Hillerdal 1986.

Methods	Multi‐centre RCT of pleurodesis using Corynbacterium parvum vs bleomycin (Sweden)
Participants	Inclusion criteria: pleural effusion due to metastases from cytologically‐ or histologically‐proven bronchogenic carcinoma or adenocarcinoma; at least two previous aspirations of effusion 40 participants randomised
Interventions	Corynebacterium parvum 7 mg in 10 ‐ 20 ml saline IP or bleomycin 60 mg in 100 ml saline intrapleurally A second dose of the allocated agent was given if the first was ineffective No details given about method of drainage prior to instillation of pleurodesis agent or how long the drain remained in place
Outcomes	Pleurodesis success ("Success" = no recurrence of fluid within six weeks; "Partial success" = 2 instillations required within six weeks, with no recurring effusion within six weeks of the second instillation)
Notes	People with trapped lung eligible for trial entry For the purposes of this review, if participants required more than one treatment due to effusion recurrence within six weeks, they were counted as a failure Included in network meta‐analysis for pleurodesis efficacy, fever and pain
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	No specific mention of blinding but drugs reconstituted in different volumes
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Definition of pleurodesis efficacy quite vague and not stated if blinded. Side effect reporting may be influenced by lack of blinding of participants and personnel
Incomplete outcome data (attrition bias) All outcomes	High risk	No data on mortality. Numbers don't add up for side effects data
Selective reporting (reporting bias)	Low risk	All stated outcomes reported
Other bias	Low risk	No other biases identified