Oral antiviral treatment for COVID-19 in patients with systemic autoimmune rheumatic diseases

To describe data on the safety and efficacy of molnupiravir (MP) and nirmatrelvir/ritonavir (NM/R) in patients with systemic autoimmune rheumatic diseases (SARD).Among patients with SARD being followed in two tertiary outpatient rheumatology clinics, we retrospectively identified those infected with SARS-CoV-2 between February and August 2022 who received MP or NM/R. Patients' medical files were reviewed for demographics, disease-related characteristics as well as COVID-19 characteristics, including vaccination status, antiviral treatment, side effects and COVID-19 outcomes.Seventy-four SARD patients (52 females) were identified who had been infected with SARS-CoV-2 and received MP (n=26,35.1%) or NM/R (n=48,64.9%). Most patients were vaccinated against SARS-CoV-2 (n=62,83.8%). Among frequently used regimens were corticosteroids (n=43,58.1%), mycophenolate (n=26,35.1%), TNF-inhibitors (n=14,18.9%), methotrexate (n=13,17.6%) and rituximab (n=12,16.2%). Common adverse events were reported only by four patients receiving NM/R (metallic taste, gastrointestinal upset, hypertension), not leading to drug discontinuation. During follow up, all but two patients (n=72, 97.3%) recovered at home without COVID-19 related complications. Nonetheless, we describe two presumptive cases of COVID-19 rebound who progressed to severe COVID-19.This data argues in favor of a favorable outcome and acceptable safety profile of the two oral antiviral therapies among a high-risk SARD population. However, cases of COVID-19 rebound are being increasingly identified. These findings call for continuous surveillance in order to capture the realworld efficacy and safety profiles in our subpopulations of interest.