What is your approach to maintenance rituximab in patients with IgG4-RD?

Since patients can go into a prolonged remission after rituximab induction therapy, I tend to monitor them for signs and symptoms of recurrence before retreating with rituximab. In patients with significant damage from IgG4-RD, such as damage to pancreatic endocrine or exocrine function, I will re-treat for any change such as rising IgG4 level. In those with less damaging manifestations (salivary gland enlargement), I usually wait until there is a clear clinical or radiographic change.