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No large-scale phase 3 trials have been completed

235 The above evidence demonstrates that the MS, SLE, RA, and SS patients have active EBV lytic replication

The consequences of severe hypokalemia can be life-threatening: Cardiac arrhythmias (irregular heartbeats) Muscle weakness and paralysis Respiratory failure (breathing problems) Rhabdomyolysis (breakdown of muscle tissue) Potential cardiac arrest (heart stopping) Patients with poor nutritional status or other metabolic conditions are particularly vulnerable to this complication

However, conditions affecting the gastrointestinal tractincluding pernicious anaemia, Crohn's disease, coeliac disease, or gastric surgerycan significantly impair absorption, necessitating alternative supplementation routes such as intramuscular hydroxocobalamin injections, which deliver B12 directly into the bloodstream