IPCs without daily drainage are probably less effective at obtaining a definitive pleurodesis (cessation of pleural fluid drainage facilitating IPC removal) than talc slurry (OR 7.60, 95% Cr‐I 2.96 to 20.47 rank = 18/21, 95% Cr‐I 13 to 21 moderate certainty). Evidence for any difference was further reduced when restricting analysis to studies at low risk of bias (defined as maximum one high risk domain in the risk of bias assessment) (pleurodesis failure talc poudrage versus talc slurry: OR 0.78, 95% Cr‐I 0.16 to 2.08). There is little evidence of a difference between the pleurodesis failure rate of talc poudrage and talc slurry (OR 0.50, 95% Cr‐I 0.21 to 1.02 moderate certainty). Talc slurry (ranked 6, 95% credible interval (Cr‐I) 3 to 10) is an effective pleurodesis agent (moderate certainty for comparison with placebo) and may result in fewer pleurodesis failures than bleomycin and doxycycline (bleomycin versus talc slurry: odds ratio (OR) 2.24, 95% Cr‐I 1.10 to 4.68 low certainty ranked 11, 95% Cr‐I 7 to 15 doxycycline versus talc slurry: OR 2.51, 95% Cr‐I 0.81 to 8.40 low certainty ranked 12, 95% Cr‐I 5 to 18). We estimated the rank of each intervention's effectiveness. We included 55 studies of 21 interventions in the primary network meta‐analysis. Due to the nature of the interventions, most studies were unblinded. We found all except three studies at high or unclear risk of bias for at least one domain. We identified 80 randomised trials (18 new), including 5507 participants.
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