In the past year, the FDA, the EMA or the MHRA authorised fifty-three (53) novel drugs. While this 2024 harvest is not as rich as that of 2023, when 70 new chemical entities were approved, the number of “orphan” drug authorisations in 2024 (21) is similar to that of 2023 (24), illustrating the very dynamic development of therapeutics in areas of high unmet need. Clearly, the most striking characteristic of the 2024 drug yield is the creative pharmacological design, which allows these medicines to employ a novel approach to target a disease. Some such 2024 notable examples are: the first drug successfully using a ”dock-and-block” mechanism of inhibition (zenocutuzumab), the first approved drug for schizophrenia designed as an agonist of M1/M4 muscarinic receptors (xanomeline), the first biparatopic antibody (zanidatamab), binding two distinct epitopes of the same molecule, the first haemophilia therapy that instead of relying on external supplementation of clotting factors, restores Factor Xa activity by inhibiting TFPI (marstacimab), or the first ever authorized direct telomerase inhibitor (imetelstat) that reprogrammes the tumour cells’ oncogenic drive. In addition, in 2024 an impressive percentage of the novel drugs were first-in-class (28 out of 53, or 53% of the total) and a substantial number of them can be considered disease-agnostic, indicating the possibility of future approved extension of their use into additional indications. Overall, the 2024 harvest demonstrates the therapeutic potential of innovative pharmacological design, which allows the effective targeting of intractable disorders and addresses crucial, unmet therapeutic needs