Introduction/objectives Prior studies have evaluated the relationship between antiviral medications for COVID-19 and the risk of post-acute sequelae of COVID-19 (PASC, i.e., “long COVID”) in the general population. We evaluated PASC in individuals with systemic autoimmune rheumatic diseases (SARDs) by antiviral use, hypothesizing that antivirals are associated with lower PASC risk. Methods We investigated oral outpatient antiviral use (nirmatrelvir/ritonavir or molnupiravir) and PASC in a prospective SARD cohort at Mass General Brigham ≥ 28 days following COVID-19 infection (16/December/2021–30/January/2025). Participants completed surveys regarding symptom duration. We investigated odds of PASC at 28 and 90 days following COVID-19 using multivariable logistic regression. Results Among 431 participants (mean age 56.2 years, 81% female), 51% were treated with oral antivirals. The most common SARD type was inflammatory arthritis (46%), 46% were using conventional synthetic DMARDs, and 41% were using biologic DMARDs. Nearly all (96%) were vaccinated at the time of COVID-19 infection. Those who received antivirals had similar odds of PASC at 28 days (30.9% vs. 31.1%, aOR 0.98, 95% CI: 0.64–1.49) and numerically lower odds at 90 days (5.2% vs. 10.5%, aOR 0.44, 95% CI: 0.19–1.02) compared to those who did not receive antivirals. Conclusion In this contemporary cohort, risk of PASC 90 days after COVID-19 onset was overall low. Those who received antiviral therapy had similar odds of PASC at 28 days and numerically lower odds of PASC at 90 days compared to those who did not receive antivirals, providing evidence to quantify PASC risk when considering oral outpatient antiviral treatment.<Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> Key Points • Among people with rheumatic diseases, post-acute sequelae of COVID-19 (PASC) status at 28 days after symptom onset was similar regardless of antiviral use. • Odds of PASC at 90 days were numerically lower with antiviral use. • Patient-reported outcomes were similar regardless of antiviral use. </entry> </row> </tbody> </tgroup> </Table>

Association of oral outpatient antiviral medications for COVID-19 with the risk of post-acute sequelae of COVID-19 at 28 and 90 days in a cohort of individuals with systemic autoimmune rheumatic diseases

期刊论文
发表日期：

2026年7月16日

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Madison Negron,
Jiaqi Wang,
Xiaosong Wang,
Lauren A. O’Keeffe,
Grace Qian,
Kevin T. Mueller,
Alene A. Saavedra,
Natalie A. Davis,
Liya S. Getachew,
Jeffrey A. Sparks,
Naomi J. Patel

摘要

Introduction/objectives

Prior studies have evaluated the relationship between antiviral medications for COVID-19 and the risk of post-acute sequelae of COVID-19 (PASC, i.e., “long COVID”) in the general population. We evaluated PASC in individuals with systemic autoimmune rheumatic diseases (SARDs) by antiviral use, hypothesizing that antivirals are associated with lower PASC risk.

Methods

We investigated oral outpatient antiviral use (nirmatrelvir/ritonavir or molnupiravir) and PASC in a prospective SARD cohort at Mass General Brigham ≥ 28 days following COVID-19 infection (16/December/2021–30/January/2025). Participants completed surveys regarding symptom duration. We investigated odds of PASC at 28 and 90 days following COVID-19 using multivariable logistic regression.

Results

Among 431 participants (mean age 56.2 years, 81% female), 51% were treated with oral antivirals. The most common SARD type was inflammatory arthritis (46%), 46% were using conventional synthetic DMARDs, and 41% were using biologic DMARDs. Nearly all (96%) were vaccinated at the time of COVID-19 infection. Those who received antivirals had similar odds of PASC at 28 days (30.9% vs. 31.1%, aOR 0.98, 95% CI: 0.64–1.49) and numerically lower odds at 90 days (5.2% vs. 10.5%, aOR 0.44, 95% CI: 0.19–1.02) compared to those who did not receive antivirals.

Conclusion

In this contemporary cohort, risk of PASC 90 days after COVID-19 onset was overall low. Those who received antiviral therapy had similar odds of PASC at 28 days and numerically lower odds of PASC at 90 days compared to those who did not receive antivirals, providing evidence to quantify PASC risk when considering oral outpatient antiviral treatment.

Key Points

• Among people with rheumatic diseases, post-acute sequelae of COVID-19 (PASC) status at 28 days after symptom onset was similar regardless of antiviral use.

• Odds of PASC at 90 days were numerically lower with antiviral use.

• Patient-reported outcomes were similar regardless of antiviral use.