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Anti–tumour necrosis factor-α therapy increases body weight in patients with chronic plaque psoriasis: a retrospective cohort study


*Corresponding author, Section of Dermatology and Venereology, Department of Biomedical and Surgical Science, University of Verona, Piazzale A. Stefani 1, I-37126 Verona, Italy, tel. +39 045 8122547; fax +39 045 8300521; E-mail:


Background  Chronic plaque psoriasis is associated with overweight or obesity. Anti–tumour necrosis factor-α (anti-TNF-α) treatments are now frequently used in psoriasis management. TNF-α is deeply involved in body weight homeostasis, which may be affected by TNF-α–targeted therapy.

Objective  To investigate whether anti-TNF-α treatments is associated with changes in body weight in patients with chronic plaque psoriasis.

Methods  We performed a retrospective controlled analysis comparing the variations in body weight and body mass index (BMI) in three closed cohorts of psoriatic patients during a 6-month treatment with etanercept (N = 58), infliximab (N = 40) or methotrexate (N = 43).

Results  We observed a body weight increment of 1.5 ± 2.7 kg (mean ± SD; P = 0.0002) and 2.5 ± 3.3 kg (P = 0.004) in patients treated with etanercept and infliximab, respectively. In contrast, a non-significant change (0.6 ± 1.4 kg; P = 0.4) was measured in patients treated with methotrexate. The BMI increased with 0.5 ± 0.5 (P = 0.01) and 0.8 ± 1 (P = 0.003) points in patients treated with etanercept and infliximab, respectively, whereas it did not change (< 0.2 ± 0.5; P = 0.06) in patients treated with methotrexate. About one fourth of patients experienced a 4- to 10-kg weight gain. Differences in body weight variations among patients treated with anti-TNF-α therapies and methotrexate were statistically significant (P = 0.0005). We could not identify clinical parameters predicting this phenomenon.

Conclusions  Patients with psoriasis treated with long-term anti-TNF-α therapies may manifest a body weight gain. This effect should be taken into account in the global approach to patients with psoriasis.