What type of study is this?

This is a Systematic Review study.

What question did this study set out to answer?

To assess the representation and diversity of populations in the literature on biologics for chronic rhinosinusitis.

February 16, 2026Journal of Otolaryngology - Head and Neck Surgery0 citationsOpen Access

Geographic Disparities in Evidence Investigating the Use of Biologics in Chronic Rhinosinusitis

IMItai MargulisMcMaster University MSMohd Afiq Mohd SlimForth Valley Royal Hospital ESE SommerWilfrid Laurier University

Key Points

To assess the representation and diversity of populations in the literature on biologics for chronic rhinosinusitis.
Conducted systematic review following PRISMA guidelines.
Analyzed published studies from 2006 to 2023 for analysis A, and RCTs and RW studies to 2025 for analysis B.
Collected data on patients’ demographics, biologic types, funding, and publication metrics.
169 out of 2768 studies were included in the analyses.
Dupilumab was the most studied biologic agent (37.8%).
Only 11.2% of studies reported patients’ race/ethnicity, with Asian and Caucasian being most represented.

Abstract

Importance Despite a surge in the volume of evidence assessing the safety and efficacy of biologics for the treatment of chronic rhinosinusitis (CRS), nuances relating to geographic variations in this literature remain insufficiently elucidated. Objective To assess the diversity and representation of populations within the literature investigating the use of biological agents for CRS. Design/Setting Systematic review. Participants Adults ≥18 years with CRS treated with biologic agents. Interventions Following PRISMA guidelines, 2 complementary analyses of all studies published between 2006 and 2023 (analysis A), and randomized controlled trials (RCT) and real-world (RW) studies published between 2006 and 2025 (analysis B) were performed. Main outcomes measures Patients’ number and country of origin, race/ethnicity, authors’ affiliated countries and Human Development Index (HDI). Types of biologics agents and metrics of the publications were collected. Results Out of 2768 studies reviewed, 169 were included in the final analyses. Dupilumab was the most studied biologic agent (37.8%), followed by mepolizumab. The United States had the highest absolute representation and Belgium the highest number of authors per capita, which was correlated with patients’ nationality. The majority of the journals’ and authors’ country of origin was the United States. Only 19 (11.2%) studies disclosed patients’ race/ethnicity, with Asian and Caucasian subjects most commonly represented. The authors’ HDI correlated with journals’ H-index and impact factor. Sixty-seven studies (39.6%) had industry funding, with dupilumab representing the highest number (15.9%). Conclusion Although the use of biologics has shown promising results in the management of CRS, most of the evidence comes from the United States and Europe. There is a paucity of representation from certain regions, including Africa, Latin America, and Asia, and inadequate overall disclosure of race/ethnicity in existing studies. This warrants further high-quality investigation of biological agents’ safety and efficacy among these underrepresented populations. Relevance Addressing gaps in clinical studies is important for furthering understanding of the pathophysiology and pharmacology of biologic agents for CRS, and bridging treatment disparities.

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