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Before escalating to second- or third-line therapies, clinicians should first evaluate for potential confounding factors such as non-adherence, sub-optimal drug dosing, azathioprine hypermethylation, alternative etiologies, and co-existing conditions like celiac disease, metabolic dysfunction-associated steatotic liver disease, or ASC/overlap syndromes [29, 104]

A recent Cochrane review of these trials, involving 153 patients, found comparable serum B12 levels in patients taking either route (Wang et al., 2018)

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In addition to the dose, other factors to take into consideration include time of the last dose and any concurrent opioid use

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