Background-X-linked hypophosphatemia in children is characterized by elevated serum FGF23, hypophosphatemia, rickets, lower extremity bowing, and growth impairment. We compared the efficacy and safety of continuing conventional therapy, consisting of oral phosphate and active vitamin D, versus switching to burosumab, a fully human monoclonal antibody against FGF23, in pediatric X-linked hypophosphatemia. Methods-In this randomised, active-controlled, open-label, phase 3 trial at 16 clinical sites, we enrolled children with X-linked hypophosphataemia aged 1-12 years. Key eligibility criteria were a total Thacher rickets severity score of at least 2•0, fasting serum phosphorus lower than 0•97 mmol/L (3•0 mg/dL), confirmed PHEX (phosphate-regulating endopeptidase homolog, X-linked) mutation or variant of unknown significance in the patient or a family member with appropriate Xlinked dominant inheritance, and receipt of conventional therapy for at least 6 consecutive months for children younger than 3 years or at least 12 consecutive months for children older than 3 years. Eligible patients were randomly assigned (1:1) to receive either subcutaneous burosumab starting at 0•8 mg/kg every 2 weeks (burosumab group) or conventional therapy prescribed by investigators (conventional therapy group). Both interventions lasted 64 weeks. The primary endpoint was change in rickets severity at week 40, assessed by the Radiographic Global Impression of Change global score. All patients who received at least one dose of treatment were included in the primary and safety analyses. The trial is registered with ClinicalTrials.gov, number NCT02915705. Findings-Recruitment took place between Aug 3, 2016, and May 8, 2017. Of 122 patients assessed, 61 were enrolled. Of these, 32 (18 girls, 14 boys) were randomly assigned to continue receiving conventional therapy and 29 (16 girls, 13 boys) to receive burosumab. For the primary endpoint at week 40, patients in the burosumab group had significantly greater improvement in Radiographic Global Impression of Change global score than did patients in the conventional therapy group (least squares mean +1•9 [SE 0•1] with burosumab vs +0•8 [0•1] with conventional therapy; difference 1•1, 95% CI 0•8-1•5; p<0•0001). Treatment-emergent adverse events considered possibly, probably, or definitely related to treatment by the investigator occurred more frequently with burosumab (17 [59%] of 29 patients in the burosumab group vs seven [22%] of 32 Imel et al.

Postprandial lipemia (PPL) is characterized by prolonged and increased levels of lipids especially triglycerides (TG) and triglyceride-rich lipoprotein levels after a meal. There are an increasing number of evidence that postprandial lipemia is a significant risk factor for cardiovascular disease because of its causative role in atherosclerosis and endothelial dysfunction. This has serious implications because common dietary patterns are characterized by high fat content and meal consumption; hence, most will be in a postprandial state resulting to frequent and prolonged exposure to high lipid levels. The review will present the current evidences for the role of postprandial lipemia as a risk factor for cardiovascular disease and its association with other cardiovascular risk factors, namely, diabetes and obesity. We will also present recommendations on the diagnosis and management of postprandial lipemia.