Noppen 1997.

Methods	Single centre RCT of talc vs bleomycin in MPE (Belgium)
Participants	Inclusion criteria: hist/cytologically proven, symptomatic MPE; karnofsky performance score ≥ 50; expected survival of one year or less. Exclusion criteria: previous pleurodesis attempt 26 participants randomised
Interventions	14 Fr chest drain with suction drainage until completely drained. Intrapleural lignocaine and subcutaneous morphine given prior to instillation of study drug. After instillation of drug, drain clamped for 30 mins and then left on suction drainage until output < 150 ml/24hours Bleomycin group: 1 mg/kg bleomycin in 50 ml saline intrapleurally. 1 dose Talc group: 5 g in 50 ml saline intrapleurally. 1 dose
Outcomes	Response to therapy (defined by re‐accumulation on CXR and need for repeat procedure). Time point unclear Side effects Survival
Notes	People with trapped lung were included in the study Included in network meta‐analysis for pleurodesis efficacy and fever
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer‐generated numerical table
Allocation concealment (selection bias)	Low risk	Computer‐generated numerical table
Blinding of participants and personnel (performance bias) All outcomes	High risk	Not stated explicitly but drugs have different appearances
Blinding of outcome assessment (detection bias) All outcomes	High risk	Symptom recurrence and side effects could be biased by lack of blinding. Not stated if CXR interpretation was blinded
Incomplete outcome data (attrition bias) All outcomes	Low risk	No LTFU. Outcome data provided on all participants
Selective reporting (reporting bias)	Low risk	Time point used to define pleurodesis not specified
Other bias	Unclear risk	No fixed endpoint for follow up