Heghine Khachatryan: Vitamin B12 Replacement Choosing the Right Route for Each Patient
Heghine Khachatryan, Editor-in-Chief of Hemostasis Today, Head of Hemophilia and Thrombosis Center at Yeolyan Hematology and Oncology Center, shared a post on LinkedIn about a recent article by Daniela Debone et al, published in eClinicalMedicine, adding:
“Vitamin B12 replacement: individualising the route of treatment
The 2026 systematic review by Debone and colleagues in EClinicalMedicine revisits an everyday clinical decision: choosing between oral, sublingual and intramuscular vitamin B12 replacement.
Across 13 studies, all three routes increased serum B12 concentrations.
Several comparisons suggested comparable biochemical responses with oral and intramuscular treatment, while evidence for sublingual therapy remained limited.
Clinical outcomes were rarely reported, and methodological limitations warrant cautious interpretation. (thelancet.com, sciencedirect.com, thelancet.com)
My interpretation is that these findings support individualised prescribing.
Comparable serum responses alone cannot establish equivalent neurological recovery or sustained clinical benefit.
Treatment selection should consider the cause of deficiency, clinical severity, adherence, patient preference and access.
Existing guidance remains essential: NICE recommends lifelong intramuscular replacement for deficiency associated with autoimmune gastritis, total gastrectomy or complete terminal ileal resection. (nice.org.uk)
Future comparative trials should prioritise symptom resolution, neurological recovery, quality of life and sustained treatment response.”
Title: Comparative efficacy of vitamin B12 supplementation routes in adults with replacement indication: a systematic review
Authors: Daniela Debone, André Ferreira Azeredo da Silva, Julianne Tannous Cordenonssi, Ricardo V Cohen 
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