Intervention Review

Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency

  1. Josep Vidal-Alaball1,*,
  2. Christopher Butler2,
  3. Rebecca Cannings-John2,
  4. Andrew Goringe3,
  5. Kerry Hood2,
  6. Andrew McCaddon4,
  7. Ian McDowell5,
  8. Alexandra Papaioannou6

Editorial Group: Cochrane Metabolic and Endocrine Disorders Group

Published Online: 20 JUL 2005

Assessed as up-to-date: 30 DEC 2004

DOI: 10.1002/14651858.CD004655.pub2


How to Cite

Vidal-Alaball J, Butler C, Cannings-John R, Goringe A, Hood K, McCaddon A, McDowell I, Papaioannou A. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD004655. DOI: 10.1002/14651858.CD004655.pub2.

Author Information

  1. 1

    National Public Health Service for Wales, Swansea, Wales, UK

  2. 2

    Cardiff University, Department of Primary Care and Public Health, School of Medicine, Cardiff, UK

  3. 3

    Cardiff and Vale NHS Trust, Department of Haematology, Cardiff, Wales, UK

  4. 4

    Cardiff University, Department of General Practice, Wales College of Medicine, Wrexham, Wales, UK

  5. 5

    Cardiff University, Department of Medical Biochemistry and Immunology, Cardiff, Wales, UK

  6. 6

    McMaster University, Department of Medicine, Hamilton, Ontario, Canada

*Josep Vidal-Alaball, National Public Health Service for Wales, 36 Orchard Street, Swansea, Wales, SA1 5AQ, UK. Josep.Vidal-Alaball@nphs.wales.nhs.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 JUL 2005

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Vitamin B12 deficiency is common and rises with age. Most people with vitamin B12 deficiency are treated in primary care with intramuscular vitamin B12 which is a considerable source of work for health care professionals. Several case control and case series studies have reported equal efficacy of oral administration of vitamin B12 but it is rarely prescribed in this form, other than in Sweden and Canada. Doctors may not be prescribing oral formulations because they are unaware of this option or have concerns regarding effectiveness.

Objectives

To assess the effectiveness of oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency.

Search methods

Searches were undertaken of The Cochrane Library, MEDLINE, EMBASE and Lilacs. The bibliographies of all relevant papers identified using this strategy were searched. In addition we contacted authors of relevant identified studies and Vitamin B12 research and pharmaceutical companies to enquire about other published or unpublished studies and ongoing trials.

Selection criteria

Randomised controlled trials (RCTs) examining the use of oral or intramuscular vitamin B12 to treat vitamin B12 deficiency.

Data collection and analysis

All abstracts or titles identified by the electronic searches were independently scrutinised by two reviewers. When a difference between reviewers arose, we obtained and reviewed a hard copy of the papers and made decisions by consensus. We obtained a copy of all pre-selected papers and two researchers independently extracted the data from these studies using piloted data extraction forms. The whole group checked whether inclusion and exclusion criteria were met, and disagreement was decided by consensus. The methodological quality of the included studies was independently assessed by two researchers and disagreements were brought back to the whole group and resolved by consensus.

Main results

Two RCT's comparing oral with intramuscular administration of vitamin B12 met our inclusion criteria. The trials recruited a total of 108 participants and followed up 93 of these from 90 days to four months. High oral doses of B12 (1000 mcg and 2000 mcg) were as effective as intramuscular administration in achieving haematological and neurological responses.

Authors' conclusions

The evidence derived from these limited studies suggests that 2000 mcg doses of oral vitamin B12 daily and 1000 mcg doses initially daily and thereafter weekly and then monthly may be as effective as intramuscular administration in obtaining short term haematological and neurological responses in vitamin B12 deficient patients.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency

Vitamin B12 deficiency can cause anaemia and neurological complications. Vitamin B12 is rarely prescribed in the oral form in most countries. Two randomised controlled studies were included in this review. The trials recruited a total of 108 participants and followed up 93 of these from 90 days to four months. The evidence derived from these limited studies suggests that high oral doses of B12 (1000 mcg and 2000 mcg) could be as effective as intramuscular administration in achieving haematological and neurological responses.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

以口服或肌肉注射方式對維生素B12缺乏進行補充之比較

維生素B12缺乏相當常見,且其發生率隨著年齡增加。大多數的患者均以肌肉注射維生素B12的方式來治療;如此,會對醫療從業人員帶來相當的工作負擔。有幾個病例對照及病例系列研究曾指出口服的維生素B12亦有相當的療效;然而,除了在瑞典與加拿大以外,維生素B12極少以口服的方式處方。醫師們可能因為不知道有此一選擇,或是擔心其療效,故不開立口服的維生素B12的處方。

目標

為了比較以口服或肌肉注射方式對維生素B12缺乏進行補充之效果。

搜尋策略

自2005年初起,我們開始對Cochrane Library,MEDLINE,EMBASE及Lilacs的搜尋。所有依此法被找出的相關論文,我們亦進一步地搜尋其參考文獻。除此之外,我們聯繫了相關研究作者、其他維生素B12研究的作者和藥廠,以取得其他公布及未公布的研究,和進行中試驗的資料。

選擇標準

我們選擇了評估以口服或肌肉注射方式對維生素B12缺乏進行治療的隨機對照試驗(RCTs)。

資料收集與分析

我們選擇了評估以口服或肌肉注射方式對維生素B12缺乏進行治療的隨機對照試驗(RCTs)。

主要結論

所有藉由電子搜尋找到的摘要或標題,都由2位回顧者獨立地仔細檢視過。當2位回顧者間出現歧異時,我們便回顧論文的紙本,並由彼此間的共識來做出決定。我們取得所有事前選擇好的論文的複本,並由2位研究者以預設的數據截取格式,獨立地將數據資料自這些研究中截取出來。全體的研究人員均確認資料是否符合收錄或排除的標準;如有意見不一的情形,則依共識來做出決定。關於被收錄研究之研究方法學的品質,則由2位研究者獨立地審查;如有意見不一的情形,則由全體研究人員的共識來解決。

作者結論

經由來自這些有限研究的證據顯示:每日口服2000微克維生素B12,或每日口服1000微克維生素B12,之後再改為每週或每個月服用,對於維生素B12缺乏患者的短期血液學及神經學症狀改善,與肌肉注射的補充方式一樣有效。

翻譯人

本摘要由臺灣大學附設醫院林志弘翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

每日口服高劑量的維生素B12可能和肌肉注射一樣有效。維生素B12缺乏可能會造成貧血及神經學上的併發症。在大多數的國家,維生素B12極少以口服的劑型開立。在本篇回顧中,共有2個隨機對照試驗被收錄。這2個試驗共招集了108名受試者,且對於其中的93名進行了90天至4個月的追蹤。經由來自這些受限研究的證據顯示:口服高劑量的維生素B12(1000和2000微克),對於改善血液學及神經學症狀改善,可能與肌肉注射的補充方式一樣有效。