Rafiei 2014.

Methods	Single centre RCT comparing the pleurodesis success of doxycycline and bleomycin in MPE (Iran)
Participants	Inclusion: symptomatic, cytologically proven MPE Exclusion: allergy to doxycycline or bleomycin; past history of sclerotherapy; systemic chemotherapy immediately prior to or in the next two months after sclerotherapy 42 participants randomised
Interventions	All participants underwent 'fluid evacuation'. Agent then instilled through the tube, which was clamped for one hour. Then suction applied and drain removed when < 100 ml/24 hr drainage Bleomycin group: 45 mg bleomycin intrapleurally Doxycyclline group: 600 mg doxycycline in 50 ml saline and 10 ml 1% lignocaine intrapleurally
Outcomes	CXR appearances of the effusion size at two months (mild, moderate or severe) Need for repeat pleural fluid drainage Dyspnoea (mild, moderate or severe) Complications
Notes	People with trapped lung not excluded Pleurodesis success primarily defined radiologically, but data presented at three months for need for repeat pleural intervention For this review, need for repeat pleural drainage was used as measure of pleurodesis success Included in network meta‐analysis for pleurodesis efficacy, fever and pain
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Not stated and no response from study authors to clarify
Allocation concealment (selection bias)	Unclear risk	Not stated and no response from study authors to clarify
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Not stated if anyone was blinded. No response from study authors
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not stated if anyone was blinded. No response from study authors
Incomplete outcome data (attrition bias) All outcomes	Low risk	No loss to follow up
Selective reporting (reporting bias)	Low risk	All stated outcomes reported
Other bias	Low risk	No other biases identified