Ong 2000.

Methods	Single centre RCT of talc vs bleomycin in MPE (Singapore)
Participants	Inclusion: symptomatic, unilateral MPE confirmed by cytology or pleural biopsy (all cell types) Exclusion: trapped lung or loculated effusion; incomplete drainage (e.g. > 100 ml/day for 10 days); previously treated effusions; life expectancy < 1month 50 participants randomised
Interventions	20 ‐ 24 Fr tube thoracostomy until complete lung re‐expansion on CXR and < 100 ml/day for two days. Both drugs diluted in 50 ml saline and 10 ml 1% lignocaine. After study drug inserted, drain clamped for six hours with patient rotation. Then suction applied. Drain removed when < 200 ml/day drainage Talc group: 1 dose. 5 g talc intrapleurally Bleomycin group: 1 dose. 1 unit/kg bleomycin intrapleurally
Outcomes	Treatment response at one month (according to recurrence of effusion on CXR. Scoring system 0‐3 used for size of effusion) Hospital stay (days) Side effects within 48 hours of pleurodesis
Notes	People with trapped lung excluded from trial entry Pleurodesis success based only on radiology Included in network meta‐analysis for pluerodesis efficacy, pain, fever 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	High risk	Not stated explicitly, however drugs have differing appearances
Blinding of outcome assessment (detection bias) All outcomes	Low risk	"A single investigator who was blinded to treatment allocation scored all the follow up chest x rays"
Incomplete outcome data (attrition bias) All outcomes	Low risk	12/50 patients excluded due to death or LTFU in first month, but balanced between treatment arms
Selective reporting (reporting bias)	Low risk	All stated outcomes reported
Other bias	Low risk	No other biases identified