How long do you maintain patients with anti-synthetase syndrome on Rituximab?

This is a challenging question to address, as there are no evidence-based guidelines, and multiple approaches may be attempted. My practice is that once the patient has been stable for at least 6–12 months, and after discussing the risk of flare with them, I attempt to reduce immunosuppression. For rituximab specifically, I begin by extending the interval between infusions, adjusting the timing based on when the patient reports the return of symptoms. If the patient remains asymptomatic, I try t...

I agree with Dr. @Dr. First Last. We always try to use the least amount of medication to get the job done and her thoughtful suggestions are appreciated. In several ASyS patients on rituximab, I have been able to follow CD19 levels and redose with B cell reappearance without a flare of disease. We did this in general for patients on rituximab during the pandemic to minimize immunosuppression and I was surprised at how long a dose of rituximab was able to suppress CD19 levels. There is some data ...