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The most common cause of vitamin B12 deficiency is pernicious anaemia
Furthermore, it should be noted that based on the CombiRx study data, the arms of glatiramer acetate monotherapy and combined glatiramer acetate and IFN-beta-1a IM weekly did not show a statistically significant difference with respect to the primary outcome (annualized relapse rate)

The theoretical concern is real and is one reason mainstream pharmaceutical development has been cautious

Administer the medication slowly

Noticeable in first week

Some notice increased appetite (a GH effect, usually mild)
