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Strong evidence, from decades of treating individuals with inborn errors of B 12 metabolism, supports the safety of parenteral, lifelong, even high dose hydroxocobalamin, sometimes even at very high doses

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J Exp Clin Cancer Res (2023) 42(1):52

Over the past decade, CVOTs in this class have evolved from primarily assessing safety in patients with type 2 diabetes mellitus (T2DM) to demonstrating broader cardioprotective advantages, including in non-diabetic individuals with obesity [43]