Which combination constitutes first-line pharmaceutical therapy for Goodpasture's disease?

• A. High dose corticosteroids + cyclophosphamide + plasmapheresis
• B. ACE inhibitors alone
• C. Anticoagulation therapy
• D. Dialysis without immunosuppression

Answer: (A)

Goodpasture's disease is an autoimmune attack where antibodies target the glomerular and alveolar basement membranes, so treatment must both remove the antibodies and stop their production. Plasmapheresis quickly clears circulating anti-GBM antibodies from the bloodstream, while high-dose corticosteroids reduce immune system inflammation, and cyclophosphamide suppresses the production of new antibodies by B cells. This combination directly addresses the ongoing immune attack and helps prevent progression to kidney failure and severe lung bleeding. Other approaches don’t tackle the autoimmune process: ACE inhibitors don’t remove antibodies, anticoagulation isn’t effective for this immune-mediated damage, and dialysis alone manages kidney failure without stopping antibody production or clearing circulating antibodies.