Alysia and others might have better insight than I. All I know is on FB I had chatted with "Lennie Saurkraut" (did I get that right?) about this same topic, since he and a woman on the WG FB group had been regularly taking Rtx since before it was FDA approved for WG. So, a long time! I am interested in this topic because in the world of pediatric-onset WG, the majority of Drs prescribe Rtx every six months. If you consider that kids are most often get sick at the onset of puberty that would mean several decades of the every-six-months protocol. Basically most indications are that most people will not build up immunity to it - but there is some indication that some people do in fact build up the immunity. In our daughter's case in consultation with her rheumy and his okay, she only receives Rtx as needed, and gets her labs done frequently to monitor that need.

Another concern, at least for pediatrics, is wiping out the immune system so much that the child becomes dependent on IViG and we want to forestall that. Not to mention that the biggest lethality for Weggies comes from infection once the diagnosis period has passed. We wanted to keep her immune system as strong as possible while still hobbling it.