How would you approach medication de-escalation in a patient with a history of rapidly progressive CTD-ILD who responded to and is currently on mycophenolate 3 grams daily and IVIG 2mg/kg monthly infusions and has been stable for two years?  

This is an excellent question with the very little data to go by. We spend most of our time studying escalation of therapy and very little time discussing de-escalation. It has been my experience as a rheumatologist for almost 37 years that many autoimmune diseases initially can be quite immunologic...

I would let the patient decide. Not every patient can handle goal max dose MMF or Myfortic. I would favor dec IS of this agent first r/t GI side effects. Then, if no flares start every other IVIG and taper to Q3 months. If a patient needs an oral option can’t infuse then makes since IVIG off a...