Ponticelli regimen (Policlinico di Milano)

The Ponticelli regimen is a cyclical immunosuppressive therapy that serves as a standard of care for idiopathic membranous nephropathy (IMN). Developed by Dr. Claudio Ponticelli, the regimen traditionally spans six months, alternating monthly between high-dose corticosteroids (intravenous methylprednisolone pulses followed by oral prednisone) and an alkylating agent. While the original protocol utilized chlorambucil, the modified Ponticelli regimen typically employs cyclophosphamide due to a more favorable safety profile. The mechanism involves the broad anti-inflammatory and immunosuppressive effects of glucocorticoids combined with the cytotoxic action of alkylating agents, which cross-link DNA to inhibit the proliferation of B cells and the production of pathogenic autoantibodies against the phospholipase A2 receptor (PLA2R).

Other names

Modified Ponticelli regimenCyclical corticosteroid/alkylating-agent therapyPonticelli protocol