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Before committing to long-term supplementation, clinicians should establish the underlying cause of deficiency in particular, whether pernicious anaemia is present (assessed by testing for anti-intrinsic factor antibodies and, where appropriate, anti-parietal cell antibodies), as this determines the treatment route and duration

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The true cost-effectiveness of any treatment is empirical, and it is a limitation that analyses of both costs and clinical outcomes are modelled rather than based on long-term empirical studies

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However, the incidence of gastrointestinal events, discontinuations due to adverse events, and mean increase in pulse rate were higher with orforglipron than oral semaglutide

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