LONG-TERM EVALUATION OF VITAMIN B12 IN TREATMENT OF PERNICIOUS ANEMIA: 1. INCIDENTAL REPORT ON USE OF COMBINED ORAL THERAPY WITH VITAMIN B12 AND FOLIC ACID

In 1950 one of us (S. O. S.), working with others,1evaluated the long-term use of folic acid in pernicious anemia, with the eventual observation of both hematological and neurological relapse. Because the natural history of pernicious anemia is characterized by spontaneous exacerbations and remissions, such long-term studies were believed indicated to evaluate critically any new therapeutic agent. With the same premise in mind, we have studied 51 patients treated with parenterally given vitamin B12therapy, 32 of whom were observed over a period of four years or longer. A similar group, comprising 63 patients with pernicious anemia who were treated with liver extract, was evaluated. Of these, 34 were followed over 4 years, some for as long as 16 years. Again, as in the folic acid study, the clinical course, liver extract requirements, and neurological and hematological status were all well established and stabilized when the study