Vitamin B12 (cobalamin) is necessary for basic body functions, such as the growth and development of red blood cells and the nervous system. Many factors contribute to vitamin B12 deficiency, such as age, blood disease, vegetarian diet, indigestion, use of drugs, as well as poor nutrition. Doctors are more likely to give vitamin B12using intramuscular injection because they may be unaware of the option to use oral vitamin B12 or uncertain about how well it works.Dr. Wang H and Co-researchers from Beijing University of Chinese Medicine and the Catalan Health Institute, Spain performed an analysis of 3 randomized controlled trials (RTC) to investigate whether oral vitamin B12 have similar effects as intramuscular injections of vitamin B12 for people with vitamin B12 deficiency or not.They found that when compared to intramuscular (IM) vitamin B12, oral vitamin B12 has associated with similar outcomes in terms of efficacy and safety in the treatment of vitamin B12 deficiency, although the evidence was deemed ‘low quality’.”Doctors may not be prescribing oral vitamin B12 formulations because they may be unaware of this option or have concerns regarding its effectiveness,” the authors write.
In the study, the researchers recruited 153 participants (74 participants to oral vitamin B12 and 79 participants to intramuscular vitamin B12). and the treatment duration and follow-up ranged between three and four months. The mean age of participants ranged from 39 to 72 years.
They searched CENTRAL, MEDLINE, Embase, and LILACS, as well as the WHO ICTRP and ClinicalTrials.gov for randomized controlled trials that directly compared oral and IM vitamin B12. The 3 trials used for analysis included 153 participants in total (74 administered oral vitamin B12, 79 administered IM vitamin B12). The average follow-up period was 3–4 months.
Results from 2 trials using 1000μg/day oral vitamin B12 showed no clinically relevant difference in vitamin B12levels when compared with the IM formulation. In 1 trial, a mean difference of 680pg/mL favoring oral vitamin B12 was noted when 2000μg/day was used. Of the 2 trials that reported treatment-related adverse events, 1 found that 2 of 30 individuals in the oral vitamin B12 group left the study due to adverse events, while the other reported no adverse events in either treatment group. Additionally, oral vitamin B12 demonstrated lower treatment-associated costs than IM vitamin B12 in one trial (low-quality evidence due to serious imprecision).
The authors concluded that “Low-quality evidence shows oral and IM vitamin B12 having similar effects in terms of normalising serum vitamin B12 levels, but oral treatment costs less. We found very low-quality evidence that oral vitamin B12 appears as safe as IM vitamin B12.However, more trials need to be conducted that have “better randomization and blinding procedures, recruit more participants, and provide adequate reporting.
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Dr. Kamal Kant Kohli
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