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Blood, Vol. 92 No. 4 (August 15), 1998:
pp. 1191-1198
Effective Treatment of Cobalamin Deficiency With Oral
Cobalamin
Antoinette M. Kuzminski,
Eric J. Del Giacco,
Robert H. Allen,
Sally P. Stabler, and
John Lindenbaum
From the Division of General Internal Medicine, Bassett Healthcare,
Cooperstown, NY; the Division of Hematology, Department of Medicine,
University of Colorado Health Sciences Center, Denver, CO; and the
Department of Medicine, Columbia University College of Physicians and
Surgeons, New York, NY.
Because cobalamin deficiency is routinely treated with parenteral
cobalamin, we investigated the efficacy of oral therapy. We randomly
assigned 38 newly diagnosed cobalamin deficient patients to receive
cyanocobalamin as either 1 mg intramuscularly on days 1, 3, 7, 10, 14, 21, 30, 60, and 90 or 2 mg orally on a daily basis for 120 days.
Therapeutic effectiveness was evaluated by measuring hematologic and
neurologic improvement and changes in serum levels of cobalamin
(normal, 200 to 900 pg/mL) methylmalonic acid (normal, 73 to 271 nmol/L), and homocysteine (normal, 5.1 to 13.9 µmol/L). Five patients
were subsequently found to have folate deficiency, which left 18 evaluable patients in the oral group and 15 in the parenteral group.
Correction of hematologic and neurologic abnormalities was prompt and
indistinguishable between the 2 groups. The mean pretreatment values
for serum cobalamin, methylmalonic acid, and homocysteine were,
respectively, 93 pg/mL, 3,850 nmol/L, and 37.2 µmol/L in the oral
group and 95 pg/mL, 3,630 nmol/L, and 40.0 µmol/L in the parenteral
therapy group. After 4 months of therapy, the respective mean values
were 1,005 pg/mL, 169 nmol/L, and 10.6 µmol/L in the oral group and
325 pg/mL, 265 nmol/L, and 12.2 µmol/L in the parenteral group. The
higher serum cobalamin and lower serum methylmalonic acid levels at 4 months posttreatment in the oral group versus the parenteral group were
significant, with P < .0005 and P < .05, respectively. In cobalamin deficiency, 2 mg of cyanocobalamin
administered orally on a daily basis was as effective as 1 mg
administered intramuscularly on a monthly basis and may be superior.
© 1998 by The American Society of Hematology.
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