New and emerging pharmacological treatment options for acromegaly: a 2026 update

INTRODUCTION: Acromegaly is associated with significant morbidity, impaired quality of life (QoL), and increased mortality when uncontrolled. While current treatments achieve biochemical control in many patients, a substantial proportion remain uncontrolled or experience persistent treatment-related burdens, highlighting a need for safer, more effective, and convenient therapeutic alternatives. AREAS COVERED: This narrative review examines current treatment modalities, the growing role of precision medicine and biomarker-guided algorithms, and newly approved or emerging pharmacological options. A comprehensive literature search was performed in Pubmed database for articles in English, including the following terms: 'acromegaly AND new treatments,' acromegaly AND new drugs," 'acromegaly AND CAM2029,' 'acromegaly AND paltusotine,' 'acromegaly AND debio4126,' 'acromegaly AND CAM4071,' 'acromegaly AND MAR002,' 'acromegaly AND HTL0030310,' 'acromegaly AND Hu-13H02m,' 'acromegaly AND biomarkers,' 'acromegaly AND precision medicine,' 'acromegaly AND personalized treatment.' This review highlights innovations such as long-acting subcutaneous octreotide depots (CAM2029), oral selective somatostatin receptor type 2 agonists (paltusotine), extended-interval formulations (Debio 4126), subcutaneous pasireotide depots (CAM4071), allosteric growth hormone receptor antagonists (MAR002), and direct growth hormone-neutralizing antibodies. EXPERT OPINION: Integrating personalized medicine approaches with novel pharmacological agents offering greater convenience and distinct mechanisms of action holds significant promise for overcoming current treatment limitations, optimize biochemical control, and enhance patient well-being.