination of organ systems, including thyroid gland, lungs, 
heart, abdomen, liver, kidneys and peripheral pulses (by palpation, auscultation or percussion), eyes, 
ears, nose, throat and skin (by inspection) and neurological reflexes will be performed at scheduled 
visits. In addition, a manual breast examination (by palpation) will be performed at Screening, Month 6 
and Month 3 FU visits. Results of the examinations will be recorded on source subject data file and in 
the eCRF. Baseline medical conditions (see section 12.1.3) that do worsen in severity and/or frequency 
during the study and that are considered as clinically significant by the investigator will be reported as 
AEs in the corresponding eCRF page. 

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The physical examination should be performed after the ECG. 
10.4.3 Vital signs 
BP and heart rate will be measured in sitting position. In case of abnormal vital signs (i.e. BP ≥ 150/100 
mmHg or ≤ 90/50 mmHg and/or heart rate ≥ 100 bpm or ≤ 40 bpm) and if abnormality was not pre-
existing, a repeat assessment after 5 min should be taken. In case of confirmed abnormality, which was 
not pre-existing or worsened in severity and/or frequency during the study and is considered as clinically 
significant by the investigator, an AE must systematically be reported by the Investigator in the eCRF 
AE page. The Investigator is to provide a diagnosis rather than reporting of individual vital signs 
parameters whenever possible. 
BP and heart rate should be measured after performing the 12-lead ECG. 
10.4.4 Transvaginal ultrasound 
Endometrial thickness, uterus volume and abnormality (fibroids, adenomyosis, etc…) and left/right 
ovary abnormality status will be assessed by TVUS. If TVUS is not possible, abdominal ultrasound can 
be used. The print-outs of the ultrasound will be interpreted and commented by the gynecologist and 
kept as source data. Results of the examination will be recorded on source data forms and in the eCRF. 
TVUS should be recommended (for cause) for subjects with heavy/suspicious bleeding. 
10.4.5 Endometrial biopsies 
At least two endometrial biopsies for histological assessment will have to be obtained for each subject: 
 
One at screening (unless an endometrial biopsy was performed within the past 6 months of the 
screening visit, which shows no endometrial hyperplasia of any type or adenocarcinoma and for 
which slides are available for current study assessment through retrospective central laboratory 
reading. 
 
One at Month 6 if endometrium thickness on TVUS is > 5 mm (see Figure 3) 
 
One at Month 1 FU, 2 FU, 3 FU, 4 FU, 5 FU or 6 FU if not obtained at Month 6 or if the 
preceding biopsy diagnosis is different than “benign endometrium” but is not “malignant” or 
not “hyperplasia”(see Figure 4) 
The endometrial biopsies will be analyzed by a central laboratory blinded to treatment group. 
Endometrial biopsies of hyperplasia of any type will be submitted for assessment by three independent 
expert pathologists who are blinded to the treatment and to one another’s assessment.  
 

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Figure 3 : Biopsy process for Month 6 study visit 
 
 
Figure 4 : Biopsy process for the follow-up period visits 
 
Screening endometrial biopsy should be performed at least 7 days after the first day of menstruation and 
sent for central assessment. If no tissue is available, the biopsy should be repeated as soon as possible 
in the following days. In case of multiple (at least two including the initial one) and unsuccessful 
attempts to get sufficient endometrial tissue, the subject is allowed to be randomized without any 
screening endometrial biopsy under the following conditions:  

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a. The investigator confirms and documents in source that the subject has no signs of suspected 
endometrium malignancy (e.g. abnormal bleeding profile). 
b. The investigator and subject agree that at end of treatment all necessary actions will be taken to 
get a sufficient endometrium sample (e.g. short anaesthesia, if necessary). However, it should 
be noted that for subjects who discontinue the study and complete less than 3 months of 
treatment an end-of-study biopsy is not required. 
c. The medical monitor of the study approves the inclusion of the subject. 
If there is a subsequent clinically significant finding in the biopsy, the subject will be withdrawn 
immediately 
At any time during the study, in case of endometrial biopsy diagnosis being hyperplasia of any type 
(with or without atypia) or worse (neoplasm) for patients on treatment, the laboratory will send an alert 
to the site and the Sponsor. The medical monitor will contact the sites to discuss the proceeding in line 
with local practice. The subject will be discontinued from the treatment, (and will not be eligible to enter 
the extension study), will enter the follow-up period (unless she is discontinued prior to Month 3 visit) 
and will be advised to consult for a gynecological evaluation and treatment. 
Biopsy should be recommended (for cause) for subjects with heavy/suspicious bleeding. Results from 
these procedures should be documented in the eCRF. 
Endometrial biopsy samples will be performed with the Pipelle de Cornier® (or equivalent), as 
described in the manual provided by the central laboratory. 
10.4.6 Bone mineral density and DXA 
BMD of femoral neck, total hip and lumbar spine will be assessed by DXA, under the supervision of a 
nominated primary technologist at the site. 
For each subject, the same DXA machine must be used for all scan acquisitions.  
All DXA scans will be read by a central imaging laboratory blinded to treatment group. There will also 
be centralized monitoring of DXA scan quality for each site including a pre-qualification phantom scan 
and a monthly review of daily QC data.  
In the event a scan does not meet quality standards, the site will be asked to repeat the scan. A repeated 
scan will be required for each scan showing 5% or more BMD loss from baseline. 
Instructions to measure the BMD, detailed information on the centralized reading and QC and the 
stopping rules for subjects will be included in a specific imaging manual. 
10.4.7 Bone markers 
Blood samples for exploratory bone biomarkers such as, but not limited to, collagen type 1 β-carboxy-
telopeptide (CTx), procollagen 1 Intact N-Terminal (P1NP), bone-specific alkaline phosphatase (B-
ALP) and osteocalcin will be collected as part of clinical chemistry. These exploratory data will not be 
communicated to keep the operational team and the sites blinded to treatment administration. 

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10.4.8 Laboratory parameters 
Haematology, coagulation parameters, chemistry, lipids, glucose and hormones will be assessed from 
blood samples. Haematology, coagulation parameters, chemistry and lipids will be assessed at screening 
and at each visit during the treatment period, as well as at M1 FU and M3 FU visits. E2, progesterone 
(P4) and LH will be assessed at each visit during the treatment period (not at screening visit), as well as 
at M1 FU and M3 FU visits. Serum levels of the anti-müllerian hormone (AMH) and fasting glucose 
will be assessed on Day 1 only. Serum levels of the sex hormone-binding globulin (SHBG) will be 
assessed on Day 1 and Month 3 and Month 6 visits.  
Overnight fasting is required for Day 1, Months 1, 3 and 6, and Month 3 FU visits. 
Blood samples will be analyzed by the central laboratory. Details of blood sampling process, sample 
handling and shipment are described separately in a laboratory manual provided by the central 
laboratory. Central laboratory reference ranges will be filed in the investigator site file and in the trial 
master file. All laboratory results except E2, SHBG, P4, LH and bone marker levels will be assessed by 
the Investigator/sub-investigator and clinically significant abnormalities compared to screening/baseline 
status will be reported as AEs in the eCRF. E2, SHBG, P4 and LH levels will not be communicated to 
keep the operational team and the sites blinded to treatment administration. 
The laboratory parameters are listed in Appendix N. 
There may be some additional laboratory parameters to be analysed as requested by the medical monitor 
in order to follow-up on existing abnormalities. 
10.4.9 Electrocardiogram 
Local 12-lead ECG readings of QTcF will be performed at the scheduled visits.  
ECGs should be performed prior to blood sampling, physical examination and vital signs. 
10.4.10 Columbia-Suicide Severity Rating Scale (C-SSRS) 
The C-SSRS questionnaire prospectively assess the occurrence of treatment-emergent suicidal ideation 
and behavior. The questions will be administered by the site staff to the subject and completed by the 
site staff, using one of the following paper versions: 
- either the “Baseline” C-SSRS version, dedicated to subjects under screening, capturing lifetime history 
of suicidal ideation and behavior (see Appendix R) 
- or the “already enrolled subjects” C-SSRS version, dedicated to randomized subjects who are 
providing answers to the C-SSRS for the first time during the study (see Appendix S) 
- the “since last study visit” C-SSRS version (see Appendix T), dedicated to subjects for whom the C-
SSRS was completed at the previous study visit, for use at all remaining study visits. 
10.5 LINZAGOLIX AND KP017 PLASMA LEVELS 
PK blood samples will be collected from each subject for determining linzagolix and KP017 plasma 
levels. 

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On Day 1, blood samples for PK assessment will be taken at least 1.5 h post-first dose.  
During the treatment period, on days of site visits at Months 1, 2, 3, 4 and 5), the subject will be asked 
to take the dose of IMP at site, after a pre-dose PK sampling. The approximate time of dose 
administration on the four previous days and time of PK sampling will be recorded in the eCRF. 
In case of early discontinuation visit, PK sampling is not required at the withdrawal visit if the subject 
had no IMP administration the day prior to the withdrawal visit.  
Details of blood sampling process, sample handling and shipment are described separately in a 
laboratory manual provided by the central laboratory.  
10.6 CONCOMITANT MEDICATIONS AND THERAPIES 
The Investigator will record in the appropriate section of the eCRF all concomitant medications taken 
by the subject during the study, from the date of signature of informed consent and for the whole study 
duration. 
However, the use of provided/prescribed analgesics for EAP will be recorded solely in the eDiary. 
10.6.1 Permitted Medicines 
Any medications other than those excluded by the protocol (see section 10.6.2), which are considered 
necessary for the subject’s welfare and/or which will not interfere with the study medication, may be 
given at the discretion of the Investigator. 
Analgesics: 
Only the analgesics provided/prescribed by sponsor will be allowed during the Screening, Treatment 
and Follow-up Period. Other analgesics will be prohibited. Provided/prescribed analgesics should be 
taken only when required for treatment of pain. Prophylactic use of analgesics will be prohibited. 
Permitted opioid analgesics will be prescribed and dispensed as required according to local practice. 
Subjects will be required to restrict the use of analgesics to those permitted by the protocol as listed in 
Table 1.  
Table 1: Permitted rescue analgesics 
Analgesic class 
Name and dose* 
NSAID 
ibuprofen 200 mg  
Narcotic Analgesic 
5 mg hydrocodone + 300 mg acetaminophen**  
* Use of these analgesic medications should be according to the product prescribing 
information. 
** Or local equivalent 
 

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Other:  
In order to prevent or minimize possible impact on bone mineral density, subjects will receive calcium 
500 to 1000 mg and vitamin D 400 IU supplementation which they will be advised to take daily until 
the end of study. Intake should be recorded at each study visit in eCRF. As the interaction potential is 
unknown, the intake should be separated of at least 4 hours from the intake of the study drug. 
If necessary, the dose of calcium or vitamin D supplementation may be reduced or discontinued at the 
discretion of the investigator. 
10.6.2 Prohibited Medicines 
Medication listed in exclusion criteria (see section 9.2.2) will be prohibited up to Month 6.  
To consider a subject who is currently taking any prohibited therapies for potential inclusion in this 
study, the Investigator must ensure that the subject has sufficient washout time prior to screening (see 
Section 10.2.1). 
Strong CYP3A4 inhibitors or inducers are prohibited up to end of treatment in view of the ABT 
(Appendix P). 
Linzagolix is considered to be a weak inhibitor of CYP2C8. Substrates to CYP2C8 with a narrow 
therapeutic index should be administered with caution. 
Hormonal contraception including hormonal IUD must be stopped following ICF signature until 3 
months after end of treatment.  
When a prohibited medication or treatment is necessary for the subject’s well-being, the sponsor must 
be notified and possible alternatives are to be discussed before administration of the prohibited 
medication or treatment whenever possible. 
10.6.3 Non-Drug Therapies 
Contraceptive use: 
For subjects of childbearing potential and requiring contraception, non-hormonal contraception is 
required from beginning of screening period until 3 months after the end of treatment. Two forms of 
non-hormonal contraception will be required e.g. condom with spermicide (if in the opinion of the 
investigator a woman is at risk of acquiring HIV, spermicide should be avoided; condom with diaphragm 
may be used). Suitable condoms with spermicide will be provided free of charge to subjects over the 
duration of the study. 
After 3 months after the end of the Treatment Period until the end of the Follow-up Period, contraception 
is still required but hormonal contraception is allowed. 

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10.7 SUBJECT COMPLETION AND WITHDRAWAL 
10.7.1 Subject Completion 
A subject will be considered as a “completer” when she has completed all study procedures/visits she is 
supposed to follow according to the protocol. 
10.7.2 Subject Withdrawal  
Subjects will be informed that they have the right to withdraw from the study at any time, without 
prejudice to their medical care, and that they are not obliged to state the reason(s). Any withdrawal must 
be fully documented in the eCRF exit form.  
The Investigator may withdraw a subject at any time if this is considered to be in the subject’s best 
interest.  
In addition, the sponsor could make a decision to temporarily or permanently discontinue the study for 
safety, ethical, compliance or other reasons. In this case, the subject’s participation may be ended 
prematurely without asking for her consent. 
In case of early discontinuation, the subject will be instructed to complete the relevant eDiary 
questionnaires as soon as possible upon treatment discontinuation. 
Subjects who did not receive the study drug will be withdrawn from the study and no further study 
procedures will be performed. 
Withdrawal during treatment period: 
Subjects who discontinue between Day 1 and Month 3 should undergo the procedures required at Month 
6 (except the DXA scan and the endometrial biopsy if a biopsy was obtained at screening) and will not 
enter the 6-month follow-up period. 
Subjects discontinuing the study treatment between Month 3 and Month 6 should undergo the 
procedures required at Month 6. These subjects will enter a 6-month follow-up period and will continue 
daily eDiary recording for 6 months and up to Month 6 FU visit in order to continue to collect efficacy 
data. 
PK sampling is not required if the subject had no IMP administration the day prior to the withdrawal 
visit. 
Withdrawal during follow-up period: 
Subjects discontinuing participation in the study during the follow-up period should undergo the 
procedures required at Month 6 FU visit, which includes completion of all ClinRO and ePRO 
questionnaires, except the DXA in case of discontinuation before Month 3 FU visit. 
10.7.2.1 
Discontinuation criteria 
During the course of the study, the subject may be discontinued for the following reasons: 

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- 
Adverse Event: 
Includes clinically significant new or worsening existing condition as judged 
by the Investigator. Document in the AE form. 
- 
Subject’s Request: Consent withdrawal, subject moved, schedule conflicts, etc. Specify the 
reason in the comment section of the eCRF Exit Form. 
- 
Protocol Violation: Major protocol violation which may affect the subject’s safety. Specify the 
protocol violation in the comment section of the eCRF Exit Form. 
- 
Lost to Follow-up: 
Document with at least two phone calls and a certified letter requesting return 
receipt without response. Document in the comment section of the eCRF Exit 
Form. 
- 
Pregnancy: 
Subjects that have been exposed to study treatment and who become pregnant 
during the Treatment Period will be immediately withdrawn from treatment. 
Pregnancies that have been exposed to study treatment and occurred up to 
Month 3 FU visit, or started up to 4 weeks after treatment discontinuation in 
case of early withdrawal will be followed up for pregnancy and neonatal 
outcomes at birth. Any pregnancy must be reported with the Pregnancy 
Surveillance Form (see section 12.6). 
- 
Other: 
Specify in the Comments section in the eCRF Exit Form. This reason should 
only be used if the reason for discontinuation is not better accounted for by 
another category. 
Discontinuation Rules at Day 1: Subjects presenting with ALT, AST, GGT or total bilirubin ≥ 2 ULN 
should be discussed with the Sponsor and may have to discontinue study treatment if these results are 
indicative of liver involvement.  
Subjects presenting with a clinically significant finding in the biopsy sample collected at screening and 
who have completed Day 1, will have to discontinue study treatment. 
Subjects who have a serum calcium level at Day 1 above 2.9 mmol/L and who have completed Day 1, 
should have calcium supplements interrupted. If serum calcium level at Day 1 is above 3.1 mmol/L 
calcium supplements and study treatment are to be interrupted.  A repeat test of this parameter within 
2 weeks under fasting conditions is to be performed. If the results of the repeat remain above 2.9 
mmol/L, study treatment should definitively be discontinued and the subject should be advised to consult 
an endocrinologist for further evaluation. 
Discontinuation Rules during the Treatment Period: 
Endometrial biopsies:in case of endometrial biopsy diagnosis being an endometrial hyperplasia of any 
type or worse, the subject will have to discontinue the treatment (and will not be eligible to enter the 
extension study) and will be advised to consult for a gynecological evaluation and treatment. 
Serum calcium: Subjects who have a serum calcium level on treatment above 2.9 mmol/L should 
have calcium supplements interrupted. If serum calcium level on treatment is above 3.1 mmol/L calcium 
supplements and study treatment are to be interrupted.  A repeat test of this parameter within 2 weeks 

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under fasting conditions is to be performed. If the results of the repeat remain above 2.9 mmol/L, study 
treatment should definitively be discontinued and the subject should be advised to consult an 
endocrinologist for further evaluation. 
Bone mineral density loss: subjects who experience more than 8% BMD loss or a Z-score ≤ -2.5 at any 
site (femoral neck, hip or spine) will be discontinued from study treatment and will enter the follow-up 
period (they will not be eligible to enter the extension study). 
 
Liver function tests: following the Food and Drug Administration (FDA) guidance on drug-induced 
liver injury (17), subjects who have an elevation of hepatic enzymes are to be withdrawn immediately 
from treatment if: 
• 
ALT or AST >8xULN  
• 
ALT or AST >5xULN for more than 2 weeks  
• 
ALT or AST >3xULN and (TBL >2xULN or INR >1.5)  
• 
ALT or AST >3xULN with the appearance of fatigue, nausea, vomiting, right upper quadrant 
pain or tenderness, fever, rash, and/or eosinophilia (>5%)  
Withdrawn subjects will be followed up until hepatic parameters return to normal. 
ECG : subjects who have a QTcF > 500 ms or increase > 60 ms from the highest value prior to first dose 
will have to be withdrawn from study treatment and followed up until return to QTcF < 480 ms or – if 
not reached after 3 months of treatment cessation- be referred to a cardiologist. 
10.7.3 Subject Replacement 
Discontinued subjects who did not receive the study drug may be replaced. 
Additional subjects may be recruited due to  subjects who were discontinued due to ALT, AST, GGT 
or total bilirubin ≥ 2 times the upper limit of normal at Day 1, or due to a clinically significant biopsy 
finding at Day 1 (treatment start), or due to high calcium level at Day 1. 
11 INVESTIGATIONAL MEDICINAL PRODUCT  
11.1 DESCRIPTION OF INVESTIGATIONAL MEDICINAL PRODUCTS 
The term “Investigational Medicinal Product” (IMP) will refer to the ObsEva investigational drug 
linzagolix, the ABT (E2 1 mg/NETA 0.5 mg) or their matching placebos.  
 
Investigational 
product 
Placebo 
ABT 
ABT 
Placebo 

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International 
nonproprietary name 
(INN) 
Linzagolix 
NA 
E2 and NETA 
NA 
Name of active 
ingredient 
Linzagolix 
NA 
E2 and NETA 
NA 
Form 
Film-coated 
tablet 
Film-coated  
tablet 
Capsules 
Capsules 
Strength 
75 mg and  
200 mg 
placebo for 75 mg and 
placebo for 200 mg 
1.0 mg/0.5 mg 
Placebo 
Dose or 
concentration of 
active treatment 
75 mg  
and 200 mg 
0 mg 
1.0 mg/0.5 mg 
0 mg 
Frequency and 
duration of 
administration 
Once daily for up to 6 months 
Route of 
administration 
Oral 
Manufacturer 
(Name and address) 
Patheon, Canada 
Sharp Clinical Services Inc. 
2400 Baglyos Cir, Bethlehem, 
PA 18020, United States 
Primary packaging  
PVC-PVdC/Al blister containing 
15 tablets 
PVC/Al blister containing 
7 capsules 
Secondary 
packaging (1 kit) 
4 blisters attached into a child-resistant 
wallet card* 
14 blisters in a carton box 
Storage 
Requirements 
As indicated on the study drug kit label 
*The blisters being linked together inside the wallet card, the kit is considered as a single unit and 
therefore labelling on the wallet is sufficient (individual blisters are not labelled). 
11.2 DOSAGE AND ADMINISTRATION 
Linzagolix and corresponding placebo treatments will be supplied as film-coated tablets for oral 
administration and given as monthly treatment kits (Figure 5). 
ABT and corresponding placebo will be supplied as red capsules and given as 3-monthly treatment kits. 

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IMP treatment will start on Day 1 and will be administered once daily up to the day preceding the Month 
6 visit . The subjects will have to swallow two tablets of linzagolix/placebo and one capsule of 
ABT/placebo, ideally at the same time each day. 
On the day of a study visit, the subject must take the study medication at site, after the PK blood sample 
collection, except on Day 1 visit where the study medication must be taken before the PK blood sample 
collection (at least 1.5 h before). The site staff will record in the eCRF the time of study medication 
intake. The linzagolix/placebo tablets must be taken from the kits dispensed on that visit (and not from 
the previously dispensed kits). On Day 1 and Month 3 visits, ABT/placebo capsules must be taken from 
the kits dispensed during these visits. On Month 1, 2, 4 and 5 visits, ABT/placebo capsules must be 
taken from the previously dispensed kits. 
The treatment groups are described below: 
Treatment 
group 
Daily dose Day 1 to Month 6 
 
Linzagolix 
active tablets 
Linzagolix 
placebo tablets 
ABT 
active capsules 
ABT 
placebo capsules 
75 mg 
1  75 mg 
1  placebo 200 mg  
None 
1 capsule 
200 mg 
1  200 mg 
1  placebo 75 mg 
1 capsule 
None 
Placebo 
None 
1  placebo 75 mg  
AND 
1  placebo 200 mg  
None 
1 capsule 
11.3 PACKAGING AND LABELLING 
Study drug (linzagolix/placebo) will be provided by the sponsor (or delegate) as monthly kits.  
On Day 1, Month 1, Month 2, Month 3, Month 4 and Month 5 visits, the subject will be given a wallet 
card containing four blisters in total: 
- 
Two blisters of 15 tablets each of 200 mg linzagolix or matching placebo (corresponding to the 
grey card on Figure 5), 
- 
Two blisters of 15 tablets each of 75 mg linzagolix or matching placebo (corresponding to the 
pink card on Figure 5). 
This kit covers 30 days of treatment.  

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Figure 5 : Linzagolix/placebo kit design 
Each linzagolix kit will be labeled with a unique kit number starting from B00001, B00002, B00003, 
etc. (6-characters). The blisters being attached into the wallet card, linzagolix kit is considered as a single 
unit and therefore labelling on the wallet is sufficient (individual blisters are not labelled). 
ABT and matching placebo will be provided by the sponsor (or delegate) as 3-monthly kits.  
On Day 1 and Month 3 visits, the subject will be given a carton box containing 14 blisters of seven 
capsules each of ABT or matching placebo. This kit covers 98 days of treatment. 
Each ABT kit will be labeled with a unique kit number (different from the linzagolix kit number), 
starting from N00001, N00002, N00003 etc. 
Each kit of linzagolix/placebo or ABT/placebo will have a label including a tear-off part. The tear-off 
part containing the study number and the kit number will be placed into a drug accountability form at 
site.  
Labels will be printed in the local language of the countries where the study will take place in accordance 
with applicable local regulations, the recommendations of GMP guideline (Annex 13) and FDA 21 CFR 
312.6 part. 
The kit label, i.e. on the secondary packaging, will indicate at least the following items: 
 Protocol number 
 Kit number 
 Batch number 
 Storage conditions 
 Sponsor name and address 
Label examples are filed in the study file at the Investigator’s site and in the trial master file.  
11.4 PREPARATION, HANDLING AND STORAGE 
The investigational site will store the IMP according to the specifications of the sponsor. The IMP 
storage conditions will be indicated on each kit label. 

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The storage facility at site should be locked and temperature-controlled. 
Linzagolix and ABT must be stored at 68°F to 77°F (20°C to 25°C), excursions permitted between 59°F 
and 77°F (between 15°C and 25°C). The storage temperature at the clinical site must be recorded by 
using a minimum/maximum thermometer or electronically 24 hours a day with printouts available on 
request. 
The IMP may be dispensed only by the pharmacist or by a member of staff specifically authorized by 
the Investigator. 
Any deviations from the recommended storage conditions at the site should be immediately reported to 
the sponsor (or delegate), and the IMP should not be used until authorization has been given by the 
sponsor (or delegate).  
11.5 IMP ACCOUNTABILITY 
The Investigator is responsible for ensuring IMP accountability, including reconciliation and 
maintenance of drug records. 
 
Upon receipt of the IMP, the Investigator (or delegate) will check for accurate delivery and 
acknowledge receipt in IWRS. A copy of acknowledgement of receipt will be retained in the 
investigator file. 
 
The dispensing of the IMP will be carefully recorded on the appropriate drug accountability 
form provided by the sponsor (or delegate) and in eCRF, and an accurate accounting will be 
available for verification by the study monitor at each monitoring visit. 
 
IMP accountability records will include: 
o Confirmation of IMP delivery to the trial site 
o The inventory at the site of IMP delivered 
o The use of each dose by each subject (accountability to be done at each visit) 
o Dates, quantities, batch numbers and kit numbers assigned to the subject. 
o The return to the sponsor (or delegate) or alternative disposition of used and unused 
IMP 
 
The Investigator should maintain records that adequately document: 
o The subjects were provided with the doses specified by the protocol/amendment(s). 
o All IMP provided were fully reconciled. 
Unused IMP must not be discarded or used for any purpose other than the present study. IMP that has 
been partially dispensed to a subject must not be re-dispensed to a different subject. 
The Study monitor will check on an ongoing basis the IMP accountability form and verify all IMP 
dispensations and returns (both unused and used treatments) during the entire study period and prior to 
making arrangements for their return to the sponsor (or delegate) or authorizing their destruction by the 
study site in agreement with the sponsor. 

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11.6 ASSIGNMENT TO TREATMENT GROUPS 
Prior to the start of the study, a randomization list and 2 treatment kit lists (one for linzagolix/placebo, 
one for ABT/placebo) will be generated by a designated statistician from the sponsor or delegate to be 
transmitted to the assigned clinical packaging organization for labelling and to a fully integrated IWRS. 
The IWRS will provide the kit numbers, which will correspond to the linzagolix/placebo and 
ABT/placebo kit numbers.  
Subjects will be randomized to one of three treatment groups in a 1:1:1 ratio. There will be no 
stratification. 
11.7 ASSESSMENT OF INVESTIGATIONAL MEDICINAL PRODUCT 
COMPLIANCE 
The subject will record her IMP intake daily in the eDiary. 
Each subject must be instructed to bring with her to each visit both opened and unopened IMP packages 
(linzagolix/placebo, ABT/placebo), in order to allow the assessment of compliance with study treatment.  
The decision to withdraw a non-compliant subject from the study will be discussed between the 
Investigator and the sponsor. A blind review meeting will take place prior to unblinding. Subjects with 
poor compliance and other significant protocol violations may be excluded from the Per Protocol 
Analysis Set. 
During the entire study period, the study monitor will perform drug accountability and the assessment 
of compliance with study treatment by checking both opened and unopened IMP packages, as well as 
empty blisters.  
11.8 METHOD OF BLINDING 
The study design is double blind. Linzagolix/placebo treatments will be provided in monthly treatment 
kits, packaged, labelled and administered in the same manner to protect the blinded nature of the trial. 
ABT/placebo treatments will be supplied as 3-monthly kits, packaged, labelled and administered in the 
same manner to protect the blinded nature of the trial. Each treatment kit will be labelled with a unique 
kit number. Treatment kit numbers will be provided through IWRS.  
The randomization list will be secured in a computer file with restricted access to only the designated 
personnel including those responsible for labelling and handling the study medication until the study 
database is locked and ready to be unblinded. 
Every effort will be done to keep the Investigator, the subject and the sponsor study personnel fully 
blinded. Individual E2, SHBG, P4, LH, bone marker levels and PK data will not be communicated to 
them. 
Post-randomization eDiary bleeding data will remain blinded to the Investigator, the operational team 
and to the sponsor study personnel.  

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11.9 EMERGENCY UNBLINDING 
The study blind may be broken for an individual subject only in the case of an emergency when 
knowledge of the IMP is essential for the clinical management of the subject. The Investigator can break 
the blind for a subject by using the IWRS that permits immediate unblinding. In case of doubt as to 
whether emergency unblinding is necessary, the Investigator should contact the sponsor prior to 
breaking the study blind. 
In the case of a code break, the Investigator must inform the sponsor immediately without revealing the 
code to the sponsor study personnel nor the complete Study Team. 
11.10 TREATMENT OF OVERDOSE AND MISUSE  
An overdose is defined as any dose (i.e. quantity of drug given per administration or per day) above the 
maximum dosage defined in the protocol (200 mg per day).  
Misuse is the term used if more precise information is not available and additional information is needed 
to determine if there was a “medication error”, “drug abuse” or “overdose”. 
Any details of overdose or misuse must be recorded in the eCRF.  
Any case of overdose or misuse associated with an AE or a SAE must be reported as per the instructions 
detailed in Sections 12.2.3 for AEs or 12.3.2 for SAEs. 
The effects of an overdose of linzagolix are unknown, but single and repeated doses of up to 400 mg 
were shown to be safe in a Phase 1 single and multiple ascending dose study, and doses up to 200 mg 
daily for 3 months were safe in endometriosis subjects (see Section 5.5.3). 
11.11 OTHER SUPPLIES TO BE USED IN THE STUDY 
A limited quantity (as per Investigator’s judgement) of standard doses of permitted analgesics will be 
provided/prescribed to the subject as rescue medication for EAP. These will be provided by the sponsor 
free of charge to the subject or reimbursed.  
Electronic diaries will be provided for subjects use. These remain the property of the sponsor. 
Condoms with spermicide as well as calcium and vitamin D supplements will also be provided by the 
sponsor free of charge to the subject. If required, spermicide-free condoms and diaphragms may be 
reimbursed to the subject. 
12 ADVERSE EVENTS AND SERIOUS ADVERSE EVENTS 
Comprehensive assessments of any apparent toxicity experienced by the subject will be performed 
throughout the course of the study from the time of subject’s signature of informed consent. Study site 
personnel will report any AE, whether observed by the Investigator or reported by the subject (see 
section 12.2.1). 

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The safety profile of linzagolix will be assessed through the recording, reporting and analysis of baseline 
medical conditions, AEs, physical examination findings, ECGs, vital signs, laboratory tests, BMD 
assessments. 
The reporting period for AEs is described in section 12.5. 
12.1 ADVERSE EVENTS 
12.1.1 Definitions 
Adverse Event: 
An adverse event (AE) is defined as any untoward medical occurrence in a clinical trial subject 
administered an investigational medicinal product (IMP) and which does not necessarily have a causal 
relationship with this treatment. It can therefore be any unfavourable sign (including an abnormal 
laboratory finding), symptom, or disease temporally associated with the use of an IMP, whether or not 
considered related to the IMP. 
Events occurring prior to first IMP administration in the study are not considered AEs per se, but an 
event that could be due to the disease or specific circumstances. For monitoring purposes, any event 
occurring after signature of the informed consent form, as assessed by the Investigator, should be 
reported on an AE form or an SAE form, as appropriate. In case of AE reporting prior to IMP intake, an 
assessment should be performed whether an event constitutes rather a baseline medical condition (e.g. 
Gilbert’s disease - to be reported on the “medical history page of the eCRF”) or an AE. 
Severity: 
The severity of AEs must be assessed by the Investigator according to the following definitions. The 
term “severity” is used to describe the intensity of a specific event. This has to be distinguished from 
the term “serious”. 
Mild: 
The subject is aware of the event or symptom, but the event or symptom is 
easily tolerated (e.g. no reduction in daily activities is required). 
Moderate: 
The subject experiences sufficient discomfort to interfere with or reduce her 
usual level of activity. 
Severe: 
Significant impairment of functioning: the subject is unable to carry out usual 
activities and/or the subject’s life is at risk from the event.  
Causality assessment: 
The causality assessment of an AE to the linzagolix and/or ABT will be rated as follows by the 
Investigator: 
Not related: 
There is no reasonable possibility of causal relationship between an AE and 
IMP. 

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Related: 
There is at least a reasonable possibility of a causal relationship between an 
AE and an IMP. This means that there are facts (evidence) or arguments to 
suggest a causal relationship. 
Unexpected Adverse Event: 
Any AE which is not consistent in specificity or severity with the current Investigator’s Brochure 
(section 6.7.1), including all amendments, is considered unexpected. 
Outcome: 
Outcome describes the status of the AE. The Investigator will provide information regarding the subject 
outcome of each AE, and the options include: 
Fatal 
Termination of life as a result of an AE. 
Not recovered/not resolved 
Subject has not recuperated or the AE has not improved. 
Recovering/resolving 
Subject is recuperating or the AE is improving. 
Recovered/resolved 
Subject has recuperated or the AE has resolved. 
Recovered with sequelae/resolved 
with sequelae 
AE has resolved, but the subject has symptoms or pathology. 
Unknown 
Unknown, not observed, not recorded, or refused. 
Action taken regarding study drug: 
The Investigator will provide the action taken regarding study drug in response to each AE, and the 
options include: 
Dose not changed 
No change in the administration of study drug. 
Drug (study drug) interrupted 
Study drug is being temporarily interrupted due to AE. 
Drug (study drug) withdrawn 
Decision was made to withdraw the study drug due to AE. 
Unknown 
Unknown, not observed or not recorded. 
Not applicable 
AE started before dosing or after dosing finalized. 

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12.1.2 Abnormal laboratory findings and other objective measurements 
Abnormal laboratory findings and other objective measurements (e.g. vital signs) must be reported as 
an AE only if assessed by the Investigator as “clinically significant” e.g. meeting at least one of the 
following conditions: 
1. The abnormality suggests a disease and/or organ toxicity AND this abnormality was not present 
at the screening visit or is assessed as having evolved since the screening visit. 
2. The abnormality is a Serious Adverse Event. 
3. The abnormality results in discontinuation of the IMP. 
4. The abnormality requires medical intervention or concomitant therapy. 
The Investigator must initial and date each laboratory report/eCRF page and note directly on the 
report/eCRF page whether or not each out-of-range laboratory result is clinically significant. The 
outcome of this assessment will be reported using an AE or SAE form, as appropriate. 
When reporting an abnormal finding for laboratory parameters or other objective measurements on the 
AE page of the eCRF, a clinical diagnosis should be recorded rather than the abnormal value itself, if 
available (for example, “anaemia” rather than “decreased red blood cell count”). 
For all of these AEs, whether or not related to the treatment, the laboratory test(s) will be followed-up 
as appropriate. 
12.1.3 Baseline Medical Conditions 
Medical conditions present at the Screening visit(s), including results of the study screening 
assessments, are defined as Baseline Medical Conditions. These medical conditions should be 
adequately documented on the “medical history page of the eCRF”. Baseline Medical Conditions that 
worsen in severity or frequency during the study should be recorded and reported as AEs. 
12.1.4 Exacerbation of endometriosis 
In this protocol, symptoms and signs of exacerbation or worsening of endometriosis will usually be 
captured in the context of efficacy assessment. Therefore, symptoms, exacerbation or worsening of 
endometriosis will NOT be considered as AEs nor captured on the AE page of the eCRF unless clinically 
significant AND not consistent with the anticipated natural progression of the disease.  
Lack of efficacy of the study drug is NOT considered as an AE. 
12.1.5 Adverse Events of Special Interest 
Not Applicable. 

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12.2 PROCEDURES FOR ELICITING, RECORDING AND REPORTING 
ADVERSE EVENTS 
12.2.1 Eliciting Adverse Events 
Data on AEs will be obtained at scheduled or unscheduled study visits, based on information 
spontaneously provided by the subject and/or through questioning of the subject. 
To elicit AEs, questioning at each study visit should begin with simple non-leading questions. For 
example: 
 
How have you felt since your last visit? 
 
Have you had any health problems since you were here last?  
If a subject is seen by a physician not involved with the study in relation to an AE, the Investigator 
should make every effort to contact the treating physician in a timely manner in order to obtain all 
information necessary for the appropriate reporting of the event. 
12.2.2 Recording of Adverse Events in the eCRF 
As the quality and precision of acquired AE data are critical, Investigators should use the AE definitions 
provided in the above sections and should follow this guideline when completing the AE pages of the 
eCRF: 
 
Whenever possible, recognized medical terms should be used to describe AEs rather than 
colloquialisms (for example, ‘influenza’ rather than ‘flu’), and abbreviations should be avoided 
in provided AE term. 
 
AEs should be described using a specific clinical diagnosis, if this is available, rather than a list 
of component signs or symptoms (for example, ‘congestive heart failure’ rather than ‘dyspnoea, 
rales and cyanosis’).  
 
However, signs and symptoms that are not linked (as "co-manifestations”) to an identified 
disease or syndrome, or for which an overall diagnosis is not available, should be reported as 
individual AEs in separate eCRF AE page(s).  
 
Provisional diagnosis (e.g. “suspected Myocardial Infarction”) are acceptable but should be 
followed up to a definite diagnosis, if finally available. 
 
AEs occurring secondary to other events (e.g. sequelae or complications) should be identified 
by the primary cause. A primary AE, if clearly identifiable, generally represents the most 
accurate clinical term to record in the eCRF. The Investigator should be invited to provide 
his/her opinion of which is the primary AE. 
12.2.3 Reporting of Adverse Events 
Complete and accurate data on all AEs experienced for the duration of the reporting period, as defined 
in section 12.5, will be reported on an ongoing basis in the AE pages of the eCRF. 

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It is important that each AE report includes a description of the event, whether it is considered serious 
(and if so the criterion satisfied), its duration (onset and resolution dates), its severity, its relationship to 
the IMP(s), any other potential causality factors, any treatment given or other action taken (including 
dose modification or discontinuation of the IMP) and its outcome. 
12.3 SERIOUS ADVERSE EVENTS 
12.3.1 Definitions 
A Serious Adverse Event (SAE) is defined as any untoward medical occurrence or effect that at any 
dose: 
 
results in death, 
i.e. the AE causes or contributes to the death. 
 
is life-threatening, 
i.e. the AE places the subject at immediate risk of death; it does not refer to AE which 
hypothetically might have caused death if it were more severe. 
 
requires inpatient hospitalization or prolongation of existing hospitalization, 
i.e. the AE requires at least an overnight admission or prolongs a hospitalization beyond the 
expected length of stay. Hospital admissions for surgery planned before study entry, for social 
reasons, for any elective surgery (i.e. plastic surgery) or for normal disease management 
(including treatment adjustment) are NOT to be considered as SAE according to this criterion.. 
 
results in persistent or significant disability / incapacity, 
i.e. the AE resulted in a substantial disruption of the subject’s ability to conduct normal 
activities. 
 
is a congenital anomaly / birth defect, 
i.e. an adverse outcome in a child or fetus of a subject exposed to the IMP before conception or 
during pregnancy. 
 
is an important medical event, i.e. is medically significant ; 
Medical and scientific judgment should be exercized in deciding whether an AE is serious in 
other situation. Important medical events that may not be immediately life-threatening or result 
in death or hospitalization but may jeopardise the subject or may require intervention to prevent 
one of the other outcomes listed in the definition above should also be considered serious. 
Examples of such events are intensive treatment in an emergency room, or at home for allergic 
bronchospasm, blood dyscrasias or convulsions that do not result in hospitalization, or 
development of drug dependency or drug abuse. 

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12.3.2 SAE Urgent Reporting Procedure 
If a SAE occurs from subject consent up to the end of the follow-up period, or in case of study 
discontinuation, if the site becomes aware of an SAE up to 4 weeks post study treatment discontinuation, 
regardless of relationship and expectedness, the Investigator is to take prompt and appropriate 
therapeutic action, if necessary, to protect the safety of study subjects and report such SAE as following. 
For blinded studies, refer to section 10.9. for instructions related to emergency unblinding. 
The Investigator must notify VOISIN CONSULTING (acting on behalf of ObsEva 
Pharmacovigilance) WITHIN 24 HOURS of awareness of a new SAE or of new information on a 
previously reported SAE (= follow-up). 
To do so, the Investigator must complete a SAE report and any specific eCRF pages if justified by the 
protocol e.g. AE, medical history, concomitant medication eCRF pages and blinded and anonymized 
copies of any other supporting source documents such as lab reports, hospital discharge letter/report, 
etc. ), sign it and send it directly to Voisin Consulting by e-mail using the dedicated e-mail address 
specified below: 
 
Name/Title:  
Voisin Consulting Life Sciences / ObsEva Pharmacovigilance 
 
E-mail:  
obsevasafety@voisinconsulting.com 
VOISIN CONSULTING will notify ObsEva Pharmacovigilance within 1 working day after the receipt 
of the SAE form report or follow-up information, using the same reporting forms. 
The SAE follow-up observation period, for the concerned subjects, will be jointly decided by the 
Investigator or one of the co-investigators (in case of Investigator’s absence) and the sponsor.  
In addition, the Investigator must respond to any request for follow-up information or questions 
regarding the SAE the sponsor may have, within 1 working day for urgent queries or 5 working days 
for normal queries. SAE will be followed until the Investigator and ObsEva agree that the event is 
satisfactorily documented and resolved/stabilized. 
For any new SAE, the following minimum information is required as initial notification: 
 
Clear identification of the Investigator/Reporter with full contact information or site number, 
 
Subject identification details (study number, site number, subject’s unique study identification 
number and date of birth), 
 
IMP(s) administration details (dose and dates), 
 
Diagnosis of the event (or a brief description of signs/symptoms/clinical course if the diagnosis 
is not available) and the date of onset,  
 
Seriousness criteria, see 12.3.1, 
 
Causal relationship (Investigator’s opinion) of the event with the IMP(s) or with the trial 
procedure (e.g. the causality according to the Investigator during screening). 

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12.4 REPORTING TO THE INSTITUTIONAL REVIEW BOARDS AND 
REGULATORY AUTHORITIES 
The Investigator must comply with any applicable requirements related to the reporting of SAEs 
involving the study subjects to the IRB/REB that approved the study.  
ObsEva will comply with the applicable regulatory requirements related to the expedited reporting of 
suspected unexpected serious adverse reactions (SUSARs) to the regulatory authorities (e.g. Health 
Authority, Central IRB/REB). The sponsor will be responsible, through their US Agent, for notifying 
the FDA of any SUSAR, and the sponsor or designee is responsible for notifying the Central IRB/REB. 
In regions/countries other than the US, reporting of events to local authorities will be performed by the 
Investigator/sponsor or designee and in accordance with local procedures/regulations. 
In accordance with ICH GCP guidelines, the sponsor will inform the Investigator of “findings that could 
affect adversely the safety of subjects, impact the conduct of the trial or alter the IRB/REB’s 
approval/favourable opinion to continue the trial”. In particular and in line with respective regulations, 
the sponsor will inform the Investigator of AEs that are both serious and unexpected (i.e. as per the 
linzagolix Investigator Brochure and SmPC for the ABT) and are considered by the Investigator or the 
sponsor, to have a reasonably possibility of causal relationship between the administered IMP and the 
AE (i.e. SUSAR). The Investigator will keep copies of these safety reports in the investigator’s file. 
National regulations with regards to safety reports notifications to Investigators will be taken into 
account. 
Unless clearly defined otherwise by national or site-specific regulations, and duly documented, the 
responsible Investigator will promptly notify the concerned IRB/REB of any safety reports provided by 
the sponsor and provide copies of all related correspondence to the sponsor. Only when specifically 
required by regulations, the sponsor (or delegate) will provide appropriate safety reports directly to the 
concerned IRB/REB and maintain records of these notifications. 
12.5 REPORTING PERIOD 
AEs are collected on an ongoing basis from the day of signed informed consent. All new AEs and 
updates on all ongoing AEs or AEs with an unknown outcome, must be recorded up to the M6 FU visit. 
Events occurring during the screening period (i.e between ICF signature and Day 1 visit) must be 
recorded in the eCRFs using the AE form (and SAE form if appropriate) until the date the subject is 
determined to be a screening failure. Beyond that date, only serious or medically relevant protocol-
related events will be followed-up. 
A last batch of queries will be sent after last study visit if remaining ongoing/unknown outcomes of 
reported AEs are pending. After the last batch of queries with all collected data has been fully processed, 
eCRF and database will no longer be updated. Only SAEs and medically relevant ongoing/unknown 
outcome AEs will be followed-up until resolution or stabilization, under Voisin Consulting 
responsibility. 

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12.6 PREGNANCY AND IN UTERO DRUG EXPOSURE 
However, all pregnancies that are diagnosed up to M3 FU visit or up to 4 weeks after the last IMP 
administration for subjects prematurely terminating the study must be recorded using the Pregnancy 
Surveillance Form (PSF) – Part I (History and Start of Pregnancy; PSF-part I), provided by the 
sponsor (or delegate) at the beginning of the study.  
Initial reporting of pregnancies: 
Subjects who become pregnant during the study Treatment Period will be immediately withdrawn from 
the IMP treatment. 
The Investigator must notify the sponsor in an expedited manner (same as SAE reporting) of any 
pregnancy occurring during the above-mentioned period, by completing the PSF-part I. 
This form should be sent to ObsEva’s Representative for Pharmacovigilance as per the same procedures 
and timelines described for SAE Urgent Reporting in section 12.3.2. This form should be accompanied, 
as needed, by copies of the eCRF Medical History, Previous and Concomitant Therapy and the Exit 
Form. 
Follow-up of pregnancies: 
The Investigator must actively follow-up, document and report to ObsEva’s Representative for 
Pharmacovigilance the progress by tri-monthly updates up to the final outcome of the pregnancy 
using the Pregnancy Surveillance Form – Part II: (Course of Pregnancy; PSF-part II). If the subject 
can no longer be reached (lost to follow-up), documentation of the non-response/contact with two phone 
calls and a letter (certified with return receipt) are required. 
Pregnancy outcomes are not recorded in the eCRF unless considered AEs. 
Pregnancy outcomes must be reported to ObsEva’s Representative for Pharmacovigilance by 
completing the Pregnancy Surveillance Form – Part III: (Course and Outcome of Pregnancy; PSF-
part III). Timelines vary according to the nature of the pregnancy outcome: 
- 
For normal outcomes, ObsEva’s Representative for Pharmacovigilance should be notified within 
45 days of birth/delivery. 
- 
For abnormal outcomes, the fully completed form must be sent to ObsEva’s Representative for 
Pharmacovigilance according to the same procedures and timelines described for expedited AE 
reporting in section 12.3.2 (within 24 hours of awareness of this outcome). An SAE Report form 
should be completed in addition to the PSF-part III if the subject sustains an event meeting 
seriousness criteria (e.g. abnormality for the pregnancy (spontaneous abortion, stillbirth) or 
abnormality for the birth itself (e.g. prolongation of hospitalization due to caesarean section 
complications). In case of congenital malformation or birth defect of the child, a SAE form for 
the child should be completed in addition to the PSF-part III (Subject identifier = Subject ID – 1 
for a singleton neonate). 

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13 DATA ANALYSIS AND STATISTICS 
13.1 TEST OF HYPOTHESES 
All statistical hypothesis tests and confidence intervals will be two sided. To maintain an overall type I 
error rate of 0.05, as there are two linzagolix versus placebo comparisons, Bonferoni corrected p-values 
will be produced (raw p-values will be multiplied by two prior to comparing to 0.05), along with 
corresponding 97.5% confidence intervals. 
The two co-primary efficacy endpoints will be clinically meaningful reduction (see section 13.5.2) over 
the last 28 days of randomized treatment up to the Month 3 visit (the 4-week period preceding Month 3 
visit) from baseline in the mean daily assessment of DYS and of NMPP measured on a VRS, along with 
a stable or decreased use of analgesics for EAP. 
The primary objective will be assessed by testing the following two-sided hypotheses for each co-
primary endpoint, for each linzagolix group versus placebo separately: 
Null hypothesis (H0): There is no difference in the odds of subjects meeting the primary endpoint for 
the active treatment group compared to placebo, that is, the odds ratio (OR) equals 1. 
H0: OR =1 
Alternative hypothesis (H1): There is a difference in the odds of subjects meeting the primary endpoint 
for the active treatment group compared to placebo, that is, the OR is not equal to 1. 
H1: OR ≠ 1 
Where odds are equal to the proportion of subjects meeting the endpoint divided by proportion of 
subjects not meeting the endpoint. 
Each linzagolix group will need to demonstrate a statistically significant difference for both co-primary 
endpoints in order for the group to be considered more efficacious than placebo, thus maintaining an 
overall type I error rate of 0.05.  
For each linzagolix group that is statistically significantly more efficacious than placebo for the co-
primary endpoints, a fixed-sequence testing strategy shall be used within the group to test the ranked 
secondary endpoints as ordered in Section 7.1.2.1, so as to maintain the family-wise type I error rate. 
That is, the comparison for each linzagolix group versus placebo for each ranked endpoint will only be 
declared statistically significant different if the raw p-value multiplied by two is less than or equal to 
0.05 for that endpoint and for all preceding endpoints for that dose versus placebo.  
Response rates for DYS and NMPP pain at each visit will be analyzed to evaluate the changes in pain 
over time, with nominal bonferroni corrected p-values used in the comparisons of treatment groups at 
each visit. These are supportive analyses and will primarily be considered as descriptive. The analyses 
do not form part of the fixed-sequence strategy being used for the ranked secondary endpoints and will 
not be fully controlled for an overall type I error rate. However, to maintain consistency with the primary 
and secondary analyses, Bonferroni corrections will be used due to there being two linzagolix versus 
placebo comparisons for each endpoint / time point. 

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13.2 SAMPLE SIZE 
The planned sample size for this study is 150 subjects per treatment group (450 subjects in total).  
An overall two-sided type I error of 0.05 will be used. As there are two linzagolix versus placebo 
comparisons, Bonferoni corrected p-values will be produced (raw p-values will be multiplied by two 
prior to comparing to 0.05). The planned sample size takes into account the hierarchical, fixed sequence 
testing of the ranked secondary endpoints as well as the co-primary endpoints. The assumptions used 
for the sample size calculations are based on analyses of clinically meaningful reduction in pain with a 
stable or decreased use of analgesics from the Phase 2b Edelweiss study. Calculations were performed 
using East® 6.5 software. 
One hundred and fifty (150) subjects per treatment group will provide a power greater than 95% to reject 
the null hypothesis for both co-primary endpoints for either treatment group, assuming a placebo 
response rate of 14.6% and an active treatment response rate of 48.6% (75 mg, Edelweiss result) or 
64.7% (200 mg, Edelweiss result) for DYS, and a placebo response rate of 18.8% and an active treatment 
response rate of 42.1% (75 mg, Edelweiss result; the response rate for 200 mg in Edelweiss was lower 
but was inconsistent with the other doses and also the other timepoints for the same dose and so has not 
been used) for NMPP. In addition, 150 subjects per treatment group provides 85% power to reject all 
the ranked secondary endpoints based on the observed results from the placebo and 200 mg treatment 
group in the Edelweiss study.  
The values used for the sample size calculations assume that this is what would be seen on average when 
under treatment including taking into account any subjects who might withdraw from treatment early 
and therefore the calculations do not need to be further adjusted for dropouts.  
13.3 RANDOMIZATION 
Randomization will be performed via a centralized IWRS. Subjects will be randomized on Day 1 to one 
of three treatment groups in a 1:1:1 ratio for linzagolix 75 mg, linzagolix 200 mg with ABT and placebo. 
Subjects will be randomized into permutated blocks of a pre-determined length. 
Subjects participating in the extension phase and who are in the placebo treatment group will be 
randomized at Month 6 visit to either linzagolix 75 mg or linzagolix 200 mg with ABT in a 1:1 ratio. 
Subjects participating in the extension phase and who are in the linzagolix treatment groups will remain 
on the same dose that they were taking at the end of Month 6 and will undergo a dummy randomization 
in order to maintain the blind.  
13.4 ANALYSIS SETS 
The following data sets will be used for the statistical analysis: 
1. Safety Set: All randomized subjects who received at least one dose of double-blind study drug 
irrespective of the treatment received. Subjects will be analyzed according to treatment 
received. 

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2. Full Analysis Set (FAS): All randomized subjects who received at least one dose of double-
blind study drug irrespective of the treatment received. This is the same as the Safety Set, but 
for the FAS subjects will be analyzed according to randomized treatment. 
3. Per Protocol (PP) Set: All randomized subjects who completed the six months of treatment 
excluding those identified as having major protocol deviations that could potentially affect the 
efficacy assessments up to Month 6. Subjects will be analyzed according to randomized 
treatment. 
4. Follow-up (FU) Set: All randomized subjects who completed the six months of treatment and 
entered the drug free follow-up period. Subjects will be analyzed according to randomized 
treatment. 
5. Pharmacokinetic (PK) Set: all subjects who received active study medication, had no major 
protocol deviations impacting PK and with available PK data. 
Individual data points may also be excluded from the analysis sets. Rules for such exclusions will be 
described in the statistical analysis plan (SAP), including, where appropriate, time windows for various 
safety and efficacy analyses. In general, analyses of efficacy will be conducted using the FAS and PP 
sets, analyses of safety will be conducted using the Safety Set and analyses of PK will be conducted 
using the PK Set.  
A sub-group analysis will be performed for the secondary endpoint of dyspareunia as described in 
Section 13.5.3.5. Additional pre-planned sub-group analyses will be described in the SAP. 
13.5 DATA ANALYSIS 
More details of the proposed statistical analyses will be documented in the SAP, which will be written 
following finalization of the protocol and prior to the blinded responder threshold analysis of the Month 
3 data. The SAP will then be updated prior to unblinding and analysis of the data up to Month 6, in order 
to incorporate the results of the blinded responder threshold analysis. 
For continuous data and for ordered categorical data, if appropriate, the number of non-missing 
observations, mean, standard deviation, median, first and third quartiles, minimum and maximum will 
be calculated, including for change from baseline when applicable. The baseline mean will be calculated 
for all subjects based on the FAS. A baseline mean will also be calculated for each visit using the 
baseline data for the subset of patients who attend that visit, such that the same subjects contribute to 
the mean for the visit and the mean for the corresponding baseline values. Summary statistics will be 
based primarily on non-missing values. For ordered categorical data and nominal data, absolute counts 
and relative frequencies (in %) will be calculated. As appropriate, time windows for various safety and 
efficacy analyses will be defined in the SAP. 
This study will be conducted at approximately 130 study sites, resulting in only a few subjects per site 
on average. Subjects from all sites will be pooled and no adjustment for sites will be carried out in the 
statistical analyses. 
The number of subjects randomized, who received at least one dose of study drug, who completed the 
study and who prematurely discontinued will be calculated overall and for each site by treatment group, 
as well as for all subjects combined. Premature discontinuation of study drug will be summarized for 

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each treatment group, as well as for all subjects combined, with frequencies and percentages overall and 
by reason for discontinuation for all randomized subjects. 
Raw and derived data will be listed.  
13.5.1 Baseline Assessment 
Descriptive statistics will be performed on relevant screening and baseline data (i.e. data collected prior 
to the treatment administration) and on demographic characteristics for each treatment group and 
overall. There will be no formal comparison of baseline data, that is, no statistical hypothesis testing. 
13.5.2 Primary Efficacy Analysis 
The primary efficacy analysis aims to estimate the effect of linzagolix versus placebo on DYS and 
NMPP over the last 28 days  up to and including the Month 3 visit or, for subjects who discontinue 
randomized treatment prior to the Month 3 visit, over the last 28 days of randomized treatment. Use of 
analgesic medication for EAP will be included in the responder definitions. A responder for each of the 
co-primary endpoints needs to demonstrate both a reduction in pain (DYS or NMPP, depending on the 
endpoint) and a stable or decreased use of analgesics for EAP. Anyone who does not meet both of these 
criteria will be defined as a non-responder. 
The primary efficacy analysis will be conducted using the FAS. 
For each of the co-primary endpoints, the criterion for defining a subject as a responder over the last 28 
days of randomized treatment up to the Month 3 visit will include a reduction of X or greater from 
baseline in pain, where X will be determined using appropriate anchors as described below, as well as 
a stable or decreased use of analgesics for EAP. 
Mean pelvic pain scores for DYS and for NMPP will be calculated by averaging over the corresponding 
28 calendar days immediately prior to and including the day of the Month 3 visit. DYS will use days 
with uterine bleeding, defined as those days on which the subject records any uterine bleeding or spotting 
in the subject eDiary; NMPP will use days with no uterine bleeding. If a subject's mean score for DYS 
is undefined numerically because her daily eDiary reports indicate that she did not experience uterine 
bleeding on any days during the 28 calendar day time period, then the mean score for DYS will be set 
equal to zero (which reflects the absence of any DYS during that reporting time period). For subjects 
who discontinue treatment prior to Month 3, the last available observations prior to discontinuation will 
be used, in order to estimate the treatment effect of while under treatment, that is the 28 calendar days 
immediately prior to and including the last dose date (or fewer if treatment is stopped less than 4 weeks 
after randomization). The baseline mean overall pelvic pain scores for DYS and NMPP will be 
calculated by averaging over the two complete menstrual cycles during screening, which may not be 
exactly 28 days each. For both DYS and NMPP, responses of "None," "Mild," "Moderate," and "Severe" 
will be assigned a score of 0, 1, 2, and 3, respectively. 
For the assessment of a stable or decreased use of analgesics for EAP, the analgesic use for any defined 
period will be based on the mean of the total pill count for each class of rescue analgesics (endometriosis-
associated). The total pill count for each class of rescue analgesic is the sum of the pill count of the 
corresponding class of rescue analgesic, as reported in the eDiary during the time period of interest. The 
baseline analgesic use will be calculated as the mean of daily pill count of analgesics over the two 
complete menstrual cycles during screening. For purposes of determining a stable or decreased use of 

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analgesics, the averaging will be done over the same calendar days as used for the pelvic pain scores. 
The evaluation of a stable or decreased use of analgesics will be done per the specification in Appendix 
O. 
The analysis of each co-primary endpoint will be conducted using a logistic regression model, with 
treatment group as the main effect (three values) and including the baseline pain score as a covariate. 
Individual linzagolix versus placebo treatment group comparisons will be made using the same logistic 
regression model. 
Responder threshold analysis: 
For each of the co-primary endpoints, the criterion for defining a subject as a responder over the last 28 
days of randomized treatment up to the Month 3 visit will be a reduction of X or greater from baseline 
in pain. The threshold for response in the responder analysis (i.e., the value of X) will be chosen to 
represent a clinically meaningful reduction in pain and may not be the same for each endpoint. The 
threshold will be determined based on separate analyses of overall mean change using the mPGIS at 
Month 3 as an anchor. A 2-point improvement in the mPGIS will be used to define responders for the 
primary analysis. Response categories of “very mild” and “mild” will be collapsed into one category 
prior to the analyses. Monthly questions specific to DYS, NMPP, overall pelvic pain, dyschezia, 
dyspareunia and daily function will be used as separate anchors. PGIC as an anchor, Cumulative 
Distribution Function (CDF) and Probability Density Function (PDF) curves, and Receiver Operating 
Characteristic (ROC) analyses will be used as supportive analyses. The thresholds have been estimated 
in an analysis of DYS and NMPP data from the Phase 2b Edelweiss study and will be re-estimated in 
this study, calculated based on the blinded Month 3 data. As with the under treatment efficacy analysis, 
for subjects who discontinue treatment prior to Month 3, the 28 calendar days immediately prior to and 
including the last dose date will be used, along with the closest time matched PGIS and PGIC. The final 
response thresholds taking into account the previous estimates from phase 2b will be included in the 
final SAP prior to breaking the blind after Month 6. Based on the results from the Phase 2b Edelweiss 
study, it is expected that the responder threshold will be in the range of a 0.7 to 1.25 point (40% to 50%) 
reduction in pain in the 4-point VRS for a 2-point improvement and a 0.25 to 0.75 point (20% to 30%) 
reduction in pain in the 4-point VRS for a 1-point improvement. The numerical thresholds for DYS are 
expected to be larger than those for NMPP. 
13.5.3 Secondary Efficacy Analysis 
All secondary efficacy endpoints will be summarized by descriptive statistics for each treatment group, 
for each time point, including summaries of change from baseline when applicable. As with the primary 
analysis, individual linzagolix versus placebo treatment groups comparisons will be made. 
13.5.3.1 
Change from baseline to Month 6 in DYS (VRS) / NMPP (VRS) 
Mean pelvic pain scores for DYS and for NMPP for each subject will be calculated in the same way as 
for the primary endpoints. The change from baseline to Month 6 (the last 28 days of randomized 
treatment up to the Month 6 visit, or the 28 calendar days immediately prior to and including the last 
dose date for subjects who discontinue treatment prior to Month 6) in DYS using the VRS, and the 
change from baseline to Month 6 (the last 28 days of randomized treatment up to the Month 6 visit, or 
the 28 calendar days immediately prior to and including the last dose date for subjects who discontinue 

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treatment prior to Month 6) in NMPP (VRS), will be analyzed via analysis of co-variance with treatment 
group as the main effect (three values) and including the baseline pain score as a covariate.  
13.5.3.2 
Change from baseline to Month 6 in dyschezia (NRS) 
Mean dyschezia scores for each subject will be calculated by averaging over the corresponding 28 
calendar days immediately prior to and including the day of the Month 6 visit (or the 28 calendar days 
immediately prior to and including the last dose date for subjects who discontinue treatment prior to 
Month 6). The baseline mean dyschezia score will be calculated by averaging over the two complete 
menstrual cycles during screening. The change from baseline to Month 6 in dyschezia using the NRS 
will be analyzed via analysis of co-variance with treatment group as the main effect (three values) and 
including the baseline pain score as a covariate. 
13.5.3.3 
Change from baseline to Month 6 in overall pelvic pain (NRS) 
The change from baseline to Month 6 (the last 28 days of randomized treatment up to the Month 6 
visit, or the 28 calendar days immediately prior to and including the last dose date for subjects who 
discontinue treatment prior to Month 6) in overall pelvic pain using the NRS will be analyzed the 
same way as for dyschezia. 
13.5.3.4 
Change from baseline to Month 6 in the interference of pain with the ability to perform 
daily activities, measured using the pain dimension of the EHP-30  
The EHP-30 pain dimension consists of 11 items each addressing the effect of pain on various activities 
and each assessed on a 5-point scale (0=Never through to 4=Always). The EHP-30 Pain Impact Domain 
comprises the following items : 
During the last 4 weeks, because of your endometriosis, how often have you... 
1. Been unable to go to social events because of the pain?  
2. Been unable to do jobs around the house because of the pain?  
3. Found it difficult to stand because of the pain? 
4. Found it difficult to sit because of the pain? 
5. Found it difficult to walk because of the pain? 
6. Found it difficult to exercise or do the leisure activities you would like to do because of the 
pain? 
7. Lost your appetite and/or been unable to eat because of the pain? 
8. Been unable to sleep properly because of the pain? 
9. Had to go to bed/lie down because of the pain? 
10. Been unable to do the things you want because of the pain? 
11. Felt unable to cope with the pain? 
It shall be scored as per the user manual, resulting in a score on a scale from 0 (best possible health 
status) to 100 (worst possible health status). The change from baseline to Month 6 (the last 28 days of 
randomized treatment up to the Month 6 visit) in ability to perform daily activities, measured using the 
pain dimension of the EHP-30 will be analyzed via analysis of co-variance with treatment group as the 
main effect (three values) and including the baseline pain score as a covariate.  

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13.5.3.5 
Change from baseline to Month 6 in dyspareunia (VRS) 
The responses to the daily dyspareunia questions will be scored as follows. Responses where the subject 
was not sexually active for reasons other than their endometriosis will not be included in the analysis. 
 
Response 
Score 
No pain during sexual intercourse. 
0 
I was able to tolerate the pain during sexual intercourse. 
1 
Intercourse was interrupted due to pain.  
2 
I avoided sexual intercourse because of anticipation of pain.  
3 
 
Mean dyspareunia scores for each subject will be calculated by averaging over the corresponding 28 
calendar days immediately prior to and including the day of the Month 6 visit (or the 28 calendar days 
immediately prior to and including the last dose date for subjects who discontinue treatment prior to 
Month 6). The baseline mean dyspareunia score will be calculated by averaging over the two complete 
menstrual cycles during screening.  
Dyspareunia scores will be summarized using the FAS and for the sub-group of subjects who have a 
mean dyspareunia score > 1 at baseline. The statistical analysis of dyspareunia will only use the sub-
group of subjects in order to estimate the effect of treatment on such subjects. It is anticipated that this 
will be around 60% to 70% of the randomized subjects. This is a baseline assessment and does not 
influence the blinded, randomized treatment group. As per section 13.1, the type I error is maintained 
due to using fixed-sequence testing strategy. The change from baseline to Month 6 in dyspareunia will 
be analyzed via analysis of co-variance with treatment group as the main effect (three values) and 
including the baseline pain score as a covariate. 
13.5.3.6 
No analgesics use / no opiate use for EAP during the preceding 4-week period at 6 
months 
The analysis of the proportion of subjects reporting no analgesic use for EAP, and the proportion of 
subjects reporting no opiate use for EAP, during the preceding 4-week period at 6 months will be 
conducted using a logistic regression model, with treatment group as the main effect (three values). 
In addition to analyzing the absence of analgesic use for EAP, the amount used for each 4-week  period 
will be summarized, including the change from baseline. As it is likely that more than one opioid will 
be used (opioid analgesic may be different depending on countries), the amount of opioid used will be 
converted to morphine milligram equivalents (MME) in order to better quantify the actual amount of 
opioids used by subjects.  

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13.5.4 Additional Efficacy Analysis 
Endpoints that are collected daily using the eDiary will be based on the 28 calendar days immediately 
prior to and including the day of the corresponding visit, or the 28 calendar days immediately prior to 
and including the last dose date for subjects who discontinue treatment prior to the visit in question (or 
fewer if treatment is stopped less than 4 weeks after randomization), in order to estimate the treatment 
effect of while under treatment. Corresponding baseline values will be calculated based on the two 
complete menstrual cycles during screening, which may not be exactly 28 days each. 
The values for other endpoints are defined as the value at the corresponding visit, or the closest 
completed assessment to the last dose date for subjects who discontinue treatment prior to the visit in 
question. 
An additional analysis of the co-primary endpoints will be conducted that considers all subjects who 
prematurely discontinue the study treatment before the Month 3 visit as non-responders. These are 
composite endpoints that estimate the proportion of subjects with clinically meaningful reduction in 
pain, a stable or decreased use of rescure medication and who complete 3 months of treatment.  
An additional analysis of the co-primary endpoints will be also conducted to estimate the effect of 
treatment policy rather than that of while on treatment. A reference based multiple imputation approach 
will be used for subjects who discontinue the study prior to Month 3. Further details will be provided in 
the SAP. 
All exploratory efficacy endpoints will be summarized by descriptive statistics for each treatment group, 
for each time point, including summaries of change from baseline when applicable. Individual linzagolix 
versus placebo treatment group comparisons will be made. 
In general, between group comparisons for continuous endpoints will be analyzed via analysis of (co)-
variance. Between-group comparisons for binary endpoints will be analyzed via logistic regression. 
Between-group comparisons for ordinal categorical data will be analyzed using a Mantel-Haenszel test, 
or using Koch’s method when there is also a baseline covariate. Full details describing the derivation 
and analyses of each exploratory endpoint will be provided in the SAP. 
Sub-group analyses based on demographic and baseline characteristics will be performed for each co-
primary endpoint and select secondary endpoints, and will be specified in the SAP. 
13.5.5 Safety Analysis 
The safety and tolerability profile will be assessed versus baseline conditions and differences between 
treatment groups and descriptive statistics will be produced for both values and change from baseline, 
where applicable.  
Extent of exposure and compliance to treatment will be evaluated.  
Concomitant medications will be summarized using the World Health Organization (WHO) Drug 
Dictionary with frequencies and percentages for each treatment group. All medications administered 
between the date of the first dose of study drug and the date of the last dose of study drug, inclusive, 
(i.e., all medications starting or ongoing during the time interval) will be included. Thus, all medications 
with an end date prior to the first study drug dose will be excluded from the summary table. 

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An analysis of the TEAEs will be done. AEs will be summarized using the Medical Dictionary for 
Regulatory Activities tabulated by (MedDRA) dictionary preferred term and system organ class. TEAEs 
will be summarized with frequencies and percentages for each treatment group. TEAEs are defined as 
AEs with a start date on or after the first dose of study drug. Adverse events starting more than 30 days 
following discontinuation of study drug will not be included in summaries of TEAEs but will be 
summarized separately as post-treatment AEs. Tabulations by severity and drug-relatedness will also be 
made. 
Laboratory parameters values will be summarized for each visit for each treatment group including 
within-group changes from baseline. Evaluation of shifts for changes from baseline according to the 
normal range will be provided. 
BMD values and corresponding Z-scores will be summarized at baseline and at Month 6 for each 
treatment group, using the observed data. The within-group percent changes from baseline for BMD 
values will also be summarized, including 2-sided 95% confidence intervals. Categorical summaries of 
percent change from baseline will also be produced. The percent changes from baseline to Month 6 will 
be compared between each of the linzagolix groups and the placebo group via analysis of co-variance 
with treatment group as the main effect (three values) and including the baseline as a covariate. Sub-
group analyses based on demographic and baseline characteristics will be performed for BMD, and will 
be specified in the SAP.The Safety Analysis Set shall be used when summarizing safety data. 
13.5.6 Pharmacokinetic analysis methodology 
PK sample analysis will be performed using a validated assay. The analyses have to be performed 
unblinded by the analytical laboratory. The analyst may be aware of the subject number, sampling time 
and dose group.  
For descriptive statistics of plasma concentrations mean (arithmetic and geometric), standard deviation, 
median, 1st and 3rd quartiles, minimum, maximum, coefficient of variation (CV%) and number of 
observations will be provided. Concentrations below the limit of quantification (LOQ) will be assigned 
a value of zero. Explorative analyses of correlations between plasma concentrations and intrinsic PK 
factors such as e.g. body weight/BMI, race, age will be performed, as appropriate, and will be reported 
separately.  
PK analyses will be based on the PK Set.  
13.5.7 Pharmacodynamic analysis methodology 
Pharmacodynamic parameters, such as for example. estradiol and other hormones, will be summarized 
by time point for each treatment group, and listed for each subject by visit day and dose regimen. Where 
appropriate, changes from baseline will be presented. Possible PK-PD relationships may be investigated 
graphically and through statistical modeling, whilst also exploring possible covariates, and will be 
reported separately. 

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13.5.8 Missing Data 
Summary statistics will be based primarily on non-missing values. The planned statistical analyses aim 
to estimate the efficacy of linzagolix versus placebo whilst under randomized treatment and therefore 
lack of data after treatment discontinuation will not be considered as missing for these analyses.  
Subjects who cannot be assessed as a responders or not for the co-primary efficacy endpoints, e.g. due 
to lack of enough on treatment pain data will be considered as non-responders. In addition, for endpoints 
assessing the numeric change from baseline, such subjects will be assigned a change from baseline of 
zero. It is expected that very few subjects will be affected by these rules. 
As additional analyses, in order to estimate the effect of treatment policy, a reference based multiple 
imputation approach will be used for the co-primary endpoints for subjects who discontinue the study 
early under the assumption that the efficacy of the linzagolix treated subjects gradually transitions to 
that observed in the placebo subjects.  
There may be missing data during the screening period and whilst under treatment, for example, missed 
days of completing the eDiary. The primary analyses will use observed data only in such cases provided 
that a minimum number of completed daily edairy entries are available. This effectively assumes that 
the individual values such as daily eDiary assessments (observed or not) are independent of being 
missing.  
Further details on the handling of missing values and the methods and planned sensitivity analyses to 
check the robustness of the analysis results under alternative assumptions with regards to missing data 
will be provided in the SAP. 
13.6 STUDY SPECIFIC DATA ANALYSIS 
13.6.1 Responder Threshold Analysis 
An analysis will be performed using the blinded Month 3 data to determine the criterion for defining a 
subject as a responder for each co-primary and secondary endpoint, as described in section 13.5.2.  
13.6.2 End-of-Treatment Period Analysis 
After all subjects have completed the Treatment Period (Month 6), a complete analysis will be 
performed. This analysis will include all data up to the Month 6 visit. A database lock will be performed 
prior to unblinding of treatment, and any discrepant data will be clarified before the lock. Since this end-
of-treatment-period analysis is the only and final analysis of the primary and ranked secondary 
endpoints, no additional adjustment of alpha-level is necessary beyond that described in section 13.1. 
The results for the Treatment Period will be summarized and described in an integrated Clinical Study 
Report. 
13.6.3 Treatment Free Follow-Up Period Analysis 
A 6 months follow-up period without treatment is planned after the 6 months Treatment Period, or after 
the optional extension study. 

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Analyses of the follow-up period data for subjects not entering the extension study will be reported in 
an addendum to the integrated Clinical Study Report. 
After the Treatment period (Month 6), the Sponsor will be unblinded to the subject’s treatment allocation 
but treatment allocation will remain blinded up to the end of the follow-up period for the Investigator, 
the subject and the CRAs. 
14 STUDY ADMINISTRATION 
14.1 REGULATORY AND ETHICAL CONSIDERATIONS 
This study is to be performed in accordance with the protocol, with the ethical principles that have their 
origin in the Declaration of Helsinki (18), the ICH Harmonized Tripartite Guideline for GCP and all 
applicable local regulatory requirements. 
14.1.1 Informed Consent 
Before a subject can participate in the study, she must give written informed consent. The informed 
consent process will be in accordance with ICH GCP and local regulatory requirements. 
14.1.2 Regulatory Authority Approval 
Before the study is initiated at a site, the sponsor (or its delegate) will obtain approval to conduct the 
study from the appropriate regulatory authority in accordance with any applicable country-specific 
regulatory requirements. 
14.1.3 Institutional Review Board Requirements / Research Ethics Boards  
Before initiation of the study at a given site, written approval of the protocol, ICF and any information 
presented to potential subjects must be obtained from the appropriate Institutional Review Board (IRB)/ 
Research Ethics Board (REB). If any amendments to any of these documents occur during the study, 
notification or written approval as appropriate must be obtained prior to their implementation. The 
Investigator is responsible for ensuring that these actions occur.  
Where required by local regulations, the sponsor (or its delegate) is responsible for ensuring IRB/REB 
approval of the study. 
14.1.4 End of the study 
For administrative and safety reporting purposes, the end of the study will be defined as the date of the 
final clinical database lock after the last subject has completed the drug-free follow-up period. This 
provides a single and conservative definition across all study sites. 

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14.2 INVESTIGATOR RESPONSIBILITIES 
The Investigator must be familiar with and conduct the study according to ICH GCP guidelines, the 
FDA Code of Regulation and applicable local laws and regulations. 
Where required by local regulations, national level coordinating Investigators may be appointed. Their 
responsibilities are outlined in a separate agreement with the sponsor. 
14.3 DATA MANAGEMENT 
The Investigator or designee will be responsible for recording study data in the eCRF provided by the 
sponsor. It is the Investigator’s responsibility to ensure the accuracy of the data entered in the eCRFs. 
The data will be entered into a validated database. The sponsor or delegate will be responsible for data 
processing, in accordance with the sponsor (or delegate) data management procedures. Database lock 
will occur once quality assurance procedures have been completed. The database will not be locked 
before all data clarifications have been resolved and monitored and the decision on subject evaluation 
has been completed. PDF files of the eCRFs will be sent to the Investigator at the completion of the 
study. 
14.4 STUDY MONITORING 
The Investigator must ensure that eCRFs are completed in a timely manner and must allow a sponsor 
representative (e.g. CRA or study monitor) periodical access to subject records and all study-related 
materials. The frequency of monitoring visits will be determined by factors such as the design of the 
study, the frequency of subject visits and the site enrolment rate. In order to verify that the study is 
conducted in accordance with ICH GCP, regulatory requirements, and the study protocol and that the 
data are authentic, accurate and complete, the study monitor will review eCRFs and other study 
documents and will conduct source data verification. 
Upon study completion, the sponsor representative (e.g. CRA or study monitor) will visit the site to 
conduct a Study termination visit. This will involve collection of any outstanding documentation and 
study material if applicable. 
14.5 DATA MONITORING COMMITTEE 
The Data Monitoring Committee (DMC) is a group of independent experts external to the study that, 
collectively, has experience in the management of subjects with endometriosis and in the conduct and 
oversight of randomized clinical trials. 
Composition, responsibilities, rules for decision and procedures of the DMC will be described in more 
details in the DMC charter. 
The DMC will be responsible for: 
- 
safeguarding the interests of trial participants, 
- 
assessing the safety of the IMP during the trial (reviewing unblinded safety data and AEs and 
SAEs, on a regular basis, as per charter prepared for the study). 

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The DMC will provide advisory support to the Study Director, the trial team and any other Sponsor 
representative. The Study Director will be responsible for promptly reviewing the DMC 
recommendations and determine whether expedited reporting of any safety issues, amendments to the 
protocol or changes in study conduct are required. 
14.6 SUBJECT CONFIDENTIALITY 
The Investigator and the CRA (or study monitor) representing the sponsor must ensure that the subject’s 
anonymity is maintained. In the eCRFs or other documents submitted to the sponsor, the subject should 
not be identified by her name, but by her assigned SIN. If a subject’s name is included on copies of 
documents to be submitted to the sponsor, the name (except for initials) must be obliterated and the 
assigned SIN added to the documents. 
The Investigator should keep a separate log of SINs, names, addresses, telephone numbers and hospital 
numbers (if applicable). Documents not for submission to the sponsor, such as signed ICFs, should be 
maintained in strict confidentiality by the Investigator. 
14.7 QUALITY ASSURANCE 
In compliance with ICH GCP and regulatory requirements, the sponsor, a third party acting on behalf 
of the sponsor, regulatory agencies or IRB/REB may conduct quality assurance audits at any time during 
or following a study. The Investigator must agree to allow auditors direct access to all study-related 
documents including source documents, and must agree to allocate his or her time and the time of his or 
her study staff to the auditors in order to discuss findings and issues. 
14.8 PROTOCOL DEVIATIONS 
A protocol deviation is any noncompliance with the clinical trial protocol or International Conference 
on Harmonization Good Clinical Practice (ICH GCP) requirements. It is the responsibility of the site 
investigator to use continuous vigilance to identify and report deviations. All deviations must be 
addressed in study source documents and reported to the reviewing IRB/REB per their policies. The site 
investigator is responsible for knowing and adhering to the reviewing IRB/REB requirements. 
All Protocol Deviations will be reported to the Sponsor and documented in the monitoring report. These 
will be classified as minor or major based on their effect on the right, safety or well-being of the subjects 
and/or the quality and integrity of the data, and the final rating of all deviations will be confirmed prior 
to database lock. 
14.9 STUDY OR SITE DISCONTINUATION 
The sponsor may temporarily or permanently discontinue the study for safety, ethical, compliance or 
other reasons. If this is necessary, the sponsor will endeavour to provide advance notification to the site. 
If the site or study is suspended or discontinued, the Investigator will be responsible for promptly 
informing the IRB/REB.  

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Where required by local regulations, the sponsor (or delegate) will be responsible for informing the 
IRB/REB of study or site discontinuation. In such cases, all study data and unused IMP must be returned 
to the sponsor. 
14.10 RETENTION OF ESSENTIAL STUDY DOCUMENTS 
Essential documents as defined by ICH GCP include the signed protocol and any amendment(s), copies 
of the completed eCRFs, signed ICFs from all subjects who consented, hospital records, diary cards and 
other source documents, IRB/REB approvals and all related correspondence including approved 
documents, drug accountability records, study correspondence and a list of the subjects’ names and 
addresses.  
The Investigator must retain copies of the essential documents for the period specified by ICH GCP and 
by applicable regulatory requirements. 
The Investigator will inform the sponsor of the storage location of the essential documents, and must 
contact the sponsor for approval before disposing of any. The Investigator should take measures to 
prevent accidental or premature destruction of these documents. 
14.11 PUBLICATION POLICY 
ObsEva registers clinical trials (Phase I – IV) wherever and whenever mandatory on publicly accessible 
websites (e.g.: www.clinicaltrials.gov ; www.clinicaltrialsregister.eu), including posting the trial design, 
population, and study details as required. 
ObsEva posts the outcome of clinical trials on the required medium(a), within required timelines, 
regardless of the nature of the outcome. 
ObsEva shares information on the outcome of clinical trials with the Principal/Coordinating 
Investigators of trials in the form of a final report synopsis, regardless of the trial outcome. 
ObsEva duly communicates to stakeholders all relevant information arising from research activities 
related to products developed by the company, at any point and during any phase of the development of 
a product and the entire life-cycle of an ObsEva product. 
Registration, reporting and communication of clinical trial results, results and/or outcome of non-clinical 
research are subject to mandatory preliminary review and authorization by the relevant ObsEva 
functions, prior to disclosure. 
 
 

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15 APPENDICES 
APPENDIX A. SCHEDULE OF STUDY ASSESSMENTS – SCREENING AND TREATMENT PERIODS ............ 107 
APPENDIX B. SCHEDULE OF STUDY ASSESSMENTS – FOLLOW-UP PERIOD ......................................... 112 
APPENDIX C. MODIFIED BIBEROGLU & BEHRMAN SYMPTOM SEVERITY SCALE* ............................... 115 
APPENDIX D. ENDOMETRIOSIS HEALTH PROFILE QUESTIONNAIRE (EHP-30) ..................................... 117 
APPENDIX E. PROMIS FATIGUE – SHORT FORM 6A ........................................................................... 122 
APPENDIX F. HEALTH-RELATED PRODUCTIVITY QUESTIONNAIRE (HRPQ) ......................................... 123 
APPENDIX G. HEALTH RESOURCE UTILIZATION QUESTIONNAIRE (HRUQ) .......................................... 125 
APPENDIX H. PATIENT GLOBAL IMPRESSION OF CHANGE (PGIC) ....................................................... 130 
APPENDIX I. POST-TREATMENT PATIENT GLOBAL IMPRESSION OF CHANGE (PPGIC) ....................... 131 
APPENDIX J. PATIENT GLOBAL IMPRESSION OF SEVERITY (PGIS) ...................................................... 132 
APPENDIX K. SUBJECT SURGERY INTENTION QUESTIONNAIRE (SSIQ) ................................................ 133 
APPENDIX L. PHYSICIAN SURGERY INTENTION QUESTIONNAIRE (PSIQ) ............................................ 134 
APPENDIX M. EQ-5D-5L ...................................................................................................................... 135 
APPENDIX N. LABORATORY PARAMETERS ......................................................................................... 138 
APPENDIX O. ANALGESIC CHANGE DURING TREATMENT PERIOD ...................................................... 139 
APPENDIX P. STRONG CYP3A4 INDUCERS AND INHIBITORS .............................................................. 141 
APPENDIX Q. REFERENCE LIST ............................................................................................................ 143 
APPENDIX R. BASELINE C-SSRS .......................................................................................................... 145 
APPENDIX S. C-SSRS ALREADY ENROLLED SUBJECTS ......................................................................... 148 
APPENDIX T. C-SSRS SINCE LAST VISIT ............................................................................................... 151 
 

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Appendix A. Schedule of study assessments – Screening and Treatment Periods 
 
Schedule of study assessments – Screening and Treatment Periods 
Timing1 
Screening Period 
(up to 3 months2) 
Treatment Period 
Day 1 
M1 
M2 
M3 
M4 
M5 
M6 
Informed Consent 
x 
 
 
 
 
 
 
 
Inclusion-Exclusion criteria 
x 
x 
 
 
 
 
 
 
Demography, height, weight, medical history 
x 
 
 
 
 
 
 
 x3 
mB&B 
x 
 
 
 
 
 
 
 
Columbia-Suicide Severity Rating Scale 
x 
x 
x 
x 
x 
x 
x 
x 
 
 
 
1 All post-baseline visits should take place at the end of the defined period (i.e. M1 visit should be scheduled at the end of Month 1, M2 visit should be scheduled at the end of Month 
2, etc.). Post-baseline visits dates are calculated from Day 1 visit date. A month is defined as 28 days/4 weeks. Visits should be scheduled ± 3 days from the calculated date. 
2 If required for washout of oral contraceptives, other sex hormones, or GnRH antagonists/agonists (provided that the reason for discontinuing the previous GnRH-antagonist is not 
lack of efficacy),  a period of up to 3 months is allowed between signing the informed consent and the screening visit. 
3 Only weight will be recorded. 

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Schedule of study assessments – Screening and Treatment Periods 
Timing1 
Screening Period 
(up to 3 months2) 
Treatment Period 
Day 1 
M1 
M2 
M3 
M4 
M5 
M6 
ECG 
x 
 x4 
x 
x 
x 
x 
x 
x 
Physical examination 
x 
 
 
 
x 
 
 
x 
Vital signs 
x 
x 
x 
x 
x 
x 
x 
x 
Urine pregnancy test 
x 
x 
x 
x 
x 
x 
x 
x 
TVUS of uterus 
x 
 
 
 
x 
 
 
x 
Gynecological examination 
x 
 
 
 
x 
 
 
x 
Endometrial biopsy 
x 
 
 
 
 
 
 
 x5 
Pap smear test 
x 
 
 
 
 
 
 
 
Breast examination (mammogram if required) 
x 
 
 
 
 
 
 
x 
 
 
 
4 ECG on Day 1 should be performed twice: once before treatment and once after treatment (just before PK sampling). 
5 If endometrium thickness in TVUS is ≤ 5 mm, no endometrial biopsy will be necessary. 

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Schedule of study assessments – Screening and Treatment Periods 
Timing1 
Screening Period 
(up to 3 months2) 
Treatment Period 
Day 1 
M1 
M2 
M3 
M4 
M5 
M6 
Clinical laboratory & urinary protein dipstick 
x 
x6 
x6 
x 
x6 
x 
x 
x6 
Blood sample for PK7 
 
x 
x 
x 
x 
x 
x 
x 
BMD by DXA 
x 
 
 
 
 
 
 
x 
Adverse events 
x 
x 
x 
x 
x 
x 
x 
x 
Previous/concomitant medication 
x 
x 
x 
x 
x 
x 
x 
x 
Contraceptive dispensing and counselling 
x 
x 
x 
x 
x 
x 
x 
x 
Permitted analgesic prescribing/dispensing 
x 
x 
x 
x 
x 
x 
x 
x 
Vitamin D and calcium dispensing 
 
x 
x 
x 
x 
x 
x 
x 
Subject eDiary completion training/check 
x 
x 
x 
x 
x 
x 
x 
x 
 
 
 
6 Overnight fasting is required. 
7 PK samples should be taken after the ECG and before the daily dose of IMP, except on Day 1 when the PK sample should be taken at least 1.5 h after the IMP administration. 

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Schedule of study assessments – Screening and Treatment Periods 
Timing1 
Screening Period 
(up to 3 months2) 
Treatment Period 
Day 1 
M1 
M2 
M3 
M4 
M5 
M6 
IMP accountability 
 
 
x 
x 
x 
x 
x 
x 
Dispense study drug 
 
x 
x 
x 
x 
x 
x 
 
Dispense ABT 
 
x 
 
 
x 
 
 
 
EHP-30, EQ-5D-5L and PROMIS8 
 
x 
x 
 
x 
 
 
x 
mPGIS, PGIC, HRUQ and HRPQ 
 
 x9 
x 
x 
x 
x 
x 
x 
Specific monthly severity questions8 
 
x 
 
 
x 
 
 
x 
SSIQ and PSIQ8 
 
x 
 
 
 
 
 
x 
AMH 
 
x 
 
 
 
 
 
 
E2, LH, P4 
 
x 
x 
x 
x 
x 
x 
x 
SHBG 
 
x 
 
 
x 
 
 
x 
Bone biomarkers 
 
x 
 
 
x 
 
 
x 
 
 
 
8 ClinROs (Monthly dyspareunia question, PSIQ and HRUQ) will be administered to the subject by the site staff and the responses will be filled in the eDiary. ePROs (EHP-30, EQ-5D-
5L, PROMIS, PGIS, PGIC, HRPQ and SSIQ, and specific monthly severity questions) will be filled in by the subject in the eDiary. 
9 PGIC not done at Day 1. 

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Schedule of study assessments – Screening and Treatment Periods 
Timing1 
Screening Period 
(up to 3 months2) 
Treatment Period 
Day 1 
M1 
M2 
M3 
M4 
M5 
M6 
Question regarding treatment received  
 
 
 
 
 
 
 
x 

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Appendix B. Schedule of study assessments – Follow-up Period 
 
Schedule of study assessments – Follow-up Period 
Timing1 
M1 FU 
M2 FU 
M3 FU 
M4 FU 
M5 FU 
M6 FU 
Previous/concomitant medication 
x 
x 
x 
x 
x 
x 
Adverse events 
x 
x 
x 
x 
x 
x 
Columbia-Suicide Severity Rating Scale 
x 
x 
x 
x 
x 
x 
ECG 
x 
 
x 
 
 
x 
Physical examination 
 
 
x 
 
 
x 
Weight 
 
 
 
 
 
x 
Vital signs 
x 
 
x 
 
 
 
Gynecological examination 
 
 
x 
 
 
 
 
 
 
1 All follow-up study visits should take place at the end of the defined period (i.e. M1 FU visit should be scheduled at the end of the first month of follow-up, M2 FU visit should be 
scheduled at the end of the second follow-up visit, etc.). A month is defined as 28 days/4 weeks. Visits should be scheduled ± 7 days from the calculated date. 

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Schedule of study assessments – Follow-up Period 
Timing1 
M1 FU 
M2 FU 
M3 FU 
M4 FU 
M5 FU 
M6 FU 
Breast manual examination 
 
 
x 
 
 
 
Endometrium TVUS 
 
 
x 
 
 
x 
Endometrial biopsy 
x2 
x2 
x2 
x2 
x2 
x3 
Clinical laboratory & urinary protein dipstick 
x 
 
x4 
 
 
 
Subject eDiary completion check 
x 
x 
x 
x 
x 
x 
Subject eDiary collection and deactivation 
 
 
 
 
 
x 
EHP-30, HRUQ, HRPQ, EQ-5D-5L and PROMIS 
 
 
x 
 
 
x 
mPGIS and PPGIC  
x 
x 
x 
x 
x 
x 
BMD by DXA 
x5 
E2, LH, P4 
x 
 
x 
 
 
 
 
 
 
2 Endometrial biopsy will be taken only if diagnosis at preceding month was different than “benign endometrium” or if no endometrial biopsy was done at Month 6 nor at any visit 
since Month 6. 
3 An end-of-study biopsy is mandatory if no endometrial biopsy was obtained at M6 nor at any of the subsequent monthly visits. 
4 Overnight fasting is required. 
5 Subjects with a BMD decrease from baseline of > 1.5% for lumbar spine and/or > 2.5% for total hip at Month 6 FU visit will have an additional DXA scan 6 months later. 

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Schedule of study assessments – Follow-up Period 
Timing1 
M1 FU 
M2 FU 
M3 FU 
M4 FU 
M5 FU 
M6 FU 
FSH at local laboratory for subjects that do not resume 
menses at M3 FU visit 
 
 
x 
 
 
 
Bone biomarkers 
x 
 
Permitted analgesic prescribing/dispensing 
x 
x 
x 
x 
x 
 
Vitamin D and calcium dispensing 
x 
x 
x 
x 
x 
 
Urine pregnancy test and contraceptive dispensing and 
counselling 
x 
x 
x 
 
 
x 
 

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Appendix C. Modified Biberoglu & Behrman symptom severity scale* 
 
A. Dysmenorrhea 
None 
0 = No symptoms 
Mild 
1 = Some loss of ability to work or carry out normal activities 
Moderate 
2 = Unable to work or carry out normal daily activities for part of 1 or more days 
and/or moderately decreased work efficiency 
Severe  
3 = Unable to work or carry out normal daily activities for 1 or more full days and/or 
significantly decreased work efficiency 
 
B. Deep Dyspareunia 
None 
0 = No symptoms 
Mild 
1 = Tolerated discomfort during intercourse 
Moderate 
2 = Interference of usual frequency of sexual intercourse due to pain 
Severe  
3 = Avoids, or wishes to avoid, intercourse because of pain 
 
C. Non Menstrual Pelvic Pain 
None 
0 = No symptoms 
Mild 
1 = Occasional pelvic discomfort 
Moderate 
2 = Noticeable discomfort for most of cycle 
Severe  
3 = Pain persistent during cycle other than during menstruation 
 
 
D. Pelvic Tenderness (assessed by the physician) 
None 
0 = No findings 
Mild 
1 = Minimal tenderness on palpation 
Moderate 
2 = Moderate tenderness on palpation 
Severe  
3 = Exam limited due to tenderness 
 
E. Induration (assessed by the physician) 
None 
0 = No findings 
Mild 
1 = Uterus freely mobile, minimal induration in the cul-de-sac 
Moderate 
2 = Significant induration in the cul-de-sac, restricted uterine mobility 
Severe  
3 = Nodular adnexa and cul-de-sac, uterus fixed 
 
Composite Pelvic Pain and Physical Sign Score (A + B + C + D + E) 
None 
 
0 
Mild 
 
1 - 2 
Total Pelvic Pain Score (A + B + C) 
None 
 
0 
Mild 
 
1 - 3 
Total Physical Sign Score (D + E) 
None 
 
0 
Mild 
 
1 - 2 

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Moderate 
 
3 - 5 
 
Severe 
 
6 - 10 
Very Severe 
11 – 15 
 
* based on Biberoglu KO, Behrman SJ. Dosage aspects of danazol therapy in endometriosis: 
short term and long term effectiveness. Am J Obstet Gynecol. 1981;139:645.  
 

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Appendix D. Endometriosis Health Profile questionnaire (EHP-30) 
 
Final English (US) EHP-30 + Section C 
© Copyright, Oxford University Innovation Limited 2001. All Rights Reserved. 
The authors, being Professor Crispin Jenkinson, Professor Stephen Kennedy and Dr. Georgina Jones, 
have asserted their moral rights. 
 
PART 1: CORE QUESTIONNAIRE 
 
DURING THE LAST 4 WEEKS,  
BECAUSE OF YOUR ENDOMETRIOSIS, HOW OFTEN HAVE YOU... 
 
Never 
Rarely 
Sometimes 
Often 
Always 
1. 
Been unable to go to social events 
because of the pain?  
 
 
 
 
 
 
2. 
Been unable to do jobs around the 
house because of the pain?  
 
 
 
 
 
 
3. 
Found it difficult to stand because 
of the pain? 
 
 
 
 
 
 
4. 
Found it difficult to sit because  
of the pain? 
 
 
 
 
 
 
5. 
Found it difficult to walk because  
of the pain? 
 
 
 
 
 
 
6. 
Found it difficult to exercise or do 
the leisure activities you would like 
to do because of the pain? 
 
 
 
 
 
 

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OBSEVA CONFIDENTIAL 
 
DURING THE LAST 4 WEEKS,  
BECAUSE OF YOUR ENDOMETRIOSIS, HOW OFTEN HAVE YOU... 
 
Never 
Rarely 
Sometimes 
Often 
Always 
7. 
Lost your appetite and/or been 
unable to eat because of the pain? 
 
 
 
 
 
 
8. 
Been unable to sleep properly 
because of the pain? 
 
 
 
 
 
 
9. 
Had to go to bed/lie down because 
of the pain? 
 
 
 
 
 
 
10. Been unable to do the things you 
want because of the pain? 
 
 
 
 
 
 
11. Felt unable to cope with the pain? 
 
 
 
 
 
 
12. Generally felt unwell? 
 
 
 
 
 
 
13. Felt frustrated because your 
symptoms are not getting better? 
 
 
 
 
 
 
14. Felt frustrated because you are not 
able to control your symptoms? 
 
 
 
 
 
 

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OBSEVA CONFIDENTIAL 
 
DURING THE LAST 4 WEEKS,  
BECAUSE OF YOUR ENDOMETRIOSIS, HOW OFTEN HAVE YOU... 
 
Never 
Rarely 
Sometimes 
Often 
Always 
15. Felt unable to forget your 
symptoms? 
 
 
 
 
 
 
16. Felt as though your symptoms  
are ruling your life? 
 
 
 
 
 
 
17. Felt your symptoms are taking 
away your life? 
 
 
 
 
 
 
18. Felt depressed? 
 
 
 
 
 
 
19. Felt weepy/tearful? 
 
 
 
 
 
 
20. Felt miserable? 
 
 
 
 
 
 
21. Had mood swings? 
 
 
 
 
 
 
22. Felt bad-tempered or short-
tempered? 
 
 
 
 
 
 

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OBSEVA CONFIDENTIAL 
 
DURING THE LAST 4 WEEKS,  
BECAUSE OF YOUR ENDOMETRIOSIS, HOW OFTEN HAVE YOU... 
 
Never 
Rarely 
Sometimes 
Often 
Always 
23. Felt violent or aggressive? 
 
 
 
 
 
 
24. Felt unable to tell others how  
you feel? 
 
 
 
 
 
 
25. Felt others do not understand  
what you are going through? 
 
 
 
 
 
 
26. Felt as though others think  
you are whining? 
 
 
 
 
 
 
27. Felt alone? 
 
 
 
 
 
 
28. 
Felt frustrated that you cannot 
always wear the clothes you  
would choose? 
 
 
 
 
 
 
29. Felt your appearance has been 
affected? 
 
 
 
 
 
 
30. Lacked confidence? 
 
 
 
 
 
 
 
 
PART 2: MODULAR QUESTIONNAIRE CORRESPONDING TO SEXUAL RELATIONSHIPS 

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OBSEVA CONFIDENTIAL 
 
DURING THE LAST 4 WEEKS,  
BECAUSE OF YOUR ENDOMETRIOSIS, HOW OFTEN HAVE YOU... 
 
Never 
Rarely 
Sometimes 
Often 
Always 
1. 
Experienced pain during  
or after intercourse? 
If not applicable,  
please check here 
 
 
 
 
 
 
 
2. 
Felt worried about having 
intercourse because of the pain? 
If not applicable,  
please check here 
 
 
 
 
 
 
 
3. 
Avoided intercourse  
because of the pain? 
If not applicable,  
please check here 
 
 
 
 
 
 
 
4. 
Felt guilty about not wanting  
to have intercourse? 
If not applicable,  
please check here 
 
 
 
 
 
 
 
5. 
Felt frustrated because you  
cannot enjoy intercourse? 
If not applicable,  
please check here 
 
 
 
 
 
 
 
 
 
 

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Appendix E. PROMIS Fatigue – Short Form 6a 
 
This scale is formally known as PROMIS Item Bank v1.0 – Fatigue – Short Form 6a. The questions 
and the response categories included in this scale are presented below. 
 
 
Please respond to each question or statement by marking one box per row. 
 
 
During 
the 
past 
7 
days… 
Not at all 
A little bit 
Somewhat 
Quite a 
bit 
Very 
much 
1 
I feel fatigued 
□ 
□ 
□ 
□ 
□ 
2 
I have trouble starting 
things because I am tired 
□ 
□ 
□ 
□ 
□ 
 
In the past 7 days… 
 
 
 
 
 
3 
How run-down did you 
feel on average? 
□ 
□ 
□ 
□ 
□ 
4 
How fatigued were you 
on average? 
□ 
□ 
□ 
□ 
□ 
5 
How much were you 
bothered by your fatigue 
on average? 
□ 
□ 
□ 
□ 
□ 
6 
To what degree did your 
fatigue interfere with 
your 
physical 
functioning? 
□ 
□ 
□ 
□ 
□ 
 
Scoring Rules: 
The mapping of the response categories is as follows: 
1 = Not at all; 2 = A little bit; 3 = Somewhat; 4 = Quite a bit; 5 = Very much 
Assessment will be based on the sum of the individual scores across the six questions (possible scores 6 to 30, 6 = not at all, 
30 = very much). Missing data will not be imputed. 
 
 

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Appendix F. Health-Related Productivity Questionnaire (HRPQ) 
 

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Appendix G. Health Resource Utilization Questionnaire (HRUQ) 
 (To be completed by Site Staff) 
Subject number: ___________________________ 
Study Visit (please ensure to tick 1 visit only):  
Treatment period 
☐ Day 1 
☐ Month 1 
☐ Month 2 
☐ Month 3  
 
 
 
 
 
☐ Month 4  
☐ Month 5 
☐ Month 6 
Follow-up period 
☐ Month 3 FU  ☐ Month 6 FU  
Date of Assessment:  __________________________________________ 
 
Instructions to complete:  
At each scheduled on-site visit in the Treatment Period (Day 1 through Month 6) and at Month 3 FU 
and Month 6 FU visits in the Follow-up period, please ask if the subject saw a non-study health care 
practitioner since her last scheduled on-site visit for a routine/general health care visit that is not 
associated with an adverse event. 
Only record below the health care visits with non-study health care practitioners. Any visits associated 
with Adverse Events should be recorded on the AE eCRF form only (do not record below). 
 
*********** 
 
 

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Question 1 
Since the subject's last scheduled study on-site visit, has she seen a non-study health care practitioner 
(e.g., physician, nurse practitioner, physician assistant, dentist, physical therapist) for a 
routine/general health care visit that is not associated with an adverse event? 
☐ No  
☐ Yes   
If Yes, please complete the questions 2 and 3 below. 
Question 2 
a. Select the type of non-study health care practitioner who saw the subject.  
b. Indicate if it was at an office or a clinic (includes a hospital outpatient visit) 
c. Indicate the number of times the subject was seen by each practitioner. 
Types 
of 
non-study 
health 
care 
practitioner who saw the subject 
(check all that apply) 
Type of facility  
Number 
of 
times 
subject was seen by 
this non-study health 
care practitioner 
 
Office 
Clinic 
Office 
Clinic 
☐ AUDIOLOGIST 
☐ 
☐ 
 
 
☐ ALLERGIST 
☐ 
☐ 
 
 
☐ CARDIOLOGIST 
☐ 
☐ 
 
 
☐ DENTIST 
☐ 
☐ 
 
 
☐ DERMATOLOGIST 
☐ 
☐ 
 
 
☐ ENDOCRINOLOGIST 
☐ 
☐ 
 
 
☐ ENT 
☐ 
☐ 
 
 
☐ FAMILY PHYSICIAN 
☐ 
☐ 
 
 
☐ GASTROENTEROLOGIST 
☐ 
☐ 
 
 
☐ GYNECOLOGIST 
☐ 
☐ 
 
 
☐ HEMATOLOGIST 
☐ 
☐ 
 
 
☐ HEPATOLOGIST 
☐ 
☐ 
 
 
☐ IMMUNOLOGIST 
☐ 
☐ 
 
 

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☐ INFECTIOUS DISEASE SPECIALIST 
☐ 
☐ 
 
 
☐ INTERNAL MEDICINE SPECIALIST 
☐ 
☐ 
 
 
☐ INTERNIST 
☐ 
☐ 
 
 
☐ MEDICAL GENETICIST 
☐ 
☐ 
 
 
☐ NEPHROLOGIST 
☐ 
☐ 
 
 
☐ NEUROSURGEON 
☐ 
☐ 
 
 
☐ NURSE 
☐ 
☐ 
 
 
☐ NURSE PRACTITIONER 
☐ 
☐ 
 
 
☐ OCCUPATIONAL THERAPIST 
☐ 
☐ 
 
 
☐ OPHTHALMOLOGIST 
☐ 
☐ 
 
 
☐ ORTHOPEDIC SURGEON 
☐ 
☐ 
 
 
☐ OPTOMETRIST 
☐ 
☐ 
 
 
☐ PHYSIATRIST 
☐ 
☐ 
 
 
☐ PHYSICAL THERAPIST 
☐ 
☐ 
 
 
☐ PLASTIC SURGEON 
☐ 
☐ 
 
 
☐ PODIATRIST 
☐ 
☐ 
 
 
☐ PSYCHOLOGIST 
☐ 
☐ 
 
 
☐ PULMONOLOGIST 
☐ 
☐ 
 
 
☐ RADIOLOGIST  
☐ 
☐ 
 
 
☐ REPRODUCTIVE ENDOCRINOLOGIST  
☐ 
☐ 
 
 
☐ RHEUMATOLOGIST 
☐ 
☐ 
 
 
☐ SURGEON 
☐ 
☐ 
 
 
☐ UROLOGIST 
☐ 
☐ 
 
 
☐ UNKNOWN 
☐ 
☐ 
 
 
☐ OTHER HEALTH CARE PRACTITIONER 
(specify type): 
☐ 
☐ 
 
 
 
 

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Question 3 
Did the Subject have any diagnostic or therapeutic procedures performed by a non-study health care 
practitioner since the last scheduled study on-site visit? 
☐ No  
 
☐ Yes   
If Yes, complete question 4 below. 
Question 4 
a. Select the type of diagnosis/therapeutic procedures performed by non-study health care 
practitioner who saw the subject.  
b. Indicate the number of times the diagnosis/therapeutic procedures were performed. 
Diagnostic/Therapeutic Procedure  
(check all that apply) 
Number of times the procedure was performed 
Ultrasound Scan 
☐ 
 
Physical Examination 
☐ 
 
Vital Signs 
☐ 
 
MRI 
☐ 
 
CT Scan 
☐ 
 
X-Ray 
☐ 
 
Biopsy and Histologic Examination 
☐ 
 
Pelvic Exam 
☐ 
 
Urine Test 
☐ 
 
Blood Test 
☐ 
 
Hysteroscopy 
☐ 
 
SIS ( Saline infusion Sonohysterography) 
☐ 
 
Colposcopy 
☐ 
 
Other (specify): 
 
☐ 
 
 
 

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Question 5 
Has the patient spent any nights as a hospital in-patient since the last visit? 
☐ No  
 
☐ Yes  
If Yes, how many nights did they spend in hospital? 
 
 

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Appendix H. Patient Global Impression of Change (PGIC) 
 
 
 

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Appendix I. Post-treatment Patient Global Impression of Change 
(PPGIC) 
 
 
“Overall, how have your endometriosis symptoms 
changed since you stopped taking the study drug?” 
 
 
 
 

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Appendix J. Patient Global Impression of Severity (PGIS) 
 
Daily recall (dPGIS) 
 
Monthly recall (mPGIS) 
Overall, how would you describe your 
endometriosis symptoms in the last 24 
hours? 
 
Overall, how would you describe your 
endometriosis symptoms over the past 28 
days? 
 
 
 
 
 
 

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Appendix K. Subject Surgery Intention Questionnaire (SSIQ) 
 
1. How likely are you to consider having laparoscopic surgery to treat your endometriosis if your 
symptoms continue as they are now? 
The SSIQ evaluates subject likelihood of considering endometriosis-related surgeries if current 
symptoms continue, with possible scores from 0 to 10, 
0 = not at all, 10 = very likely. 
 
 

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Appendix L. Physician Surgery Intention Questionnaire (PSIQ) 
 
1. How likely are you to recommend laparoscopic surgery to treat this patient's endometriosis if her 
symptoms continue as they are now? 
The PSIQ evaluates physician likelihood of recommending endometriosis-related surgeries to the 
subject if current symptoms continue, with possible scores from 0 to 10, 
0 = not at all, 10 = very likely. 
 
 

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Appendix M. EQ-5D-5L 
 
EQ-5D-5L English US version 
© EuroQol Research Foundation. EQ-5D™ is a trade mark of the EuroQol Research Foundation 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Please tap the ONE box that best describes your health TODAY. 
 

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Please tap on the scale to indicate how your health is TODAY. 

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Appendix N. Laboratory parameters 
Routine Haematology  
 
Blood Chemistry 
Haemoglobin  
 
 
Sodium  
Haematocrit 
 
 
 
Potassium 
RBC count 
 
 
 
Calcium 
WBC count 
 
 
 
Phosphate 
Neutrophils 
 
 
 
Creatinine 
Lymphocytes  
 
 
Bilirubin total 
Monocytes 
 
 
 
Indirect Bilirubin 
Eosinophils 
 
 
 
Total protein 
Basophils 
 
 
 
Albumin 
Thrombocytes  
 
 
AST 
MCV  
 
 
 
ALT 
MCH  
 
 
 
γGT 
MCHC  
 
 
 
Alkaline phosphatase 
APTT  
 
 
 
Creatine Kinase 
INR 
 
 
 
 
LDH 
PT 
 
 
 
 
HDL, LDL, total cholesterol, and LDL/HDL ratio,  
 
 
 
 
 
triglycerides 
 
 
 
 
 
Glucose 
 
 
 
 
 
Urea and uric acid 
Urinary protein dipstick 
Hormones 
E2, LH, P4, SHBG, AMH 
All the above listed tests are to be performed at the frequencies indicated in Appendix A and Appendix 
B. All above listed blood tests will be performed by a central laboratory. Please consult the central 
laboratory instructions manual for the preparation and handling of the blood samples to be drawn to 
perform these tests. 
Bone markers 
Blood samples for exploratory bone biomarkers such as, but not limited to, collagen type 1 β-carboxy-
telopeptide (CTx), procollagen 1 Intact N-Terminal (P1NP), bone-specific alkaline phosphatase (B-
ALP) and osteocalcin will be collected as part of clinical chemistry.  
 

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Appendix O. Analgesic change during treatment period 
Use of No Analgesics at Baseline 
Analgesic used during 
Screening 
Analgesic dose status at end 
of study 
Assessment of Change  
None 
None 
Stable/Decrease  
Narcotic analgesic and/or 
ibuprofen is started 
Increase 
Use of Only Ibuprofen at Baseline 
Analgesic uses at Baseline 
Analgesic dose status at end 
of study 
Assessment of Change 
ibuprofen 
Dose stopped, decreases, or is 
stable 
Stable/Decrease 
Dose increases by 15% or more 
Increase 
Narcotic analgesic is 
substituted or added 
Increase 
Use of Only Narcotic Analgesic at Baseline 
Analgesic uses at Baseline 
Analgesic dose status at end 
of study 
Assessment of Change  
Narcotic analgesic 
Dose stopped, decreases, or is 
stable 
Stable/Decrease  
Dose stopped and ibuprofen 
substituted (any dose) 
Stable/Decrease 
Dose decreases and ibuprofen 
added (any dose) 
Stable/Decrease 
 
Dose stable and ibuprofen 
added (any dose) 
Increase 
Dose increases by 15% or more 
Increase 
Use of Ibuprofen and Narcotic Analgesic at Baseline 
Analgesic uses at Baseline 
Analgesic dose status at end 
of study 
Assessment of Change  
ibuprofen + narcotic analgesic 
Ibuprofen dose stops + narcotic 
analgesic use stops, decreases, 
or is stable** 
Stable/Decrease 

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Ibuprofen use stops + narcotic 
analgesic dose increases by 
more than 15% 
Increase 
Ibuprofen dose decreases + 
narcotic analgesic use stops, 
decreases, or is stable** 
Stable/Decrease 
Ibuprofen dose decreases + 
narcotic 
analgesic 
dose 
increases by more than 15% 
Increase 
Ibuprofen dose stable + narcotic 
analgesic use 
stops, decreases, or is stable** 
Stable/Decrease 
Ibuprofen dose stable + narcotic 
analgesic dose 
increases by more than 15% 
Increase 
 
Ibuprofen dose increases by 
more than 15% + narcotic 
analgesic use stops 
Stable/Decrease 
 
Ibuprofen dose increases by 
more than 15% + narcotic 
analgesic dose decreases 
Stable/Decrease 
Ibuprofen dose increases by 
more than 15% + narcotic 
analgesic dose is stable** 
Increase 
Ibuprofen dose increases by 
more than 15% + narcotic 
analgesic dose increases by 
15% or more 
Increase 
 
**Stable =Dose is the same as the screening dose or increases by less than 15% of the screening dose. 
In addition, a subject can increase the monthly total dose of analgesics by one pill of analgesic (either 
ibuprofen or narcotic) and still be considered stable. 
 
 
 

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Appendix P. Strong CYP3A4 Inducers and Inhibitors 
 
The presented lists are indicative and should not be considered exhaustive. 
 
Strong CYP3A4 inducers prohibited up to end of treatment in view of the add-back treatment: 
 
Carbamazepine 
Enzalutamide 
Mitotane 
Phenytoin 
Rifampin 
St. John’s Wort 
 
Strong CYP3A4 inhibitors prohibited up to end of treatment in view of the add-back treatment: 
 
Boceprevir 
clarithromycin 
Cobicistat 
Conivaptan 
danoprevir and ritonavir 
diltiazem 
elvitegravir and ritonavir 
grapefruit juice 
idelalisib 
indinavir and ritonavir 
itraconazole 
ketoconazole 
lopinavir and ritonavir 
nefazodone 
nelfinavir 

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paritaprevir and ritonavir and (ombitasvir and/or dasabuvir) 
posaconazole 
ritonavir 
saquinavir and ritonavir 
telaprevir 
tipranavir and ritonavir 
troleandomycin 
voriconazole 
 
 

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Appendix Q. Reference List  
1. 
Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gynecol Clin North Am. 
1997;24(2):235-58. 
2. 
Fauconnier A, Chapron C. Endometriosis and pelvic pain: epidemiological evidence of the 
relationship and implications. Hum Reprod Update. 2005;11(6):595-606. 
3. 
Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D'Hooghe T, De Bie B, et al. 
ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29(3):400-
12. 
4. 
Vercellini P, Somigliana E, Vigano P, Abbiati A, Daguati R, Crosignani PG. Endometriosis: 
current and future medical therapies. Best Pract Res Clin Obstet Gynaecol. 2008;22(2):275-
306. 
5. 
Vercellini P, Somigliana E, Vigano P, Abbiati A, Barbara G, Crosignani PG. Endometriosis: 
current therapies and new pharmacological developments. Drugs. 2009;69(6):649-75. 
6. 
Meresman GF, Auge L, Baranao RI, Lombardi E, Tesone M, Sueldo C. Oral contraceptives 
suppress cell proliferation and enhance apoptosis of eutopic endometrial tissue from patients 
with endometriosis. Fertil Steril. 2002;77(6):1141-7. 
7. 
Practice Committee of the American Society for Reproductive M. Treatment of pelvic pain 
associated with endometriosis: a committee opinion. Fertil Steril. 2014;101(4):927-35. 
8. 
Schweppe KW. Current place of progestins in the treatment of endometriosis-related 
complaints. Gynecol Endocrinol. 2001;15 Suppl 6:22-8. 
9. 
Vercellini P, Fedele L, Pietropaolo G, Frontino G, Somigliana E, Crosignani PG. Progestogens 
for endometriosis: forward to the past. Hum Reprod Update. 2003;9(4):387-96. 
10. Olive DL. Gonadotropin-releasing hormone agonists for endometriosis. N Engl J Med. 
2008;359(11):1136-42. 
11. Farmer JE, Prentice A, Breeze A. Gonadotrophin-releasing hormone analogues for 
endometriosis: bone mineral density. Cochrane Database Syst Rev. 2003(4):CD001297. 
12. Lee DY, Park HG, Yoon BK, Choi D. Effects of different add-back regimens on 
hypoestrogenic problems by postoperative gonadotropin-releasing hormone agonist treatment 
in endometriosis. Obstet Gynecol Sci. 2016;59(1):32-8. 
13. Ezzati M, Carr BR. Elagolix, a novel, orally bioavailable GnRH antagonist under investigation 
for the treatment of endometriosis-related pain. Womens Health (Lond Engl ). 2015;11(1):19-
28. 
14. Taylor HS, Giudice LC, Lessey BA, Abrao MS, Kotarski J, Archer DF, et al. Treatment of 
Endometriosis-Associated Pain with Elagolix, an Oral GnRH Antagonist. N Engl J Med. 2017. 
15. Lewis JA, Jonsson B, Kreutz G, Sampaio C, van Zwieten-Boot B. Placebo-controlled trials 
and the Declaration of Helsinki. Lancet. 2002 Apr 13;359(9314):1337-40. 

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16. AbbVie. Orilissa: Prescribing information. 2018. 
17. FDA. Guidance for Industry - Drug-Induced Liver Injury: Premarketing Clinical Evaluation. 
2009. 
18. World Medical A. World Medical Association Declaration of Helsinki: ethical principles for 
medical research involving human subjects. JAMA. 2013;310(20):2191-4. 
 
 

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Appendix R. Baseline C-SSRS 
 
 
 

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Appendix S. C-SSRS Already Enrolled Subjects 
 
 
 

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Appendix T. C-SSRS Since Last Visit 
 

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