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Of particular note, the researchers reported that lower levels of CD320 or dietary B 12 restriction worsened the disease course in an animal model of MS and reduced the therapeutic efficacy of fingolimod, which occurred through a mechanism in which fingolimod hitchhikes by binding to the TCN2-B 12 complex, allowing delivery of all to the astrocytes via interactions with CD320, with component losses disrupting the process and worsening disease

They are compounded by US 503A pharmacies under physician prescription

10.3390/pharmaceutics11110598 77 LochheadJ

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The FDAs primary enforcement mechanism is against vendors who make explicit health claims or market compounds as supplements or medicines