Millar 1980.

Methods	RCT of intrapleural Corynebacterium parvum vs mustine in recurrent MPE (UK)
Participants	Recurrent effusion associated with histologically proved malignant disease (all cell types); at least two previous pleural aspirations; symptoms of dyspnoea, cough or local pain 21 participants randomised
Interventions	Effusion completely aspirated using an Abrams pleural biopsy needle Group A: intrapleural mustine 20 mg (max 2 doses) Group B: intrapleural C. parvum 7 mg (max 2 doses)
Outcomes	Response to pleurodesis (defined by fluid re‐accumulation on CXR and need for repeat aspiration ‐ success/partial success/failure) at four weeks Symptoms (nausea, vomiting, pain)
Notes	Trapped lung not accounted for Only 'success' counted as a pleurodesis success for analysis (not partial successes as these participants required a further aspiration of effusion) Included in network meta‐analysis for pleurodesis efficacy and mortality
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
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	No mention of blinding in the paper. If unblinded, symptom and side effect reporting could have been biased
Incomplete outcome data (attrition bias) All outcomes	Low risk	Three participants excluded from analysis as died before primary outcome measure
Selective reporting (reporting bias)	Low risk	All stated outcomes reported
Other bias	Low risk	Unclear who provided C. parvum and their study involvement