Is it time for treat-to-target in antiphospholipid syndrome?

A treat-to-target (T2T) approach aims to the identification of a clinically relevant therapeutic target and applies tight control (periodic visits at prespecified time-points and treatment adjustments) to achieve it with the goal of improving disease outcomes. The application of a T2T strategy appears to be less feasible in APS compared to other autoimmune diseases. This is primarily explicable by the disease's kaleidoscopic clinical presentation, along with the lack of a definitive tool (biomarkers or scoring system) to assess disease activity, making it complex to recognize a singular, effective therapeutic target for APS patients. Nevertheless, the conceptualization of T2T strategies should be considered a key objective when managing APS, aiming to achieve optimal disease control (including lowering the risk for recurrences), to reduce damage accumulation, and, ultimately, to enhance patients' quality of life.