Comparison of The Effectıveness of Sublingual Methylcobalamine and Intramuscular Cyanocobalamine Treatment in Pediatric Patients with Vitamin B12 Deficiency: A Single Center Experience

Background: The estimated prevalence of vitamin B12 (VB12) deficiency in the general population varies between 1.5% and 15%. The most common cause of VB12 deficiency in children is due to inadequate intake. Methylcobalamin, hydroxycobalamin and cyanocobalamin forms are used in treatment. Although intramuscular cyanocobalamin therapy is widely used in treatment until recently, the use of sublingual methylcobalamin has come to the fore in recent years with its various advantages, including potentially good compliance to treatment, easy application, safety and low cost. Additionally, this pathway provides treatment of VB12 deficiency in patients with swallowing disorders or malabsorption syndrome (inflammatory bowel diseases, intestinal surgery, short bowel syndrome, etc.). In recent years, the importance of sublingual B12 vitamin therapy has been recognized; however, few studies have evaluated this method, especially in children. The aim of this study is to evaluate the effectiveness of sublingual methylcobalamin and intramuscular cyanocobalamin in the treatment of children with VB12 deficiency.

Materials and Methods: In this cross-sectional and retrospective study, it was planned to include all patients diagnosed with B12 deficiency between the ages of 0-18 who applied to Manisa City Hospital Pediatric Hematology outpatient clinic between January 2021 and January 2022. Pre- treatment and post-treatment 6th week control evaluation results were obtained from the medical file records. The results of those using sublingual methylcobalamin (group 1) and intramuscular cyanocobalamin (group 2) were compared.

Results: The study were included 56 patients. There were 30 patients in group 1 and the average age was 5.1±6.8 (0.1-16). In group 2, the number of patients was 26 and the average age was 8.8±6.2 (0.1-16 years). In group 1, the mean vitamin B12 level before treatment was 151 (120-180) ng/dl, and the mean homocysteine was 11.9 Mmol/L (8.8-22.0). In group 2, the average pre- treatment vitamin B12 level was 160 (143-171) ng/dl, the average homocysteine was 21.8 Mmol/L (11.9-27.1). After treatment, the average vitamin B12 level in group 1 was 507 (440-625) pg/dl, homocysteine 8.3 Mmol/L (5.4-13.5); In group 2, the average vitamin B12 level was 721 (413-1172) pg/dl and homocysteine was 21.8 Mmol/L (11.9-27.1). There was no statistically significant difference in vitamin B12, homocysteine and hemogram parameters between the two groups after treatment.