State of art of oral vitamin B12 (cobalamin) treatment in Biermer's disease (pernicious anemia)

Abstract

In the setting of vitamin B12 (cobalamin) deficiency, new routes (oral and nasal) of vitamin B12 replacement have being developed and studied. In Biermer's disease, two prospective controlled randomized studies, a recent systematic review by the Cochrane group and four prospective studies were found and provide evidence that oral vitamin B12 treatment may adequately treat cobalamin deficiency. The efficacy was documented with a marked improvement in serum vitamin B12 levels or normalization of this latter. The clinical efficacy was also established with an improvement or a normalization of hematological parameters. The safety was documented in the majority of the studies. In this setting, oral replacement will be of interest for clinicians to avoid painful and administration difficulties, and cost of monthly injections. To date, effect of oral vitamin B12 treatment has not yet been adequately documented in patients presenting with severe neurological manifestations.