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Using a modified Delphi process and a structured evidence-grading framework, experts reviewed data on: - COVID-19 and influenza vaccine efficacy - Adverse events related to CSIs - Effects of CSIs on the hypothalamicpituitary axis - Incidence of COVID-19 and influenza in patients receiving CSIs - Appropriate intervals between CSIs and vaccination Key Recommendations: For non-urgent indications, offer CSIs at least 1 week before or after COVID-19 or influenza vaccination

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Any adjustments to the 5-Amino-1MQ dosage should be made with careful consideration for animal ethics guidelines and regulatory approvals

This remarkable selectivity stems from 5-amino-1MQs specific interaction with the nicotinamide-binding pocket of NNMT, rather than the SAM-binding site common to many methyltransferases