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Tendon/collagen improvements take longer (812+ weeks)

The TRIUMPH-4 Phase 3 trial in obesity with knee osteoarthritis (Bays et al., NEJM 2025) reported 28.7% mean weight loss at 68 weeks at the 12 mg dose, plus a 75.8% reduction in WOMAC knee pain scores

Precautions for Cyanocobalamin General Precautions Vitamin B 12 deficiency that is allowed to progress for longer than 3 months may produce permanent degenerative lesions of the spinal cord

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Key contraindications may include active cancer-related conditions, a history of pancreatitis, pregnancy, breastfeeding, and individual intolerance