When would you consider rituximab as induction therapy in IgG4-related disease?

This is a great question, especially given concerns around rituximab in the setting of the COVID-19 pandemic. I think it is reasonable to consider starting with steroids monotherapy for non-organ threatening diseases. Rituximab can be added if the patient relapses or if there is a concern for steroid-related adverse events (diabetes, elderly). For patients with major organ involvement (particularly pancreas, liver, renal), I generally do start with rituximab. I would ensure these patients are va...

It depends on the organs involved/severity. If the patient's initial disease was severe (pancreatic involvement, etc), I often do induction therapy with rituximab 1000 mg x2 (separated by two weeks) and then an additional dose at 6 months. If the initial disease was not severe, I might start with just the induction doses. Once the disease is in remission, I monitor symptoms, IgG4 level, eosinophil count, IgE, imaging (if applicable) and exam over time to determine if/when additional doses of rit...

With diagnosis (except with risk of covid)

And, how long do you typically maintain the Rituximab as maintenance? If stopped, what do you transition to for DMARD therapy post-RTX?