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This may also be due to the autoimmune attack on the parietal cells of the stomach in pernicious anemia

doi:10.3390/molecules191119066 Vukojevic J, Milavi M, Perovi D, et al

Use of MOUNJARO for this indication is supported by a 30-week, randomized, double-blind, placebo-controlled trial with a 22-week open label extension in 99 pediatric patients [see Clinical Studies (14.5)]