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Baseline demographic characteristics, comorbidities, medication use, and laboratory values were well balanced between groups, with SMDs below 0.1 for all covariates, indicating adequate balance consistent with the assumptions of the emulated target trial ( Table 1 )

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Future trials should also measure important outcomes such as the clinical signs and symptoms of vitamin B 12 deficiency, health related-quality of life, socioeconomic effects, and report adverse events adequately, preferably in a primary care setting. Clinical practice guidelines British Columbia Medical Services Commission (MSC)

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