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In SPMS, characterized by steady deterioration without acute attacks, treatment strategies often involve continuing or altering DMT used during the earlier RRMS phase, such as interferon beta, or considering immune-modulating agents, such as methotrexate, cyclophosphamide, or glucocorticoid pulses [142, 143]
Autoimmune Conditions: Certain autoimmune diseases may cause cell damage and disrupt normal vitamin B12 metabolism
Inherited disorders of folate and cobalamin transport and metabolism
Safety is also dose- and condition-specific: in the LOVIT sepsis trial published in the New England Journal of Medicine (2022), high-dose IV vitamin C was linked to worse outcomes than placebo, which underscores that more is not always better
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