Hamed 1989.

Methods	Prospective, single centre RCT of bleomycin and talc in MPE secondary to breast cancer (UK)
Participants	Inclusion criteria: breast carcinoma with radiographically confirmed pleural effusion Exclusion criteria: previous local treatment (apart from simple aspiration); evidence of a non‐malignant cause for the effusion 29 participants randomised
Interventions	All participants had effusion drained to dryness under general anaesthetic Talc group: talc pleurodesis (dose and mode of administration not specified, but assumed to be poudrage from text) Bleomycin group: chest tube inserted. Bleomycin 1 mg/kg in 50 ml normal saline instilled after a CXR confirming lung re‐expansion
Outcomes	Success of pleurodesis (defined as continued absence of re‐accumulation of pleural fluid on all follow‐up radiographs)
Notes	Different modes of administration of talc and bleomycin Contacted study authors for more information, but no reply People with trapped lung eligible for study entry Included in network meta‐analysis for pleurodesis efficacy
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Not stated
Allocation concealment (selection bias)	Unclear risk	Not stated
Blinding of participants and personnel (performance bias) All outcomes	High risk	Not possible to blind due to the nature of the interventions (talc poudrage vs bleomycin)
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not stated whether radiology reporting was blinded
Incomplete outcome data (attrition bias) All outcomes	Low risk	A number of participants not included in the primary analysis, but balanced numbers between the two treatment arms (4/13 in talc group, 3/16 in bleomycin group)
Selective reporting (reporting bias)	Low risk	All reported
Other bias	Low risk	No other biases identified