Objectives To identify a safe pathway for management and treatment of patients with X-linked hypophosphatemic rickets (XLH) during Covid-19 pandemic lockdown. Methods Twenty-six patients with XLH (age 3.1–25.7 years) were enrolled in Pediatric Endocrine Unit; nine of them were receiving human monoclonal anti-fibroblast growth factor 23 antibody (burosumab) and 17 (pediatric patients, age 9.5–17.9 years, n=7; young-adult patients, age 20.1–25.7 years, n=10) received conventional treatment with inorganic oral phosphate salts and active vitamin D metabolites. A Covid-19 free pathway was addressed for XLH patients receiving burosumab treatment in hospital. XLH patients receiving conventional treatment were followed by phone calls, e-mails, or telemedicine. Results All XLH patients receiving burosumab continued the scheduled follow-up and treatment; none of them was infected by Covid-19. Seven XLH patients out of 17 (41%) receiving conventional treatment showed some complication related to the disease itself or its treatment: periapical abscess with gingival fistula was diagnosed in five patients (three children and two young-adults) and treated with antibiotics with complete resolution; one child showed abdominal pain due to the administration of high doses of inorganic oral phosphate salts solved by reducing the dosage, and one child had severe legs pain during deambulation after orthopedic surgery solved with common analgesics. Conclusions Covid-19 free pathway was safe and effective to manage XLH patients receiving burosumab. E-health technologies were useful methods to follow XLH patients receiving conventional treatment during Covid-19 pandemic lockdown.

中文翻译：

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Covid-19大流行封锁期间X连锁低磷佝偻病患者的管理

目的 确定在 Covid-19 大流行封锁期间管理和治疗 X 连锁低磷佝偻病 (XLH) 患者的安全途径。方法 26 例 XLH 患者（年龄 3.1-25.7 岁）入组儿科内分泌科；其中 9 人接受人单克隆抗成纤维细胞生长因子 23 抗体（burosumab）和 17 人（儿科患者，年龄 9.5-17.9 岁，n=7；青年患者，年龄 20.1-25.7 岁，n=10）接受常规治疗用无机口服磷酸盐和活性维生素 D 代谢物治疗。为在医院接受 burosumab 治疗的 XLH 患者解决了 Covid-19 免费途径。接受常规治疗的 XLH 患者通过电话、电子邮件或远程医疗进行随访。结果所有接受burosumab治疗的XLH患者均继续按计划随访和治疗；他们都没有被 Covid-19 感染。接受常规治疗的 17 名 XLH 患者中有 7 名 (41%) 出现与疾病本身或其治疗相关的并发症：5 名患者（3 名儿童和 2 名年轻成人）被诊断为根尖周脓肿伴牙龈瘘，并使用完全解析度; 1例患儿因口服高剂量无机磷酸盐口服减量而出现腹痛，1例患儿骨科手术后下肢剧烈疼痛，用普通镇痛药解决。结论 Covid-19 游离途径可安全有效地管理接受 burosumab 的 XLH 患者。电子健康技术是跟踪在 Covid-19 大流行封锁期间接受常规治疗的 XLH 患者的有用方法。