What is your approach to steroid sparing therapy in patients with suspected CTD-ILD?

It depends on numerous factors:

1. What's the underlying CTD?
2. Has the patient been trialed on immunomodulatory agents before?
3. What's the risk of therapy in this patient?

And many others. It's a big topic. To delve into some of the above by bullet point:

1. Most guidance for immune suppression is driven by...

If there is no active infection, I would try to get ahead of the progressive lung fibrosis with rituximab, and if successful, then reconsider alternatives.