What is the future of acromegaly therapy?

Acromegaly is a chronic multisystem disorder in which biochemical control remains suboptimal for many patients. Even when control is achieved, treatment burden is often high despite surgery and a spectrum of established safe and effective therapies. In this narrative review of multinational late-stage clinical trials through October 2025, we summarize drug developments that may broaden individualized medical strategies. Oral somatostatin receptor ligands are now available in the United States, underscoring a shift toward more convenient long-term management. In parallel, non-oral innovations continue to advance. Octreotide subcutaneous depot (CAM2029) maintains biochemical control with acceptable safety and may reduce treatment burden. Emerging pituitary-directed therapy with longer application intervals (Debio 4126) also shows pharmacologic activity consistent with effective disease control. Growth hormone (GH) receptor-directed agents (ALXN2420, MAR002) likewise demonstrate activity aligned with considerable biochemical and clinical benefit. Collectively, these agents may address unmet needs by broadening the scope of options to control production of hepatic insulin-like growth factor I (IGF-I) and to attenuate additional extrahepatic GH signaling. They may also help ease the practical burden of chronic therapy.