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ImportanceDespite 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.ObjectiveTo assess the diversity and representation of populations within the literature investigating the use of biological agents for CRS.Design/SettingSystematic review.ParticipantsAdults ≥18 years with CRS treated with biologic agents.InterventionsFollowing 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 measuresPatients' 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.ResultsOut 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%).ConclusionAlthough 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.RelevanceAddressing gaps in clinical studies is important for furthering understanding of the pathophysiology and pharmacology of biologic agents for CRS, and bridging treatment disparities.