Goodpasture Syndrome Medication
- Author: Pranay Kathuria, MD; Chief Editor: Vecihi Batuman, MD, FACP, FASN more...
The goals of pharmacotherapy are to reduce morbidity and to prevent complications. The treatment of choice is a combination of plasmapheresis to remove the circulating anti–glomerular basement membrane (anti-GBM) antibodies and immunosuppression with glucocorticoids and cytotoxic agents to inhibit further autoantibody formation. In addition, antibiotic prophylaxis is indicated to reduce the risk of opportunistic infection secondary to immunosuppressive therapy.
For induction therapy, prednisone and cyclophosphamide are initiated. For severe or rapidly progressing disease, methylprednisolone at a dose of 250 mg every 6 hours should be administered. Once the patient is stabilized, continue oral therapy with prednisone.
Azathioprine may be used for patients who do not tolerate cyclophosphamide.
Prednisone is used as an immunosuppressant in the treatment of autoimmune disorders. This agent may reduce inflammation by reversing increased capillary permeability and suppressing polymorphonuclear neutrophil (PMN) activity.
Methylprednisolone is the drug of choice for severe disease. It should be started concomitantly with plasmapheresis. This agent decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
Azathioprine antagonizes purine metabolism and inhibits the synthesis of DNA, RNA, and proteins. It may decrease the proliferation of immune cells, which results in lower autoimmune activity.
Alkylating Agents (Cytotoxic Agents)
Alkylating agents bind with DNA and interfere with cell growth and differentiation.
Cyclophosphamide is chemically related to nitrogen mustards. It is a potent immunosuppressant used as an adjunct to corticosteroids and plasma exchange. This agent interferes with the inflammatory response by decreasing bone marrow response through the interference of DNA cross-linking and decreases anti–glomerular basement membrane (anti-GBM) antibody production.
Patients receiving immunosuppressive therapy should also receive prophylaxis against Pneumocystisjiroveci pneumonia.
This combination inhibits bacterial synthesis of dihydrofolic acid by competing with para-aminobenzoic acid, thus inhibiting folic acid synthesis. It results in inhibition of bacterial growth. The antibacterial activity of trimethoprim-sulfamethoxazole (TMP-SMZ) includes common urinary tract pathogens, except Pseudomonas aeruginosa. Each double strength (DS) tablet contains 160 mg of TMP and 800 mg SMZ.
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