Loutsidis 1994.

Methods	Single centre RCT of tetracycline and mechlorethamine (mustine) for pleurodesis of malignant pleural effusions (Greece)
Participants	Inclusion: documented MPE (all tumour types); respiratory distress was the main problem of the participants Exclusion: other therapy given simultaneously (chemotherapy or radiation therapy) 40 participants randomised
Interventions	All participants had a 32 Fr intercostal drain inserted with local anaesthetic and effusion drained overnight. Complete drainage confirmed on CXR After pleurodesis, drain flushed with 20 ml saline. Participants rotated and drain unclamped after two hours and put onto ‐20 cm H2O suction. Drain removed when < 50 ml/day drainage Tetracycline group: 500 mg tetracycline in 20 ml 2% lignocaine intrapleurally. 1 dose Mechlorethamine group: 0.2 mg/kg of mechlorethamine in 20 ml saline intrapleurally. 1 dose
Outcomes	Response to therapy at 60 days ('complete response' (CR) (complete lack of re‐accumulation of pleural fluid for at least 60 days), 'partial response' (PR) (small pleural effusion, asymptomatic, not requiring further treatment), 'failure' (all other cases)) Side effects
Notes	Minimal data provided on baseline participantcharacteristics of the two groups Pleurodesis defined according to symptomatic effusion recurrence For the purposes of this review, CR and PR included as a successful pleurodesis People with trapped lung included in the study 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	Unclear risk	No mention of blinding in the paper. Drugs given in the same volume but not stated whether their appearances were similar
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not stated if CXR interpretation was blinded for assessment of pleurodesis efficacy
Incomplete outcome data (attrition bias) All outcomes	Low risk	All participants followed up until the primary endpoint at 60 days
Selective reporting (reporting bias)	Low risk	All stated outcomes reported
Other bias	Low risk	No other biases identified