Therapeutic Response to Sublingual Methylcobalamin in Children With Vitamin B12 Deficiency Anemia

Objective To evaluate the efficacy and safety of sublingual methylcobalamin for the treatment of vitamin B12 deficiency anemia in children. Methods A single arm intervention study was conducted between November, 2020 and April, 2022 in children aged 1–12 years with vitamin B12 deficiency anemia. Children aged 1–6 years received a tablet of methylcobalamin (1500 mcg) by sublingual route every alternate day (three doses) while those aged 7–12 years received five such doses. Thereafter, one such sublingual tablet was given weekly and all participants were followed-up for 6 weeks. Results 37 children with a mean (SD) age of 8.2 (4.1) years were treated and followed-up. On day 10, no child needed rescue therapy with parenteral methylcobalamin. After 6 weeks, the mean (SD) serum cobalamin increased from 123.3 (35.5) pg/mL to 507.3 (274.2) pg/mL ( P <0.001), plasma homocysteine decreased from 48.9 (17.8) µmol/L to 16.3 (8.5) µmol/L ( P <0.001), the mean (SD) hemoglobin increased by 2.3 (1.1) g/dL ( P <0.001), and MCV decreased by 12.9 (6.8) fL ( P <0.001). 67.6% children persisted to have anemia, albeit majority of them had mild or moderate anemia. There were no unsolicited side-effects reported. Conclusion Sublingual methylcobalamin is effective for the treatment of vitamin B12 deficiency anemia in children; although, the duration of treatment needs to be longer than six weeks.