Dresler 2005.

Methods	Multi‐centre RCT comparing talc poudrage with talc slurry pleurodesis in MPE. Both groups received 4 g ‐ 5 g sterile talc intrapleurally (USA)
Participants	Inclusion criteria: history of malignancy (all tumour types), pleural effusion requiring sclerosis, ECOG performance status 0‐2, life expectancy > 2 months, ability to undergo general anaesthesia Exclusion criteria: pregnancy, previous intrapleural therapy or radiation therapy encompassing the entire hemithorax, changes in systemic therapy within two weeks, chylous or bilateral effusions requiring therapy 501 participants randomised
Interventions	TS Group: talc administered as a slurry in 100 ml saline through a chest tube at the bedside TTI Group: talc insufflated during thoracoscopy in the operating room
Outcomes	Primary endpoint: the percentage of patients whose lung initially re‐expanded > 90% and who had a successful pleurodesis at 30 days after treatment (defined according to cvhest x‐ray (CXR) criteria) Secondary endpoint: time to recurrence of effusion; frequency of complications and toxicities; ability to re‐expand the lung as assessed by CXR; oain; patient satisfaction; quality of life (QOL).
Notes	People with trapped lung excluded from analysis Included in network meta‐analysis for pleurodesis efficacy, mortality, pain and fever.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer‐generated randomisation lists
Allocation concealment (selection bias)	Low risk	Computer‐generated randomisation lists
Blinding of participants and personnel (performance bias) All outcomes	High risk	Not possible to blind the study due to the nature of the interventions (talc poudrage vs talc slurry)
Blinding of outcome assessment (detection bias) All outcomes	High risk	Not stated if radiological assessment was blinded. QOL and complications may be affected by lack of patient and personnel blinding
Incomplete outcome data (attrition bias) All outcomes	Low risk	Missing data accounted for and balanced between the treatment arms (10 in slurry group and 9 in thoracoscopy group excluded as ineligible or participant withdrew consent; 33/163 slurry participants and 25/177 thoracoscopy participants died within 30 days of randomisation)
Selective reporting (reporting bias)	Low risk	All outcomes reported on
Other bias	Low risk	Trapped lung defined by different means in the two treatment arms, which may have effected their primary endpoint. However, this does not have an impact on the pleurodesis success rates