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UNLABELLED BACKGROUND Chronic plaque psoriasis is associated with overweight or obesity. Anti-tumour necrosis factor-alpha (anti-TNF-alpha) treatments are now frequently used in psoriasis management. TNF-alpha is deeply involved in body weight homeostasis, which may be affected by TNF-alpha-targeted therapy. OBJECTIVE To investigate whether anti-TNF-alpha 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-alpha 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-alpha therapies may manifest a body weight gain. This effect should be taken into account in the global approach to patients with psoriasis.