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The Arg3 to Leu3 substitution disrupts a key contact residue in the IGFBP binding interface, and the N-terminal extension further sterically interferes with binding pocket access
However, for anyone with absorption issues (like pernicious anemia or IBD), oral supplements are often insufficient
Most patients see best results with 1-3 weekly treatments over 4-8 weeks
Dosing schedule and route have also been identified a major factor affecting compliance with a single weekly injection achieving just over 10% lower risk of discontinuation (Weeda et al., 2021)
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