Objective: Our aim was to assess the role of the body mass index (BMI) in the clinical response to systemic treatment for psoriasis. Methods: A nationwide cohort study of patients receiving a new systemic treatment for plaque psoriasis at reference centres in Italy was conducted. Information was gathered through a web-based electronic form. Patients being maintained on the same medication and with data available at 8 and 16 weeks by March 31, 2007, were eligible. The outcome was a reduction in the Psoriasis Area Severity Index (PASI) of at least 75% at follow-up compared to baseline (PASI-75). Results: Out of 8,072 patients enrolled, 2,368 were eligible and analysable at 8 weeks and 2,042 at 16 weeks. PASI-75 was achieved by 819 patients (34.5%) at 8 weeks and 1,034 (50.6%) at 16 weeks. The proportion steadily decreased with increased values of BMI. Compared to normal weight (BMI = 20–24) the adjusted odds ratio for achieving PASI-75 in obese patients was 0.73 (95% CI = 0.58–0.93) at 8 weeks and 0.62 (95% CI = 0.49–0.79) at 16 weeks. The impact of the BMI did not show remarkable variations according to the drug prescribed at entry. Conclusion: The BMI affects the early clinical response to systemic treatment for psoriasis.

Naldi L: Epidemiology of psoriasis. Curr Drug Targets Inflamm Allergy 2004;3:121–128.
Kimball AB, Jacobson C, Weiss S, Vreeland MG, Wu Y: The psychosocial burden of psoriasis. Am J Clin Dermatol 2005;6:383–392.
Dellavalle RP, Johnson KR: Do smoking, obesity, and stress cause psoriasis? J Invest Dermatol 2005;125:vi–vii.
Lebwohl M, Callen JP: Obesity, smoking, and psoriasis. JAMA 2006;295:208–210.
Huerta C, Rivero E, Rodríguez LA: Incidence and risk factors for psoriasis in the general population. Arch Dermatol 2007;143:1559–1565.
Setty AR, Curhan G, Choi HK: Obesity, waist circumference, weight change, and the risk of psoriasis in women. Arch Intern Med 2007;167:1670–1675.
Sterry W, Strober BE, Menter A, International Psoriasis Council: Obesity in psoriasis: the metabolic, clinical and therapeutic implications – report of an interdisciplinary conference and review. Br J Dermatol 2007;157:649–655.
Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB, Gelfand JM: Prevalence of cardiovascular risk factors in patients with psoriasis. J Am Acad Dermatol 2006;55:829–835.
Gelfand JM, Neimann AL, Shin, Wang X, Margolis DJ, Troxel AB: Risk of myocardial infarction in patients with psoriasis. JAMA 2006;296:1735–1741.
Cohen AD, Sherf M, Vidavsky L, Vardy DA, Shapiro J, Meyerovitch J: Association between psoriasis and the metabolic syndrome: a cross-sectional study. Dermatology 2008;216:152–155.
Kimball AB, Robinson D Jr, Wu Y, Guzzo C, Yeilding N, Paramore C, Fraeman K, Bala M: Cardiovascular disease and risk factors among psoriasis patients in two US healthcare databases, 2001–2002. Dermatology 2008;217:27–37.
Boffetta P, Gridley G, Lindelof B: Cancer risk in a population-based cohort of patients hospitalized for psoriasis in Sweden. J Invest Dermatol 2001;117:1531–1537.
Unaeze J, Nijsten T, Murphy A, Ravichandran C, Stern RS: Impact of psoriasis on health-related quality of life decreases over time: an 11-year prospective study. J Invest Dermatol 2006;126:1480–1489.
Sakai R, Matsui S, Fukushima M, Yasuda H, Miyauchi H, Miyachi Y: Prognostic factor analysis for plaque psoriasis. Dermatology 2005;211:103–106.
Stern RS: A promising step forward in psoriasis therapy. JAMA 2003;290:3133–3135.
Bongartz T, Sutton AJ, Sweeting MJ, et al: Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies. JAMA 2006;295:2275–2285.
Psocare: Assessment of the outcomes concerning the treatment of psoriasis in Italy. BIF 2004;XI:189–193.
Gehan EA, George SL: Estimation of human body surface area from height and weight. Cancer Chemother Rep 1970;54:225–235.
EMEA Committee for proprietary medical products (CPMP): Note for guidance on clinical investigation of medicinal products indicated for the treatment of psoriasis. CPMP/EWP/2454/02.
Breslow NE, Day NE: Statistical Methods in Cancer Research. 1. The Analysis of Case Control Studies. IARC Sci Publ No 32. Lyon, IARC, 1980.
Agenzia Italiana del Farmaco: Res. June 13, 2005. Gazzetta Ufficiale No. 146, published June 25, 2005.
Herron MD, Hinckley M, Hoffman M, et al: Impact of obesity and smoking on psoriasis presentation and management. Arch Dermatol 2007;141:1527–1534.
Naldi L, Svensson A, Diepgen T, Elsner P, Grob JJ, Coenraads PJ, Bavinck JN, Williams H, European Dermato-Epidemiology Network: Randomized clinical trials for psoriasis 1977–2000: the EDEN survey. J Invest Dermatol 2003;120:738–741.
Lindegard B: Diseases associated with psoriasis in a general population of 159,200 middle-aged, urban, native Swedes. Dermatologica 1986;172:298–304.
Henseler T, Christophers E: Disease concomitance in psoriasis. J Am Acad Dermatol 1995;32:982–986.
Naldi L, Chatenoud L, Linder D, et al: Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: results from an Italian case-control study. J Invest Dermatol 2005;125:61–67.
Bjorntorp P: Obesity. Lancet 1997;350:423–436.
Hotamisligil GS: Inflammation and metabolic disorders. Nature 2006;444:860–867.
Tanaka S, Isoda F, Ishihara Y, Kimura M, Yamakawa T: T lymphopaenia in relation to body mass index and TNF-alpha in human obesity: adequate weight reduction can be corrective. Clin Endocrinol (Oxf) 2001;54:347–354.
Altinova AE, Toruner F, Bozkurt N, Bukan N, Karakoc A, Yetkin I, Ayvaz G, Cakir N, Arslan M: Circulating concentrations of adiponectin and tumor necrosis factor-alpha in gestational diabetes mellitus. Gynecol Endocrinol 2007;23:161–165.
Himmerich H, Fulda S, Linseisen J, Seiler H, Wolfram G, Himmerich S, Gedrich K, Pollmacher T: TNF-alpha, soluble TNF receptor and interleukin-6 plasma levels in the general population. Eur Cytokine Netw 2006;17:196–201.
Kjeldsen-Kragh J, Haugen M, Borchgrevink CF, et al: Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet 1991;338:899–902.
Lithell H, Bruce A, Gustafsson IB, et al: A fasting and vegetarian diet treatment trial on chronic inflammatory disorders: effects on clinical condition and serum levels of neutrophil-derived granule proteins. Acta Derm Venereol (Stockh) 1983;63:397–403.
De Menezes Ettinger JE, Azaro E, de Souza CA, dos Santos Filho PV, Mello CA, Neves M Jr, de Amaral PC, Fahel E: Remission of psoriasis after open gastric bypass. Obes Surg 2006;16:94–97.
Hamminga EA, van der Lely AJ, Neumann HA, Thio HB: Chronic inflammation in psoriasis and obesity: implications for therapy. Med Hypotheses 2006;67:768–773.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.