Luh 1992.

Methods	Single centre RCT of OK‐432 and mitomycin C pleurodesis in lung cancer patients with MPE (Taiwan)
Participants	Inclusion criteria: histo/cyto proven MPE due to lung cancer; effusion requiring repeated thoracentesis; ECOG performance score 0‐3 Exclusion criteria: previous anticancer chemotherapy within four weeks; previous radiation therapy to the ipsilateral chest within four weeks; concomitant systemic chemo or radio‐therapy; history or evidence of penicillin allergy 55 participants randomised
Interventions	All participants hospitalised and a chest drain or pigtail catheter inserted into effusion. Drainage until < 200 ml/day. Tube clamped for one hour after drug administration. Drug administration repeated weekly for four weeks or until effusion resolved ok‐432 group: 1 KE intrapleurally Mitomycin C: 8 mg in 30 ml water intrapleurally
Outcomes	Pleurodesis success at four weeks (defined as 'complete response' (CR) (no fluid accumulation and participants free of symptoms), 'partial response' (PR) (recurrence of effusion < 50% of original effusion volume, not symptomatic and no need for thoracentesis for symptom relief) or 'failure' (recurrence of effusion > 50% of the original volume, symptomatic and need for thoracentesis to relieve symptoms)) Survival Effusion‐free period
Notes	People with trapped lung included in the study For this review, PR & CR counted as pleurodesis successes Not included in network meta‐analysis
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Sealed envelopes
Allocation concealment (selection bias)	Low risk	Sealed envelopes
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	No mention of whether the study was blinded
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not stated
Incomplete outcome data (attrition bias) All outcomes	Low risk	Two participants excluded due to early death, both in OK‐432 arm
Selective reporting (reporting bias)	Low risk	All stated outcomes reported
Other bias	Low risk	No other biases identified