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

## TL;DR

This paper highlights geographic and demographic gaps in research on biologics for chronic rhinosinusitis, showing most studies come from the US and Europe with limited representation from other regions.

## Contribution

The study systematically quantifies geographic and demographic disparities in biologics research for chronic rhinosinusitis.

## Key findings

- The majority of studies on biologics for CRS originate from the United States and Europe.
- Only 11.2% of studies disclosed patients' race/ethnicity, with Asians and Caucasians most represented.
- Belgium had the highest number of authors per capita, and 39.6% of studies had industry funding.

## Abstract

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.

To assess the diversity and representation of populations within the literature investigating the use of biological agents for CRS.

Systematic review.

Adults ≥18 years with CRS treated with biologic agents.

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.

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.

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%).

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.

Addressing gaps in clinical studies is important for furthering understanding of the pathophysiology and pharmacology of biologic agents for CRS, and bridging treatment disparities.

Graphical Abstract