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Proper handling is key

The secondary outcomes will be the serum vitamin B12 concentration (pg/ml), adverse events (description, moment of onset and resolution, intensity, cause, steps taken), adherence to treatment (measured at each patient visit via the number of vials used for patients in the oral arm, and the number of injections given in the intramuscular arm), quality of life (measured using the EuroQoL-5D questionnaire), and patient satisfaction and preferences

The time when you will notice significant changes in response to B12 supplementation is when you ask how long B12 takes to work

Sarcoma incidence is extremely rare, with different studies reporting an incidence between one in 1000 to one in 10,000 vaccines given

Avoiding these is key to a successful study