Publication date: Jul 16, 2026
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. 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. 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. 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.
| Concepts | Keywords |
|---|---|
| Antiviral | |
| Autoimmune disease | |
| COVID-19 | |
| Patient-reported outcomes |
Semantics
| Type | Source | Name |
|---|---|---|
| disease | MESH | COVID-19 |
| disease | MESH | post-acute sequelae of COVID-19 |
| disease | MESH | rheumatic diseases |
| drug | DRUGBANK | Ritonavir |
| disease | MESH | infection |
| disease | MESH | arthritis |
| disease | MESH | Autoimmune disease |