Schmidt 1997.

Methods	Multi‐centre RCT comparing pleurodesis using bleomycin with mitoxantrone (Germany). Paper in German
Participants	Inclusion: symptomatic, cytologically proven MPE; life expectancy > 3 months; WHO performance score 0‐2 Exclusion: prior chemotherapy or pleurodesis in previous four weeks; contraindication to bleomycin or mitoxantrone; persistent pneumothorax; leucopenia; thrombocytopaenia; incomplete pleural fluid drainage 102 participants randomised
Interventions	All participants had a 24 Fr chest drain inserted and left in situ for 48 hours Bleomycin group: single dose of 60 mg bleomycin in 100 ml saline intrapleurally Mitoxantrone group: single dose of 30 mg mitoxantrone in 100 ml saline intrapleurally Drains clamped for six hours after instillation and left in place for 24 ‐ 48 hours with or without suction
Outcomes	Pleurodesis success rate at four weeks (defined by recurrence of effusion requiring repeat pleural procedure) Toxicity/adverse events Length of hospital stay Time to repeat pleural intervention
Notes	Translated from German People with trapped lung excluded from participation Included in network meta‐analysis for pleurodesis efficacy, mortality, fever and pain
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Not stated
Allocation concealment (selection bias)	Low risk	Telephone randomisation
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Not stated if anyone was blinded
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not stated if anyone was blinded. If unblinded, symptom recurrence, adverse event reporting and length of stay could have been biased
Incomplete outcome data (attrition bias) All outcomes	Low risk	Six participants excluded from analysis, but reasons given and balanced numbers in the two treatment arms
Selective reporting (reporting bias)	Low risk	All outcomes reported
Other bias	Low risk	No other biases identified