Agarwal 2011.

Methods	Single centre RCT comparing the efficacy of cosmetic talc with iodopovidone for pleurodesis (India)
Participants	Inclusion: recurrent symptomatic pleural effusion with improvement of breathlessness with thoracentesis; or primary or secondary pneumothorax Exclusion: allergy to iodine; thyroid disorder; trapped lung; air leak; advanced malignancy with expected survival < 30 days 36 participants randomised
Interventions	28 Fr intercostal drain to completely drain effusion or treat pneumothorax. Pleurodesis agent given when < 150ml/day drainage and complete lung re‐expansion on chest x‐ray. All participants received intrapleural lignocaine (2 mg/kg) and IV tramadol prior to pleurodesis. Iodopovidone: 20 ml 10% iodopovidone in 80 ml saline Cosmetic talc: 5 g sterilised 'baby powder' After agent administered, chest tube clamped for four hours. Repeat administration of agent if > 250 ml/day drainage. Drain removed when < 100 ml/day output Followed up at 1 week, 1 month, 3 months and 6 months and then every 3 months thereafter
Outcomes	Pleurodesis success according to need for thoracentesis (complete success = relief of symptoms related to the effusion and no re‐accumulation on CXR at 30 days; partial success = reduced dyspnoea related to the effusion with only partial re‐accumulation of fluid on chest x‐ray and no requirement for therapeutic thoracentesis; failure = lack of success as defined above) Chest pain (measured by visual analogue scale score) Complications Time to pleurodesis
Notes	People with trapped lung excluded. Unpublished data obtained from authors relating to subgroup of participants in the study with malignant pleural effusion‐ only this data was included for the purposes of this review Included in network meta‐analysis for pleurodesis efficacy and fever.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer‐generated randomisation sequence
Allocation concealment (selection bias)	Low risk	Opaque sealed envelopes
Blinding of participants and personnel (performance bias) All outcomes	High risk	"Blinding of the allocation to treatments was not possible". Agents have different appearances
Blinding of outcome assessment (detection bias) All outcomes	High risk	Symptom recurrence, visucal analogue scale scores and complications would all be biased by lack of patient blinding. Mortality would not be effected by lack of blinding
Incomplete outcome data (attrition bias) All outcomes	Low risk	No loss to follow up. Intention‐to‐treat analysis performed
Selective reporting (reporting bias)	Low risk	All reported
Other bias	Low risk	Cosmetic talc used rather than medicinal talc, but sterilised and comparable particle size by electron microscopy. No external funding for the study