Vitamin B12 Replacement Treatment; Oral? Intramuscular?

Year 2020, Volume: 17 Issue: 1, 19 - 23, 29.04.2020

Maruf Boran , Ömer Faruk Boran Nisbet Yılmaz Başol Canbakan

https://doi.org/10.35440/hutfd.628409

Cited By: 3

Abstract

Background: Vitamin B12 deficiency is one of the common diseases in the community which can cause hematological and neurological symptoms and signs. It is usually treated by intramuscular injection after diagnosis. The aim of this study was to compare oral and intramuscular B12 replacement therapy.
Materials and Methods: The study was started with the decision dated 24/07/2013 and numbered 2013-646 of the Scientific Research Evaluation Commission of Ankara Numune Training and Research Hospital. Patients who were admitted to the internal medicine outpatient clinic between May-October 2012 and whom were recently diagnosed with vitamin B12 deficiency, that received oral or intramuscular therapy, and came to the control one month later, were included in the study. Statistical analysis was performed with “SPSS for Windows 20.0” SS package program.
Results: 56 patients with oral vitamin B12 replacement therapy and 46 patients with intramuscular vitamin B12 replacement therapy were found. According to baseline values, significant increase in vitamin B12 levels was observed in all patients. (220.73 ± 243.47 pg / ml, p <0.001). Vitamin B12 increase was 252,91 ± 297,23 pg / ml in oral treatment group and 182,96 ± 152,90 pg / ml in intramuscular treatment group respectively. There were no significant differences between two groups (p> 0.05).
Conclusion: In a study that was divided into oral and intramuscular B12 replacement therapy, an increase in vitamin B12 levels was found with oral and intramuscular treatment after 90 days of treatment, but the groups were not compared in terms of efficacy. In our study, since there was no difference between oral and intramuscular B12 replacement therapies in patients with vitamin B12 deficiency, may suggest that oral replacement therapy may be an alternative to intramuscular therapy. Further comprehensive randomized controlled studies are required to determine the efficiency of intramuscular B12 replacement therapy.

Vitamin B12 Replasman Tedavisi; Oral? İntramüsküler?

Abstract

Amaç: Bu çalışmanın amacı intramüsküler B12 replasman tedavisi ile oral B12 replasman tedavisinin kan B12 vitamini düzeyleri üzerine olan etkisinin karşılaştırılmasıdır.
Materyal ve Metod: Çalışma Ankara Numune Eğitim Araştırma Hastanesi (EAH) Bilimsel Araştırmalar Değerlendirme Komisyonunun 24/07/2013 tarih ve 2013-646 sayılı kararı ile yapılmıştır. Ankara Numune EAH 3 Dahiliye polikliniğine Mayıs–Ekim 2012 tarihleri arasında başvuran ve yeni tanı B12 vitamini eksikliği saptanan, oral veya intramüsküler tedavi başlanan, bir ay sonra kontrole gelen hastalar retrospektif taranarak çalışmaya alınmıştır. İstatistiksel analizler “SPSS for Windows 20,0” paket programı ile yapılmıştır.
Bulgular: Oral vitamin B12 replasman tedavisi alan 56, intramüsküler vitamin B12 replasman tedavisi alan 46 hasta bulundu. Başlangıç değerlerine göre tüm hastalarda anlamlı B12 vitamini düzey artışı olduğu görüldü. (220,73±243,47 pikogram/mililitre (pg/ml), p<0,001). Oral tedavi alanlarda B12 vitamini artışı 252,91±297,23 pg/ml, intramüsküler tedavi alanlarda B12 vitamini artışı 182,96±152,90 pg/ml olarak saptandı. Oral ve intramüsküler tedavi alan hastaların B12 vitamini düzey artışları arasında fark tespit edilmedi (p>0,05).
Sonuç: Oral ve intramüsküler B12 replasman tedavi kollarına ayrılarak yapılan bir çalışmada 90 günlük tedavi sonrasında oral ve intramüsküler tedavi ile B12 vitamini düzeyinde artış olduğu bulunmuş ancak gruplar etkinlik açısından karşılaştırılmamıştır. Bizim çalışmamızda B12 vitamini eksikliği saptanan hastalarda oral ve intramüsküler B12 replasman tedavileri arasında fark saptanmamış olması, oral replasman tedavisinin intramüsküler tedaviye alternatif olabileceğini akla getirmektedir. Konu ile ilgili yeni, daha geniş kapsamlı randomize kontrollü çalışmalara ihtiyaç olduğu ortadadır.

Keywords

Oral, İntramüsküler, Vitamin B12, replasman

References

• 1. Green R. Kinsella LJ. Current concepts in the diagnosis of cobalamin deficiency. Neurology 1995; 45:1435
• 2. Sullivan LW. Herberty V. Studies on the minimal daily requirement for vitamin B12 hematopoietic responses to 0.1 micrograms of cyanocobalamin or coenzyme B12, and comparison of their reletive potency. N Engl J Med 1965;272-340
• 3. Tefferi A, Pruthi RK. The biochemical basis of cobalamin deficiency. Mayo Clin Proc 1994; 69:181
• 4. Allen RH, Stabler SP, Savage DG, Lindenbaum J.Metabolic abnormalities in cobalamin (vitamin B12) and folate deficiency. FASEB J 1993; 7:1344
• 5. Pruthi RK, Tefferi A. Pernicious anemia revisited. Mayo Clin Proc 1994;69:144
• 6. Toh BH, van Driel IR, Gleeson PA. Pernicious anemia. N Engl J Med 1997;337:1441
• 7. Carmel R. How I treat cobalamin (vitamin B12) deficiency. Blood 2008;112:2214
• 8. Andrès E, Goichot B, Schlienger JL. Food cobalamin malabsorption: a usual cause of vitamin B12 deficiency. Arch Intern Med 2000; 160:2061.29
• 9. Andrès E, Loukili NH, Noel E, et al. Vitamin B12 (cobalamin) deficiency in elderly patients. CMAJ 2004; 171:251.
• 10. 30. Dali-Youcef N, Andrès E. An update on cobalamin deficiency in adults. QJM 2009; 102:17
• 11. Lindenbaum J, Healton EB, Savage DG, et al. Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. N.Engl J Med 1988; 318:1720.
• 12. Hemmer B, Glocker FX, Schumacher M, et al. Subacute combined degeneration: clinical, electrophysiological, and magnetic resonance imaging findings. J Neurol Neurosurg Psychiatry 1998; 65:822
• 13. Dhonukshe-Rutten RA, Lips M, de Jong N, et al. Vitamin B-12 status is associated with bone mineral content and bone mineral density in frail elderly women but not in men. J Nutr 2003; 133:801.14. Savage DG, Lindenbaum J, Stabler SP, Allen RH. Sensitivity of serum methylmalonic acid and total homocysteine determinations for diagnosing cobalamin and folate deficiencies. Am J Med 1994; 96:239
• 15. Lindenbaum J, Savage DG, Stabler SP, Allen RH. Diagnosis of cobalamin deficiency: II. Relative sensitivities of serum cobalamin, methylmalonic acid and total homocysteine concentrations. Am J Hematol 1990; 34:99
• 16. Matchar DB, McCrory DC, Millington DS, Feussner JR. Performance of the serum cobalamin assay for diagnosis of cobalamin deficiency. Am J Med Sci 1994; 308:276.
• 17. Stabler SP. Clinical practice. Vitamin B12 deficiency. N Engl J Med 2013;368:149
• 18. Green R. Screening for vitamin B12 deficiency: caveat emptor. Ann Intern Med 1996; 124:509
• 19. Stabler SP, Allen RH, Savage DG, Lindenbaum J. Clinical spectrum and diagnosis of cobalamin deficiency. Blood 1990; 76:871
• 20. Solomon LR. Cobalamin-responsive disorders in the ambulatory care setting: unreliability of cobalamin, methylmalonic acid, and homocysteine testing. Blood 2005; 105:978
• 21. Hvas AM,Ellegaard J, Nexø E. Increased plasma methylmalonic acid level does not predict clinical manifestations of vitamin B12 deficiency. Arch Intern Med 2001; 161:1534.
• 22. Hathcock JN, Troendle GJ. Oral cobalamin for treatment of pernicious anemia? JAMA 1991; 265:96
• 23. Solomon LR. Oral vitamin B12 therapy: cautionary note. Blood 2004;103:2863.
• 24. Eussen SJ, de Groot LC, Clarke R, et al. Oral cyanocobalamin supplementation in older people with vitamin B12 deficiency: a dose-finding trial. Arch Intern Med 2005; 165:1167
• 25. Kuzminski AM, Del Giacco EJ. Allen RH, et al. Effective treatment of cobalamin deficiency with oral cobalamin. Blood 1998; 92:1191
• 26. Butler CC, Vidal-Alaball J, Cannings-John R, et al. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency: a systematic review of randomized controlled trials. Fam Pract 2006; 23:279
• 27. Delpre G, Stark P, Niv Y. Sublingual therapy for cobalamin deficiency as an alternative to oral and parenteral cobalamin supplementation. Lancet 1999;354:740
• 28. Slot WB, Merkus FW, Van Deventer SJ, Tytgat GN. Normalization of plasma vitamin B12 concentration by intranasal hydroxocobalamin in vitamin B12-deficient patients. Gastroenterology 1997; 113:430.
• 29. Kondo H. Haematological effects of oral cobalamin preparations on patients with megaloblastic anaemia. Acta Haematol 1998;99:200-205
• 30. Nyholm E, Turpin P, Swain D, Cunningham B, Daly S, Nightingale P, Fegan C. Oral vitamin B12 can change our practice. Postgrad Med J 2003;79:218-220
• 31. Favrat et al.Oral vitamin B12 for patients suspected of subtle cobalamin deficiency: a multicentre pragmatic randomised controlled trial. BMJ Family Practice 2011;12:2
• 32. VanderBrink BA, Cain MP, King S et al. is oral vtamin B12 therapy effective for vitamin B12 deficiency in patients with plior ileocystoplasty?. The Journal Of Urology 2010;184:1781-1785
• 33. Andres A, Kaltenbach G et al. Efficacy of short-term oral cobalamin therapy for the treatment of cobalamin deficiencies related to food- cobalamin malabsorption: A study of 30 patients. Clin. Lab. Haem. 2003;25:161-166
• 34. Verhaeverbeke I, Mets T, Mulkens K et al. Normalization of low vitamin B12 serum levels in older people by oral treatment. J Am Geriatr Soc 1997;45:124-125
• 35. DeFronzo R, Goodman A. Efficacy of metformin in patients with non-insülin dependent diabetes mellitus. The Multicenter Metformin Study Group. N Eng J Med 1995;333:541-9
• 36. De-Jager J, Kooy A, Lehert P, et al. Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency:randomised placebo controlled trial. BMJ 2010;340:c2181
• 37. Ting R, Szeto C. Chan M, Ma K, Chow K. Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch Intern Med 2006;166:1675-9
• 38. Parry-Strong A, Langdana F, Haeusler S, et al. Sublingual vitamin B12 compared to intramuscular injection in patients with type 2 diabetes treated with metformin: a randomised trial. N Z Med J 2016; 129:67.