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Serum biomarkers like B12 or methylmalonic acid are not entirely useful in assessing or monitoring clinical improvement, and injection frequency should not be based on biomarker levels

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For randomised clinical trials, the Jadad scale ( To complement the Jadad score, the Cochrane Risk of Bias Tool (RoB 2) (Sterne et al., 2019) was also used for RCTs to provide a domain-based qualitative evaluation, assessing risks related to selection, performance, detection, attrition, and reporting

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