Chronic rhinosinusitis affected about 4.3%–12.5% of the population worldwide (Hopkins, 2019; Agache et al., 2021; Kato et al., 2022). Patients with chronic rhinosinusitis often require long-term use of systemic corticosteroid and/or repeated sinus surgery, suffering a high symptom burden, a huge economic burden, and a poor quality of life (Bachert et al., 2019; Chong et al., 2020; Agache et al., 2021). The management of these patients remains challenging. The successful application of biologics in asthma promoted the use of similar biologic treatments for chronic rhinosinusitis (Gevaert et al., 2013; Iqbal et al., 2020; Mullol et al., 2022).

Nowadays, biologics are considered as a promising novel treatment option for patients with chronic rhinosinusitis who fail with the standard of care (medical therapy and surgical interventions) (Gevaert et al., 2013; Mullol et al., 2022). A recent network meta-analysis proved that biologics and endoscopic sinus surgery both could significantly improve key nasal outcomes in chronic rhinosinusitis with nasal polyps (Chen et al., 2023). More particularly, dupilumab obtained better efficacy than endoscopic sinus surgery on SNOT-22 scores at 1 year. A systematic review summarized that treatment with omalizumab and mepolizumab improved endoscopic nasal polyp score and symptoms score in patients compared with placebo (Iqbal et al., 2020). Nasal polyp size was reduced after using reslizumab, especially in patients with raised intranasal interleukin-5 (IL-5) levels. Dupilumab reduced 70% of endoscopic nasal polyp score. These biologics targeted various inflammatory markers that were involved in the pathophysiology of chronic rhinosinusitis, bringing considerable clinical improvement. Therefore, a general overview of developments of biologics in chronic rhinosinusitis is required.

In the current era filled with the overwhelming abundance of information, it is increasingly arduous to maintain a comprehensive understanding of the field. As a pioneering method, the bibliometric analysis would be an excellent option to evaluate quantitatively the impact of research publications on the selected research field in terms of countries/regions, collaboration, journals, institutions, authors, and keywords (Oelrich et al., 2007; Jiang et al., 2023). Bibliometric analysis has been gradually applied in various research domains (Bornmann and Leydesdorff, 2014). Compared with the traditional systematic review and the meta-analysis, bibliometric analysis can more systematically and visually reveal the current trend and development of research topics (Bould et al., 2014; Jiang et al., 2023). Furthermore, Bibliometric analysis can identify highlights and “hotspots” to generate perspectives to guide future research orientations for potential researchers in this field.

To provide an up-to-date global overview regarding cross-border collaboration, communication, and research frontiers on biologics in chronic rhinosinusitis, we performed this bibliometric analysis based on research publications from 2004 to 2023.

After searching the currently available publications, this was the first application of qualitative bibliometric methods of biologics in chronic rhinosinusitis. In this systematic bibliometric analysis, we analyzed annual volume and growth tendency, research countries/regions, authors, institutions, journals, references, and keywords.

Research articles linked to biologics in chronic rhinosinusitis exhibited a dramatic rising trend from 2020 to 2023. The USA contributed >35% of research articles. Moreover, the USA was the most cited country, enjoying the most active cooperation with other countries/regions. Nevertheless, many publications were contributed by Italy, Japan, and China with fewer collaborations. It indicated that these similar countries should enhance international cooperation with other countries, which would increase more high-quality research articles in this field.

Being far ahead of other authors, Bachert C owned the most publications and collaborations in the field linked to biologics in chronic rhinosinusitis. Most articles of the top 15 authors were published between 2019–2023. This aspect indicated that biologics in chronic rhinosinusitis were paid more and more attention in the treatment of chronic rhinosinusitis in recent years. Bachert C, Gavaert P, and Fokkens WJ were the top three co-cited authors.

In terms of the top five institutions, Northwestern University and Harvard Medical School originated from the USA, while Ghent University, Medical University of Vienna, and Karolinska Institute originated from the Netherlands, Austria, and Sweden, respectively. This aspect reflects an globally urgent demand of biologics in the treatment chronic rhinosinusitis. Ghent University and Karolinska Institute had the most collaborations with other institutions, which provided a worthwhile lesson for other institutions.

The most relevant journals linked to biologics in chronic rhinosinusitis were Journal of Allergy and Clinical Immunology, Allergy, and Journal of Allergy and Clinical Immunology-In practice. Through these high-quality journals, more and more researchers are paying attention to biologics in chronic rhinosinusitis. Journal of Allergy and Clinical Immunology and Allergy were also the most co-cited journals. These journals led the related research in the field. The top 15 co-cited references demonstrated that the clinical application of biologics in chronic rhinosinusitis was eager to be validate the efficacy and the quality of life. The top 10 high-frequency keywords demonstrated that the researchers focused on the clinical efficacy of various biologics in chronic rhinosinusitis, with various double-blind trials. Based on the gratifying achievements of basic experimental research, the researchers were gradually shifting toward clinical practice, aiming to guide the use of various biologics in suitable patients.

Monoclonal antibodies could be a promising therapy for patients with corresponding phenotypes and endotypes (Avdeeva and Fokkens, 2018; Chapurin et al., 2022). Biologics (omalizumab, dupilumab, benralizumab, etc.) have become an emerging application for chronic rhinosinusitis in recent years (Castro et al., 2011; Bachert et al., 2016, 2019). Current evidence proved that biologics can reduce the size of nasal polyps and improve patients' quality of life (Chong et al., 2020; Fokkens et al., 2023). The application of biologics can decrease the use of oral glucocorticoids and the need for reoperation (Bachert et al., 2021; Thamboo et al., 2021). Furthermore, patients' quality of life was also concerned in the biologics era (Mullol et al., 2022). Significantly impaired quality of life has been used as a criterion for the patients' indication to use biologics. Current biologics are often applied to patients with intractable chronic rhinosinusitis with nasal polyps. Murdaca et al. pointed out the importance of pharmacogenomics in the choice of tailored biologics as TNF-alpha inhibitors in psoriatic arthritis (Murdaca et al., 2014a,b). Thus, it is urgent to explore novel therapeutic modalities (Fokkens et al., 2023). This analysis indicated that research frontiers on biologics in chronic rhinosinusitis would focus on efficacy, quality of life, safety, children, management, etc.

Unlike previous studies (meta-analysis or narrative reviews), the bibliometric analysis provides a more intuitive visualization of evidence displaying research focal points and global trends across diverse dimensions. Meanwhile, third limitations should be also noticed. Firstly, our results were analyzed based on the currently available publications in the database. Continuous updating of publications might lead to different results. Secondly, the omission of other publication types (books, chapters, letters, etc.) and non-English articles may result in some biases in this analysis. Thirdly, due to the large volume of publications, it was not feasible to comprehensively discuss each publication, potentially affecting the depth of the subarea analysis.

In summary, this bibliometric analysis displayed the overall situation and global trend on biologics in chronic rhinosinusitis. The visualization analysis of publications could assist researchers rapidly in understanding the hotspots and trends. Further research is warranted to determine the long-term effects and side effects of biologics in chronic rhinosinusitis.