Note: Prior to initiating burosumab, oral phosphates and/or active vitamin D analogs (eg, calcitriol) should be discontinued for at least 1 week. Confirm that baseline fasting serum phosphorus concentration is below the reference range for patient age before initiating burosumab. During burosumab therapy, patients should have 25-hydroxy vitamin D levels monitored; supplement as necessary with cholecalciferol or ergocalciferol to maintain serum 25-hydroxy vitamin D levels in the normal range for age. Dose and interval are age-dependent; use extra precaution.
Hypophosphatemia, X-linked (XLH):
Initial:
Infants ≥6 months, Children, and Adolescents <18 years:
Weight <10 kg: SubQ: 1 mg/kg/dose every 2 weeks; calculated dose should be rounded to the nearest 1 mg.
Weight ≥10 kg: SubQ: 0.8 mg/kg/dose every 2 weeks; minimum dose: 10 mg/dose; calculated dose should be rounded to the nearest 10 mg; maximum dose: 90 mg/dose.
Adolescents ≥18 years: SubQ: 1 mg/kg/dose every 4 weeks; calculated dose should be rounded to the nearest 10 mg; maximum dose: 90 mg/dose.
Monitoring of therapy: Evaluate fasting serum phosphorus every 4 weeks for first 12 weeks of therapy and as appropriate thereafter (eg, after dosing adjustments). Adjust dose accordingly based on fasting serum phosphorus level; see "Reference Range" for phosphorus age-based normal limits.
Dosing adjustment based on serum phosphorus:
If low serum phosphorus:
Infants ≥6 months, Children, and Adolescents <18 years: SubQ:
Weight <10 kg: If serum phosphorus below the reference range for age, increase dose to 1.5 mg/kg/dose every 2 weeks, rounded to the nearest 1 mg. Recheck fasting serum phosphorus 4 weeks after dose adjustment; burosumab should not be adjusted more frequently than every 4 weeks. If needed, dose may be further increased to the maximum dose of 2 mg/kg/dose.
Weight ≥10 kg: If serum phosphorus below the reference range for age, increase dose stepwise based on the following table. Recheck fasting serum phosphorus 4 weeks after dose adjustment; burosumab should not be adjusted more frequently than every 4 weeks. Maximum dose: 2 mg/kg/dose, not to exceed 90 mg/dose.
Weight-band (kg) |
Initial dose (mg/dose) every 2 weeks |
1st dose increase to mg/dose every 2 weeks |
2nd dose increase to mg/dose every 2 weeks |
---|---|---|---|
A Presented doses already rounded B In trials, dose titration for every-2-week dosing was 0.2 mg/kg or 0.3 mg/kg (Carpenter 2018). | |||
10 to <15 |
10 |
15 |
20 |
15 to <19 |
10 |
20 |
30 |
19 to <32 |
20 |
30 |
40 |
32 to <44 |
30 |
40 |
60 |
44 to <57 |
40 |
60 |
80 |
57 to <69 |
50 |
70 |
90 |
69 to <81 |
60 |
90 |
90 |
81 to <94 |
70 |
90 |
90 |
94 to <106 |
80 |
90 |
90 |
≥106 |
90 |
90 |
90 |
Adolescents ≥18 years: There are no dosage adjustments provided in the manufacturer's labeling for low serum phosphorus.
If normal serum phosphorus (ie, above the lower limit of reference range for age) and <5 mg/dL: Infants ≥6 months, Children, and Adolescents: Continue current dose; continue to monitor serum phosphorus as appropriate.
If high serum phosphorus:
Infants ≥6 months, Children, and Adolescents <18 years: If serum phosphorus >5 mg/dL: Hold next dose; reassess fasting serum phosphorus in 4 weeks and every 4 weeks thereafter; once serum phosphorus below reference range for age, may reinitiate burosumab at a reduced dose (see the following weight-directed re-initiation recommendations).
Re-initiation dosing: SubQ:
Patient weight <10 kg: Restart at 0.5 mg/kg/dose every 2 weeks; round dose to the nearest 1 mg. Recheck fasting serum phosphorus in 4 weeks and follow dosing adjustment recommendations based on result.
Patient weight ≥10 kg: See the following table. Recheck fasting serum phosphorus in 4 weeks and follow dosing adjustment recommendations based on result.
Previous dose (mg/dose) every 2 weeks |
Re-initiation dose (mg/dose) every 2 weeks |
---|---|
10 |
5 |
15 |
10 |
20 |
10 |
30 |
10 |
40 |
20 |
50 |
20 |
60 |
30 |
70 |
30 |
80 |
40 |
90 |
40 |
Adolescents ≥18 years: If serum phosphorus above normal range: Hold next dose; reassess fasting serum phosphorus every 4 weeks; once serum phosphorus falls below the normal range, may reinitiate burosumab at a reduced dose (approximately half the initial starting dose; see the following table [maximum dose: 40 mg/dose]). Recheck fasting serum phosphorus 2 weeks after dose adjustment; based on results, determine if additional dosing adjustment necessary.
Previous dose (mg/dose) every 4 weeks |
Re-initiation dose (mg/dose) every 4 weeks |
---|---|
40 |
20 |
50 |
20 |
60 |
30 |
70 |
30 |
≥80 |
40 |
Osteomalacia, tumor-induced (TIO):
Initial:
Children ≥2 years and Adolescents <18 years: SubQ: 0.4 mg/kg/dose every 2 weeks; calculated dose should be rounded to the nearest 10 mg; maximum dose: 180 mg/dose.
Adolescents ≥18 years: SubQ: 0.5 mg/kg/dose every 4 weeks; calculated dose should be rounded to the nearest 10 mg; maximum dose: 180 mg/dose.
Monitoring of therapy: During the first 12 weeks of therapy, evaluate fasting serum phosphorus 2 weeks postdose and monthly thereafter or more frequently as appropriate (eg, after dosing adjustments). Adjust dose accordingly based on fasting serum phosphorus level; see "Reference Range" for phosphorus age-based normal limits. Do not adjust more frequently than every 4 weeks.
Dosing adjustment based on serum phosphorus:
If low serum phosphorus:
Children ≥2 years and Adolescents <18 years: SubQ: If serum phosphorus below the reference range for age, increase dose stepwise based on the following table. Recheck fasting serum phosphorus 4 weeks after dose adjustment; burosumab should not be adjusted more frequently than every 4 weeks. The following table addresses dose titration only up to 1.5 mg/kg/dose; further increases up to 2 mg/kg/dose may be used; maximum dose: 2 mg/kg/dose, not to exceed 180 mg/dose.
Weight-band (kg) |
Initial dose (mg/dose) every 2 weeks |
1st dose increase to mg/dose every 2 weeks |
2nd dose increase to mg/dose every 2 weeks |
3rd dose increase to mg/dose every 2 weeks |
---|---|---|---|---|
ATable only includes dose titration only up to 1.5 mg/kg/dose; further increases up to 2 mg/kg/dose may be used. | ||||
10 to <15 |
5 |
10 |
15 |
20 |
15 to <19 |
5 |
10 |
20 |
25 |
19 to <32 |
10 |
20 |
25 |
30 |
32 to <44 |
10 |
30 |
40 |
50 |
44 to <57 |
20 |
40 |
50 |
70 |
57 to <69 |
20 |
50 |
70 |
90 |
69 to <81 |
30 |
60 |
80 |
100 |
81 to <94 |
30 |
70 |
100 |
120 |
94 to <106 |
40 |
80 |
110 |
140 |
≥106 |
40 |
90 |
130 |
160 |
Adolescents ≥18 years: SubQ: If serum phosphorus below the reference range for age, may increase monthly dose stepwise (see following table) or administer same dose divided every 2 weeks. Burosumab dose should not be adjusted more frequently than every 4 weeks. Maximum dose: 2 mg/kg/dose, not to exceed 180 mg/dose. Recheck fasting serum phosphorus 2 weeks after dose adjustment; burosumab should not be adjusted more frequently than every 4 weeks.
Initial dose |
1st dose increase |
2nd dose increase |
3rd dose increase |
4th dose increase |
5th dose increase |
---|---|---|---|---|---|
ARound dose to the nearest 10 mg. BIf the calculated dose is >180 mg every 4 weeks, change to a divided dose administered every 2 weeks. Maximum single dose: 180 mg/dose. | |||||
0.5 mg/kg every 4 weeks |
1 mg/kg/dose every 4 weeks OR 0.5 mg/kg/dose every 2 weeks |
1.5 mg/kg/dose every 4 weeks OR 0.75 mg/kg/dose every 2 weeks |
2 mg/kg/dose every 4 weeks OR 1 mg/kg every 2 weeks |
1.5 mg/kg/dose every 2 weeks |
2 mg/kg/dose every 2 weeks |
If normal serum phosphorus:
Children ≥2 years and Adolescents: SubQ: If serum phosphorus within reference range for age, continue current dose; continue to monitor serum phosphorus as appropriate.
If high serum phosphorus:
Children ≥2 years and Adolescents: SubQ: If serum phosphorus above normal reference range for age: hold next dose; reassess fasting serum phosphorus every 4 weeks; once serum phosphorus falls below the reference range for age, may reinitiate burosumab at a reduced dose of approximately half the initial starting dose for age and weight; maximum dose: 180 mg/dose every 2 weeks. Recheck fasting serum phosphorus 4 weeks (if <18 years of age) and 2 weeks (if ≥18 years of age) after dose adjustment; based on results, determine if additional dosing adjustment necessary.
Dose interruption: Children ≥2 years and Adolescents: If underlying tumor is treated (eg, surgical excision or radiation therapy); hold burosumab doses during treatment; after treatment completed, reassess serum phosphorus; if is below the lower limit of normal for age restart burosumab at the original initiation dose for the patient.
Infants ≥6 months, Children, and Adolescents:
Mild to moderate impairment: There are no dosing adjustments provided in the manufacturer's labeling (has not been studied); use with caution. Increased serum phosphorus may occur with renal impairment; in addition, burosumab may also cause hyperphosphatemia with risk of nephrocalcinosis; serum phosphorus levels should be monitored very closely.
Severe renal impairment or end-stage renal disease: Use is contraindicated.
There are no dosing adjustments provided in the manufacturer's labeling (has not been studied); use with caution.
(For additional information see "Burosumab: Drug information")
Note: Prior to initiating burosumab, oral phosphate and/or active vitamin D analogs (eg, calcitriol, paricalcitol, doxercalciferol, calcifediol) should be discontinued for at least 1 week; do not administer active vitamin D analogs during burosumab treatment. Confirm baseline fasting serum phosphorus level is below the reference range for patient age before initiating burosumab. Monitor serum 25-hydroxy vitamin D levels; if necessary, supplement with cholecalciferol or ergocalciferol to maintain levels in the normal range for age.
Hypophosphatemia, X-linked: SUBQ: Initial: 1 mg/kg every 4 weeks; calculated dose should be rounded to the nearest 10 mg; maximum dose: 90 mg.
Dosage adjustment based on serum phosphorus: Evaluate fasting serum phosphorus 2 weeks after treatment initiation and continue every 4 weeks for the first 12 weeks of therapy. Adjust dose accordingly based on fasting serum phosphorus level; see Reference Range for phosphorus age-based normal limits. Do not adjust dose more frequently than every 4 weeks.
If low serum phosphorus: There are no dosage adjustments provided in the manufacturer's labeling.
If normal serum phosphorus: Continue same dose.
If high serum phosphorus:
If fasting serum phosphorus above the normal age-based range, withhold next dose and reassess in 4 weeks; once serum phosphorus falls below the age-based normal range, may reinitiate burosumab at approximately one-half the initial starting dose up to a maximum dose of 40 mg every 4 weeks:
Previous dose (mg/dose) every 4 weeks |
Reinitiation dosea (mg/dose) every 4 weeks |
---|---|
aRecheck fasting serum phosphorus 2 weeks after dose adjustment; based on results, determine if additional dosing adjustment necessary. | |
40 |
20 |
50 |
20 |
60 |
30 |
70 |
30 |
≥80 |
40 |
Osteomalacia, tumor-induced: SUBQ: Initial: 0.5 mg/kg once every 4 weeks; round dose to the nearest 10 mg; maximum dose: 2 mg/kg (not to exceed 180 mg) every 2 weeks.
Dosage adjustment based on serum phosphorus: Evaluate fasting serum phosphorus monthly, measured 2 weeks postdose, for the first 3 months of treatment and as clinically necessary thereafter. Adjust dose accordingly based on fasting serum phosphorus level; see "Reference Range" for phosphorus age-based normal limits. Reassess fasting serum phosphorus level 2 weeks after dose adjustment; do not adjust dose more frequently than every 4 weeks.
If serum phosphorus is normal: Continue the same burosumab dose.
If serum phosphorus is above the normal range: Withhold the next burosumab dose and reassess serum phosphorus in 4 weeks; the serum phosphorus level must be below the reference range to reinitiate burosumab. Reinitiate at approximately one-half of the initial starting dose (up to a maximum of 180 mg every 2 weeks). Reassess serum phosphorus 2 weeks after the dose adjustment. If the level remains below the reference range, the dose can be adjusted upward (see table: "Burosumab Dose Increase Levels for Tumor-Induced Osteomalacia").
If serum phosphorus is below the normal range: Titrate burosumab dose as follows:
Starting dose |
First dose increasec |
Second dose increasec |
Third dose increasec |
Fourth dose increase |
Fifth dose increase (maximum dose) | |
---|---|---|---|---|---|---|
aRound dose to the nearest 10 mg. bDo not adjust burosumab dose more frequently than every 4 weeks. cIf serum phosphorus is less than the lower limit of the normal range, may consider dividing total dose administered every 4 weeks and administering every 2 weeks. dIf the calculated dose is >180 mg every 4 weeks, change to a divided dose administered every 2 weeks. | ||||||
If serum phosphorus is below lower limit of normal 2 weeks postdose adjustment |
0.5 mg/kg every 4 weeks |
Increase to: 1 mg/kg every 4 weeks Or 0.5 mg/kg every 2 weeks |
Increase to: 1.5 mg/kg every 4 weeksd Or 0.75 mg/kg every 2 weeks |
Increase to: 2 mg/kg every 4 weeksd Or 1 mg/kg every 2 weeks |
Increase to: 1.5 mg/kg (not to exceed 180 mg) every 2 weeks |
Increase to: 2 mg/kg (not to exceed 180 mg) every 2 weeks |
Dose interruption: Interrupt burosumab therapy if undergoing treatment (eg, surgical excision, radiation therapy) of the underlying tumor; reassess serum phosphorus after underlying tumor treatment is complete. If serum phosphorus remains below the lower limit of normal, reinitiate burosumab at the initiation dose and then adjust as necessary to maintain serum phosphorus within the reference range (see table: "Burosumab Dose Increase Levels for Tumor-Induced Osteomalacia").
Missed dose: If a dose is missed, administer as soon as possible. To avoid missed doses, treatments may be administered 3 days on either side of the scheduled treatment date.
CrCl ≥30 mL/minute: There are no dosage adjustments provided in the manufacturer's labeling.
CrCl <30 mL/minute: Use is contraindicated.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%:
Dermatologic: Eczema (adults: 11%), skin rash (10% to 27%)
Endocrine & metabolic: Vitamin D deficiency (children: 24% to 37%; adults: 7% to 12%)
Gastrointestinal: Constipation (9% to 17%), dental caries (children: 31%), diarrhea (children: 24%), toothache (children: 23%), tooth infection (adults: 13%), vomiting (children: 41% to 48%)
Immunologic: Antibody development (14% to 19%)
Infection: Tooth abscess (15% to 34%)
Local: Injection site reaction (children: 52% to 67%; adults: 15%)
Nervous system: Dizziness (10% to 15%), headache (children: 34% to 73%; adults: 11% to 13%), restless leg syndrome (adults: 7% to 12%)
Neuromuscular & skeletal: Back pain (adults: 15%), limb pain (children: 38% to 46%), muscle spasm (adults: 7% to 19%), myalgia (children: 17%)
Respiratory: Cough (children: 52%)
Miscellaneous: Fever (children: 44% to 55%)
1% to 10%:
Dermatologic: Rash at injection site (children: 10%), urticaria at injection site (children: 7%)
Endocrine & metabolic: Hyperphosphatemia (adults: ≤7%)
Gastrointestinal: Nausea (children: 10%)
Hypersensitivity: Hypersensitivity reaction (adults: 6% to 22%)
Concomitant use with oral phosphate and/or active vitamin D analogs (eg, calcitriol, paricalcitol, doxercalciferol, calcifediol); serum phosphorus within or above normal range for age; severe renal impairment or end-stage renal disease.
Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Canadian labeling: Additional contraindications (not in US labeling): Hypersensitivity to burosumab or any component of the formulation.
Concerns related to adverse effects:
• Hyperphosphatemia: Elevated serum phosphorus may increase the risk of nephrocalcinosis; dose reduction or interruption of therapy may be required. To prevent hyperphosphatemia, interrupt burosumab therapy in patients with tumor-induced osteomalacia receiving treatment for the underlying tumor. Reassess serum phosphorus after underlying tumor-related treatment has been completed; reinitiate and adjust burosumab dose as clinically necessary.
• Hypersensitivity: May cause hypersensitivity reactions (eg, rash, urticaria). Discontinue therapy immediately if serious hypersensitivity reactions occur.
• Injection site reactions: Local injection site reactions may occur. Most reactions are mild in severity, occur within 1 day of injection, and typically resolve within 1 to 3 days with no treatment. Discontinue use if severe injection site reactions occur.
Disease-related concerns:
• Restless leg syndrome: New onset or worsening of existing restless leg syndrome has been reported in adults.
Dosage form specific issues:
• Polysorbate 80: Some dosage forms may contain polysorbate 80 (also known as Tweens). Hypersensitivity reactions, usually a delayed reaction, have been reported following exposure to pharmaceutical products containing polysorbate 80 in certain individuals (Isaksson 2002; Lucente 2000; Shelley 1995). Thrombocytopenia, ascites, pulmonary deterioration, and renal and hepatic failure have been reported in premature neonates after receiving parenteral products containing polysorbate 80 (Alade 1986; CDC 1984). See manufacturer's labeling.
Other warnings/precautions:
• Vitamin D: May decrease serum vitamin D. Monitor serum 25(OH)D levels; supplement with cholecalciferol or ergocalciferol to maintain age-based normal range. Do NOT administer active vitamin D analogs during burosumab treatment.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Subcutaneous [preservative free]:
Crysvita: Burosumab-twza 10 mg/mL (1 mL); Burosumab-twza 20 mg/mL (1 mL); Burosumab-twza 30 mg/mL (1 mL) [contains polysorbate 80]
No
Solution (Crysvita Subcutaneous)
10 mg/mL (per mL): $5,341.74
20 mg/mL (per mL): $10,683.49
30 mg/mL (per mL): $16,025.23
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Subcutaneous:
Crysvita: Burosumab-twza 10 mg/mL (1 mL); Burosumab-twza 20 mg/mL (1 mL); Burosumab-twza 30 mg/mL (1 mL) [contains polysorbate 80]
Note: The product is available in multiple concentrations; verify appropriate product selection for dose. Should be administered by a health care provider. Doses may be administered 3 days on either side of a scheduled treatment date to avoid missed dosing. If missed dose falls outside of 3-day window, administer as soon as possible at prescribed dose.
Parenteral: SubQ: Administer undiluted SubQ in upper arms, upper thighs, buttocks, or any quadrant of the abdomen; rotate injection sites with each injection. Avoid injection sites where skin is tender, bruised, red, hard, not intact, or areas with moles or scars. The maximum SubQ volume per injection site is 1.5 mL; larger dose volumes need to be split between 2 injection sites. Inspect vial prior to use; do not use if solution is discolored, cloudy, or contains particulate matter.
Note: The product is available in multiple concentrations; verify appropriate product selection for dose. Should be administered by a health care provider.
SUBQ: Administer SUBQ into the upper thighs, any quadrant of abdomen, buttocks, or upper arms. Contents from 2 vials may be combined; however, the maximum volume per injection site is 1.5 mL. Administer each injection at a different anatomic location than a previous injection. Avoid areas where the skin is tender, bruised, red, hard, or not intact, or where there are scars or moles.
Store at 2°C to 8°C (36°F to 46°F) in the original carton; do not freeze. Protect from light. Do not shake.
Treatment of X-linked hypophosphatemia (XLH) (FDA approved in ages ≥6 months and adults); treatment of fibroblast growth factor 23 (FGF23)-related hypophosphatemia in tumor-induced osteomalacia associated with phosphaturic mesenchymal tumors that cannot be curatively resected or localized (FDA approved in ages ≥2 years and adults).
Burosumab may be confused with belimumab, denosumab.
The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drug classes (chemotherapeutic agent, parenteral and oral) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Acute Care, Community/Ambulatory Care, and Long-Term Care Settings).
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
Efgartigimod Alfa: May diminish the therapeutic effect of Fc Receptor-Binding Agents. Risk C: Monitor therapy
Phosphate Supplements: May enhance the adverse/toxic effect of Burosumab. Risk X: Avoid combination
Rozanolixizumab: May diminish the therapeutic effect of Fc Receptor-Binding Agents. Risk C: Monitor therapy
Vitamin D Analogs: May enhance the adverse/toxic effect of Burosumab. Risk X: Avoid combination
Burosumab is a human IgG monoclonal antibody and may be transferred across the placenta. Maternal serum phosphorus concentrations should be monitored.
Health care providers are encouraged to report exposures of burosumab during pregnancy to the manufacturer Adverse Event reporting line (888-756-8657).
Hypersensitivity reactions, local injection-site reactions, serum 25-hydroxy vitamin D levels.
Fasting serum phosphorus levels: Baseline (must be below reference range for therapy initiation); during first 12 weeks of treatment: measure 2 weeks after initial starting dose then every 4 weeks; after first 12 weeks: as clinically appropriate; following dose adjustment: every 4 weeks in age <18 years; every 2 weeks in age ≥18 years (refer to dosing fields for details).
Note: Reference ranges may vary depending on the laboratory.
Fasting serum phosphorus: 3.1 to 6.2 mg/dL (SI: 1 to 2 mmol/L) (ASPEN [Corkins 2015]); normal ranges are higher in younger patients. In clinical trials of children 5 to 12 years, a target range of 3.5 to 4.5 mg/dL (SI: 1.1 to 1.5 mmol/L) was used (Carpenter 2018).
Age-directed normal ranges (Kliegman 2020):
1 to 3 years: 3.8 to 6.5 mg/dL (SI: 1.2 to 2.1 mmol/L).
4 to 11 years: 3.7 to 5.6 mg/dL (SI: 1.2 to 1.8 mmol/L).
12 to 15 years: 2.9 to 5.4 mg/dL (SI: 0.9 to 1.7 mmol/L).
16 to 19 years: 2.7 to 4.7 mg/dL (SI: 0.9 to 1.5 mmol/L).
Burosumab binds to and inhibits the activity of fibroblast growth factor 23, thereby restoring renal phosphate reabsorption and increasing the serum concentration of 1,25 dihydroxy vitamin D.
Distribution: Vd: 8 L
Metabolism: Degraded into small peptides and amino acids via catabolic pathways
Half-life elimination: ~19 days
Time to peak: 8 to 11 days
Body weight: Clearance and volume of distribution of burosumab increases with body weight.
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