Document:

EX-10.3

 Exhibit 10.3 

FOURTH AMENDMENT TO CREDIT AGREEMENT 

THIS FOURTH AMENDMENT TO CREDIT AGREEMENT (this “Amendment”) is dated as of April 27, 2020, and is
entered into by and among RTI Surgical, Inc., a Delaware corporation (“Borrower Representative”), and JPMorgan Chase Bank, N.A., as administrative agent (“Administrative Agent”), and as a Lender. 

W I T N E S S E T H: 

WHEREAS, the Borrower Representative, Pioneer Surgical Technology, Inc., a Michigan corporation (together with Borrower
Representative, each a “Borrower” and, collectively, the “Borrowers”), the other Loan Parties party thereto, the Administrative Agent, and the Lenders from time to time party thereto, are parties to that certain
Credit Agreement dated as of June 5, 2018 (as amended, modified and supplemented from time to time, the “Credit Agreement”; capitalized terms not otherwise defined herein have the definitions provided therefor in the Credit
Agreement); 
 WHEREAS, the Borrowers, the Second Lien Agent, the other Loan Parties party thereto, and certain lenders from
time to time party thereto, are parties to the Second Lien Credit Agreement, and have informed the Administrative Agent that the Borrowers and the Loan Parties desire to enter into that certain Second Amendment to Second Lien Credit Agreement dated
as of the date hereof (the “Second Amendment to Second Lien Credit Agreement”) in the form attached hereto as Exhibit A; and 

WHEREAS, in connection with the foregoing, the Borrowers, the other Loan Parties, the Lenders and the Administrative Agent
have agreed to modify the Credit Agreement as provided herein, in each case subject to the terms and provisions hereof. 

NOW THEREFORE, in consideration of the mutual conditions and agreements set forth in the Credit Agreement and this Amendment,
and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereto hereby agree as follows: 

1. Agreements Regarding Availability Block. Borrower Representative, on behalf of itself, and on behalf of each of the
other Loan Parties, hereby agrees and acknowledges that at all times from the date hereof through and including the Fourth Amendment Availability Block End Date (or such shorter period as agreed to by the Administrative Agent in its sole discretion)
there shall be a $8,000,000 block on Availability under the Credit Agreement; provided that without limiting the terms of this Amendment, such block shall not be applied to any calculation of “Availability” pursuant to the Credit
Agreement with respect to Cash Dominion Period, Covenant Testing Period, Examination Threshold Amount or Weekly Reporting Period (such block, the “Fourth Amendment Availability Block”). Borrower Representative, on behalf of each
Loan Party, acknowledges and agrees that the Fourth Amendment Availability Block is an integral condition to the Administrative Agent and the Lenders entering into this Amendment. The Fourth Amendment Availability Block hereby replaces in its
entirety the Availability Block (as defined and set forth in that certain Waiver and Third Amendment to Credit Agreement, dated as of April 7, 2020, by and between Borrower Representative and Administrative Agent). 

 For purposes hereof, “Fourth Amendment Availability Block End
Date” means the earlier of (x) the date upon which at least $25,000,000 of the Second Amendment Incremental Term Loan Commitments (as defined in the Second Amendment to Second Lien Credit Agreement) have been funded to Borrower
Representative in accordance with the Second Lien Credit Agreement and evidence of such funding, in form and substance satisfactory to Administrative Agent, shall have been received by Administrative Agent, and (y) the date upon which
(1) no Default or Event of Default exists under the Credit Agreement (including pursuant to clause (g) of Article VII with respect to the Second Lien Credit Agreement) and (2) the Second Lien Agent notifies the Borrower Representative
that, for any reason, Second Amendment Incremental Term Loan Commitments (as defined in the Second Amendment to Second Lien Credit Agreement) have been terminated in accordance with the terms of the Second Lien Credit Agreement and evidence of such
termination, in form and substance satisfactory to Administrative Agent, shall have been delivered to Administrative Agent. 

2. Amendments to Credit Agreement. In reliance upon the representations and warranties of the Borrower Representative
set forth in Section 4 below, and subject to the satisfaction of the conditions set forth in Section 3 herein, the Credit Agreement is hereby amended as follows: 

(a) Section 1.01 of the Credit Agreement is hereby amended by amending and restating the below definitions to read as follows:

 ““Applicable Rate” means, for any day, (a) with respect to any Loan, 2.75% per
annum and (b) with respect to the commitment fees payable hereunder, 0.25% per annum.” 

““Maturity Date” means the earlier to occur of (a) June 5, 2023, or any earlier
date on which the Commitments are reduced to zero or otherwise terminated pursuant to the terms hereof and (b) the date that is 30 days prior to the Second Amendment Incremental Maturity Date (as defined in the Second Lien Credit Agreement), as
the same may be extended from time to time pursuant to the terms of the Second Lien Credit Agreement and such extension is agreed to by the Lenders. 

(b) Section 1.01 of the Credit Agreement is hereby amended by inserting the following definition therein in appropriate
alphabetical order: 
 ““Fourth Amendment Effective Date” means April 27,
2020.” 
 (c) Section 5.01(f) of the Credit Agreement is hereby amended and restated in its entirety to read as
follows: 
 “(f) as soon as available but in any event within thirty (30) days of the end of each calendar month
(or within three (3) Business Days of each Friday (x) during any Weekly Reporting Period and (y) during the period commencing on the Fourth Amendment Effective Date and continuing until July 1, 2020), and at such other times as
may be necessary to re-determine Availability or as may be requested by the Administrative Agent in its Permitted Discretion, as of the period then ended, a Borrowing Base Certificate and supporting
information in connection therewith, together with any additional reports with respect to the Borrowing Base as the Administrative Agent may reasonably request;” 

  
 -2- 

 3. Conditions to Effectiveness. The effectiveness of
Section 1 and Section 2 of this Amendment is subject to the prior or concurrent consummation of each of the following conditions: 

(a) the Administrative Agent shall have received a copy of this Amendment executed by the Loan Parties, Administrative Agent
and the Lenders; 
 (b) the Administrative Agent shall have received a copy of that certain Amendment No. 2 to
Intercreditor Agreement, dated as of the date hereof, executed by Administrative Agent, Second Lien Agent and the Loan Parties party thereto; 

(c) the Administrative Agent shall have received a copy of the Second Amendment to Second Lien Credit Agreement executed by
the Loan Parties, the Second Lien Agent and the Second Lien Lenders; 
 (d) the Administrative Agent shall have received
evidence in form and substance satisfactory to Administrative Agent of the funding of at least $16,500,000 of Second Amendment Incremental Term Loans (as defined in the Second Amendment to Second Lien Credit Agreement) to Borrower Representative in
accordance with the Second Lien Credit Agreement; 
 (e) as of the date hereof, after giving effect to this Amendment, no
Default or Event of Default shall have occurred and be continuing or shall be caused by the transactions contemplated by this Amendment; and 

(f) Borrowers shall have paid all documented fees, costs and expenses due and payable as of the date hereof under the Credit
Agreement and the other Loan Documents, including the Amendment Fee (defined below). 
 4. Representations and
Warranties. To induce the applicable Lenders to enter into this Amendment, Borrower Representative, on behalf of each Loan Party, represents and warrants to such Lenders that: 

(a) the execution, delivery and performance of this Amendment has been duly authorized by all requisite corporate action on the
part of such Loan Party and this Amendment been duly executed and delivered by such Loan Party; 
 (b) each of the
representations and warranties contained in Article III of the Credit Agreement and in all other Loan Documents executed by any Loan Party in connection therewith, are true and correct in all material respects as of the date hereof with the
same force and effect as if such had been made on the date hereof and that any representation or warranty that specifically refers to a prior date shall be true and correct in all material respects as of such date (it being understood and agreed
that any representation or warranty which is subject to any materiality qualifier is true and correct in all respects); and 

  
 -3- 

 (c) no Default or Event of Default has occurred and is continuing on the
date hereof or shall be caused by the transactions contemplated by this Amendment. 
 5. Amendment Fee. In
consideration for entering into this Amendment, Borrower Representative, on behalf of itself and each Borrower, agrees to pay to the Administrative Agent a non-refundable amendment fee equal to $80,000 on the
date hereof (the “Amendment Fee”), which Amendment Fee shall be fully earned, due, and payable in cash on the date hereof and non-refundable when paid. 

6. Acknowledgment and Reaffirmation of Loan Documents. Borrower Representative, on behalf of each Loan Party, hereby
ratifies, affirms, acknowledges and agrees that the Credit Agreement and the other Loan Documents to which it is a party represent the valid and enforceable obligations of such Loan Party, subject to the applicable bankruptcy, insolvency,
reorganization, moratorium or other laws affecting creditors’ rights generally and subject to general principles of equity, regardless of whether considered in a proceeding in equity or at law. Borrower Representative, on behalf of each Loan
Party, hereby agrees that this Amendment in no way acts as a release or relinquishment of the Liens and rights securing payment of the Obligations. The Liens and rights securing payment of the Obligations are hereby ratified and confirmed by
Borrower Representative, on behalf of each Loan Party, in all respects. 
 7. Severability. Any provision of this
Amendment held by a court of competent jurisdiction to be invalid or unenforceable shall not impair or invalidate the remainder of this Amendment and the effect thereof shall be confined to the provision so held to be invalid or unenforceable. 

8. Counterparts. This Amendment may be executed in one or more counterparts, each of which shall constitute an
original, but all of which taken together shall be one and the same instrument. Delivery by telecopy or electronic portable document format (i.e., “pdf”) transmission of executed signature pages hereof from one party hereto to
another party hereto shall be deemed to constitute due execution and delivery by such party. 
 9. Ratification. The
terms and provisions set forth in this Amendment shall modify and supersede all inconsistent terms and provisions of the Credit Agreement and shall not be deemed to be a consent to the modification or waiver of any other term or condition of the
Credit Agreement. Except as expressly modified and superseded by this Amendment, the terms and provisions of the Credit Agreement are ratified and confirmed and shall continue in full force and effect. 

  
 -4- 

 10. Release. 

(a) In consideration of the agreements of the Lenders contained herein and for other good and valuable consideration, the
receipt and sufficiency of which is hereby acknowledged, Borrower Representative, on behalf of each Loan Party, on behalf of itself and its and their successors, assigns, and other legal representatives (each Loan Party and all such other Persons
being hereafter referred to collectively as the “Releasors” and individually as a “Releasor”), hereby absolutely, unconditionally and irrevocably releases, remises and forever discharges the Administrative Agent and
the Lenders, and their successors and assigns, and their present and former shareholders, affiliates, subsidiaries, divisions, predecessors, directors,officers, attorneys, employees, agents, other representatives, and any consultants engaged by the
Administrative Agent and the Lenders or their counsel (the Administrative Agent and each Lender and all such other Persons being hereinafter referred to collectively as the “Releasees” and individually as a “Releasee”), of and
from all demands, actions, causes of action, suits, covenants, contracts, controversies, agreements, promises, sums of money, accounts, bills, reckonings, damages and any and all other claims, counterclaims, defenses, rights of set-off, demands and liabilities whatsoever (individually, a “Claim” and collectively, “Claims”) of every name and nature, known or unknown, suspected or unsuspected, both at law
and in equity, which any Releasor may now own, hold, have or claim to have against the Releasees or any of them for, upon, or by reason of any circumstance, action, cause or thing whatsoever which arises at any time on or prior to the day and date
of this Amendment for or on account of, or in relation to, or in any way in connection with any of the Credit Agreement, or any of the other Loan Documents or transactions thereunder or related thereto. 

(b) Each Releasor understands, acknowledges and agrees that the release set forth above may be pleaded as a full and complete
defense and may be used as a basis for an injunction against any action, suit or other proceeding which may be instituted, prosecuted or attempted in breach of the provisions of such release. 

(c) Each Releasor agrees that no fact, event, circumstance, evidence or transaction which could now be asserted or which may
hereafter be discovered shall affect in any manner the final, absolute and unconditional nature of the release set forth above. 

11. Governing Law. This Amendment shall be a contract made under and governed by the laws of the State of Illinois,
without regard to conflict of laws principles that would require the application of laws other than those of the State of Illinois. Whenever possible each provision of this Amendment shall be interpreted in such manner as to be effective and valid
under applicable law, but if any provision of this Amendment shall be prohibited by or invalid under such law, such provision shall be ineffective to the extent of such prohibition or invalidity, without invalidating the remainder of such provision
or the remaining provisions of this Amendment. 
 [Signature Pages Follow] 

  
 -5- 

 IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be duly
executed and delivered by their respective duly authorized officers on the date first written above. 
  

			
	BORROWER REPRESENTATIVE:
	
	RTI SURGICAL, INC.

			
		
	By:	 	 

			
	Name: Jonathon M. Singer
	Title:   Chief Financial and Administrative Officer

  
 Signature Page to Fourth Amendment to
Credit Agreement 

 
			
	LENDERS:
	
	JPMORGAN CHASE BANK, N.A.,
as Administrative Agent and a Lender

 
			
		
	By:	 	 

 
			
	Name:	 	 

 
			
	Title:EX-10.1

 Exhibit 10.1 

AKCEA THERAPEUTICS, INC. 

May 23, 2019 
 Robert Dolski 

Vice President, Finance 
 Akcea Therapeutics, Inc. 

22 Boston Wharf Road, 9th Floor 

Boston, MA 02210 
 Re: Severance and Equity Award Vesting
Acceleration  
 Dear Robert: 
 We are
pleased to inform you that the Compensation Committee of the Board of Directors of Akcea Therapeutics, Inc. (the “Company”) has approved severance and vesting acceleration terms for you, which are described in this letter
agreement (the “Agreement”). 
 The vesting acceleration described in Section 2 below will apply to the
following equity awards (collectively, the “Equity Awards”): 
  

	 	•	 	 your outstanding compensatory equity awards granted to you prior to the date hereof under the 2015 Equity
Incentive Plan, as amended (the “2015 Plan”) that are subject to a time-based vesting schedule; and 

  

	 	•	 	 unless otherwise expressly provided by the Company at the time of grant, any future compensatory equity awards
covering Company common stock, including awards of stock options, restricted stock, restricted stock units or other types of equity awards, as applicable, that the Company may grant to you in the future and that are subject to a time-based vesting
schedule. 

 Capitalized terms used in this Agreement and not defined herein will have the meanings set forth in the
applicable equity incentive plan. This Agreement amends the terms of the Equity Awards that have previously been granted to you and are currently outstanding. For purposes of clarity, any compensatory equity awards that are subject to
performance-based vesting will not be “Equity Awards” hereunder and will only vest, if at all, in accordance with the terms of the applicable Plan and award agreement. 

1. Severance. If you experience a Qualifying Termination (as defined below), then, provided you timely comply with the conditions
described in Section 3: 
 (a) the Company will pay you an amount equal to your then current base salary (disregarding for this purpose,
any reduction of your base salary that results in a termination of your employment for Good Reason) payable during the applicable Severance Period (less payroll deductions and withholdings), payable in a single
lump-sum within 60 days after the date of your Qualifying Termination; provided, however, that if the 60-day period begins in one calendar year and ends in a
second calendar year, such payment will be made in the second calendar year; 

 (b) if you timely elect to continue coverage under the Consolidated Omnibus Budget
Reconciliation Act of 1985, as amended (“COBRA”), the Company will pay your COBRA premiums, and any applicable Company COBRA premiums, necessary to continue your then-current coverage until the earliest of (A) the end of
the applicable Severance Period, (B) the expiration of your eligibility for the continuation coverage under COBRA and (C) the date you become eligible to enroll in a health insurance plan offered by another employer or entity. You agree to
immediately notify the Company in writing of any such enrollment or eligibility for enrollment and the Company’s obligation to pay any COBRA premiums will immediately cease. Notwithstanding the foregoing, if the Company determines, in its sole
discretion, that it cannot provide the foregoing benefit without potentially incurring financial costs or penalties under applicable law (including, without limitation, Section 2716 of the Public Health Service Act), the Company will in lieu
thereof provide you with a taxable monthly amount (which amount will be based on the premium for the first month of COBRA coverage hereunder), which payments will be made regardless of whether you elect COBRA continuation coverage. If the Company
elects to make such payments in lieu of paying such COBRA premiums, the payments will end on the earliest of the dates specified above; and 

(c) if such Qualifying Termination occurs during the Change in Control Period, then the lump-sum
payment described in (a) above will also include an amount equal to your target annual cash bonus for the year of termination pro-rated based on the number of days from the beginning of the calendar year
through the date of such Qualifying Termination. 
 2. Equity Award Vesting Acceleration. 

(a) If, in connection with a Change in Control, (x) an Equity Award is assumed or continued by the successor or acquiror entity in such
Change in Control or such Equity Award is substituted for a similar award of the successor or acquiror entity, and (y) you experience a Qualifying Termination within the Change in Control Period, then, provided you timely comply with the
conditions described in Section 3 below, you will become vested, effective as of the date that is 60 days following the date of such Qualifying Termination (or, if later, the effective date of such Change in Control) with respect to
100 percent of any then unvested portion of any applicable Equity Award. 
 (b) If, in connection with a Change in Control, an Equity
Award will terminate and will not be so assumed or continued by the successor or acquiror entity in such Change in Control or substituted for a similar award of the successor or acquiror entity, then, you will become vested, with respect to
100 percent of any then unvested portion of any applicable Equity Award, effective immediately prior to, but subject to the consummation of such Change in Control. 

  
 2 

 3. Conditions to Receipt of Severance and Equity Award Vesting Acceleration. In order
to receive the severance and Equity Award vesting acceleration described in Sections 1 and 2(a), above, you must sign a separation agreement containing, among other provisions, a general release of claims in favor of the Company and related persons
and entities, confidentiality, return of property and non-disparagement, in each case in a form and manner satisfactory to the Company (the “Separation Agreement and Release”) and the
Separation Agreement and Release must become irrevocable, all within 60 days after your Qualifying Termination. In order to effect the provisions of this Section 3, any termination or forfeiture of any unvested Equity Awards eligible for
acceleration of vesting pursuant to Section 2(a) above that otherwise would have occurred on or within 60 days after your Qualifying Termination will be delayed until the 60th day after the date of your Qualifying Termination (but, in the case
of any stock option, not later than the expiration date of such stock option specified in the applicable option agreement) and will only occur to the extent such equity awards do not vest pursuant to Section 2(a) above and, for purposes of
clarity, no additional vesting of any Equity Award will occur during such 60 day period. 
 4. Restrictive Covenants. In
consideration of the benefits under this Agreement, you will sign Company’s Employee Confidential Information, Inventions Assignment, Non-Competition and
Non-Solicitation Agreement. 
 5. Certain Definitions. For purposes of this Agreement, the
following terms have the following meanings: 
 (a) “Cause” means: (i) any material breach of this Agreement or
any other written agreement between you and the Company, if such breach causes material harm to the Company or reasonably threatens to cause such harm; (ii) any material failure to comply with the Company’s written policies or rules, as
they may be in effect from time to time during your employment, if such failure causes material harm to the Company, and to the extent it is curable by you, is not cured within 30 days after written notice thereof is given to you by the Company;
(iii) commission, conviction of, or a plea of “guilty” or “no contest” to, a felony under the laws of the United States or any State; (iv) any willful, intentional or grossly negligent act having the effect of
materially injuring (whether financially or otherwise) the business or reputation of the Company, which to the extent it is curable by you, is not cured within 30 days after written notice thereof is given to you by the Company; or (v) willful
misconduct with respect to any of your material duties or obligations under this Agreement, which, to the extent it is curable is not cured within 30 days after written notice thereof is given to you by the Company. 

(b) “Change in Control” means the sale of all or substantially all the assets of the Company; any
merger, consolidation or acquisition of the Company with, by or into another corporation, entity or person; or any change in the ownership of more than 50% of the voting capital stock of the Company in one or more related transactions,
provided, none of the following events will be a Change in Control: (1) acquisitions of capital stock directly from the Company for cash, whether in a public or private offering, (2) distributions of capital stock by the
Company’s stockholders, (3) acquisitions of capital stock by or from any employee benefit plan or related trust, or (4) a merger the sole purpose of which is to change the Company’s name and/or state of incorporation. 

  
 3 

 (c) “Change in Control Period” means the period commencing on the
effective date of a Change of Control and ending 12 months following such date. 
 (d) “Good Reason” means the
occurrence of any of the following events without your consent; provided, that any resignation by you due to any of the following conditions will only be deemed for Good Reason if: (i) you give the Company written notice of the intent to
terminate for Good Reason within 90 days following the first occurrence of the condition(s) that you believe constitutes Good Reason, which notice will describe such condition(s); (ii) the Company fails to remedy, if remediable, such condition(s)
within 30 days following receipt of your written notice (the “Cure Period”) of such condition(s) from you; and (iii) you actually resign your employment within the first 15 days after expiration of the Cure Period:
(a) a material reduction by the Company of your base salary as in effect immediately prior to the reduction; (b) a material reduction by the Company of your annual bonus target as in effect immediately prior to the reduction, provided a
compensation plan change that affects similarly all employees at similar levels will not constitute Good Reason; (c) a material reduction in your authority, duties or responsibilities, provided a change in job title or reporting
relationship without a reduction in your base salary or annual bonus target will not constitute Good Reason; or (d) relocation of the offices at which you are required to work to a location that would increase your one-way commute by more than 40 miles. Your death or disability will not constitute a without Cause termination or Good Reason resignation under this Agreement. 

(e) “Qualifying Termination” means a termination of your Continuous Service (as defined in the 2015 Plan) either
(x) by the Company without Cause or (y) by you with Good Reason. Termination of Continuous Service due to your death or Disability (as defined in the 2015 Plan) will not constitute a Qualifying Termination. For clarity, if you terminate
your employment without Good Reason, and the Company unilaterally accelerates your date of termination in connection therewith, such acceleration will not result in a termination by the Company without Cause or a Qualifying Termination hereunder.

 (f) “Severance Period” means 9 months, provided that the Severance Period will instead be 12 months to the
extent that a Qualifying Termination occurs during the Change in Control period. 
 6. Section 409A. The payments and benefits under
this Agreement are intended to qualify for an exemption from application of Section 409A of the Code (“Section 409A”) or comply with its requirements to the extent necessary to avoid
adverse personal tax consequences under Section 409A, and any ambiguities herein will be interpreted accordingly. To the extent that any payment or benefit described in this Agreement constitutes
“non-qualified deferred compensation” under Section 409A, and to the extent that such payment or benefit is payable upon the termination of your employment, then such payments or benefits will
be payable only upon your “separation 

  
 4 

 
from service.” The determination of whether and when a separation from service has occurred will be made in accordance with the presumptions set forth in Treasury Regulation
Section 1.409A-1(h). Notwithstanding anything in this Agreement to the contrary, if at the time of your separation from service, the Company determines that you are a “specified employee” within the meaning of
Section 409A(a)(2)(B)(i) of the Code, then to the extent any payment or benefit that you become entitled to under this Agreement on account of your separation from service would be considered deferred compensation subject to the 20 percent
additional tax imposed pursuant to Section 409A(a) of the Code as a result of the application of Section 409A(a)(2)(B)(i) of the Code, such payment will not be payable and such benefit will not be provided until the date that is the
earlier of (A) six months and one day after your separation from service, (B) your death, or (C) such earlier date as permitted under Section 409A without imposition of adverse taxation. If any such delayed cash payment is
otherwise payable on an installment basis, the first payment will include a catch-up payment covering amounts that would otherwise have been paid during the six-month
period but for the application of this provision, and the balance of the installments will be payable in accordance with their original schedule. The Company makes no representation or warranty and will have no liability to you or any other person
if any provisions of this Agreement are determined to constitute deferred compensation subject to Section 409A but do not satisfy an exemption from, or the conditions of, Section 409A. 

7. Parachute Payments. If any payment or benefit you would receive from the Company or otherwise in connection with a Change in Control
or other similar transaction (a “280G Payment”) would (i) constitute a “parachute payment” within the meaning of Section 280G of the Code, and (ii) but for this sentence, be subject to the excise tax
imposed by Section 4999 of the Code (the “Excise Tax”), then any such 280G Payment (a “Payment”) will be equal to the Reduced Amount. The “Reduced Amount” will be either
(x) the largest portion of the Payment that would result in no portion of the Payment (after reduction) being subject to the Excise Tax or (y) the largest portion, up to and including the total, of the Payment, whichever amount (i.e., the
amount determined by clause (x) or by clause (y)), after taking into account all applicable federal, state and local employment taxes, income taxes, and the Excise Tax (all computed at the highest applicable marginal rate), results in your
receipt, on an after-tax basis, of the greater economic benefit notwithstanding that all or some portion of the Payment may be subject to the Excise Tax. If a reduction in a Payment is required pursuant to the
preceding sentence and the Reduced Amount is determined pursuant to clause (x) of the preceding sentence, the reduction will occur in the manner (the “Reduction Method”) that results in the greatest economic benefit for
you. If more than one method of reduction will result in the same economic benefit, the items so reduced will be reduced pro rata (the “Pro Rata Reduction Method”). 

Notwithstanding the foregoing, if the Reduction Method or the Pro Rata Reduction Method would result in any portion of the Payment being
subject to taxes pursuant to Section 409A of the Code that would not otherwise be subject to taxes pursuant to Section 409A of the Code, then the Reduction Method and/or the Pro Rata Reduction Method, as the case may be, will be modified
so as to avoid the imposition of taxes pursuant to Section 409A of the Code as follows: (A) as a first priority, the 

  
 5 

 
modification will preserve to the greatest extent possible, the greatest economic benefit for you as determined on an after-tax basis; (B) as a second
priority, Payments that are contingent on future events (e.g., being terminated without cause), will be reduced (or eliminated) before Payments that are not contingent on future events; and (C) as a third priority, Payments that are
“deferred compensation” within the meaning of Section 409A of the Code will be reduced (or eliminated) before Payments that are not deferred compensation within the meaning of Section 409A of the Code. 

Unless you and the Company agree on an alternative accounting firm, the accounting firm engaged by the Company for general tax compliance
purposes as of the day prior to the effective date of the change of control transaction triggering the Payment will perform the foregoing calculations. If the accounting firm so engaged by the Company is serving as accountant or auditor for the
individual, entity or group effecting the change of control transaction, the Company will appoint a nationally recognized accounting firm to make the determinations required hereunder. The Company will bear all expenses with respect to the
determinations by such accounting firm required to be made hereunder. The Company will use commercially reasonable efforts to cause the accounting firm engaged to make the determinations hereunder to provide its calculations, together with detailed
supporting documentation, to you and the Company within 15 calendar days after the date on which your right to a 280G Payment becomes reasonably likely to occur (if requested at that time by you or the Company) or such other time as requested by you
or the Company. 
 If you receive a Payment for which the Reduced Amount was determined pursuant to clause (x) of the first paragraph
of this Section and the Internal Revenue Service determines thereafter that some portion of the Payment is subject to the Excise Tax, you will promptly return to the Company a sufficient amount of the Payment (after reduction pursuant to clause
(x) of the first paragraph of this Section so that no portion of the remaining Payment is subject to the Excise Tax. For the avoidance of doubt, if the Reduced Amount was determined pursuant to clause (y) in the first paragraph of this
Section, you will have no obligation to return any portion of the Payment pursuant to the preceding sentence. 
 8. Miscellaneous.
This Agreement sets forth the entire understanding between you and the Company with respect to the subject matter hereto and supersedes all prior oral and written agreements, promises and/or representations on that subject. This Agreement is not an
agreement of employment and will not confer upon you any right to be retained by or in the employ of the Company and will not interfere in any way with the right of the Company to terminate your employment or service arrangement at any time or for
any reason. This Agreement will be binding upon any surviving entity resulting from a Change in Control of the Company and upon any other person who is a successor by merger, acquisition, consolidation or otherwise to the business formerly carried
on by the Company without regard to whether or not such person or entity actively assumes the obligations hereunder. The terms of this Agreement, and any action arising hereunder, will be governed by and construed in accordance with the domestic
laws of the Commonwealth of Massachusetts without giving effect to any choice of law or conflict of law provision or rule (whether of the Commonwealth of Massachusetts or 

  
 6 

 
other jurisdiction) that would cause the application of the laws of any jurisdiction other than the Commonwealth of Massachusetts and you hereby expressly consent to the personal jurisdiction and
venue of the state and federal courts located in the Commonwealth of Massachusetts for any lawsuit filed there against you by Company arising from or related to this Agreement. 

[Remainder of Page Intentionally Left Blank – Signatures on Following Page] 

  
 7 

 Except as provided herein, all terms and conditions of your Equity Awards and any other
written agreement between you and the Company remain in full force and effect and are not amended by this Agreement. 
 Please countersign
below to acknowledge your receipt of this Agreement and your agreement to the terms described herein. 
 With best regards, 

 

	
	Akcea Therapeutics, Inc.
	
	/s/ Paula Soteropoulos
	Paula Soteropoulos
	 Chief Executive Officer

  

	
	Acknowledged and agreed:
	
	/s/ Robert Dolski
	Robert Dolski

  
 8

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