Cochrane · systematic review · CD010529
Interventions for the management of malignant pleural effusions: a network meta‐analysis
Dipper, A, Jones, HE, Bhatnagar, R, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
Pain, Palliative and Supportive CareAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
42
current version
GRADE rated
30
No studies
6
Included studies
NR
No studies 6 · 14.3%Ungraded 6 · 14.3%Very low 5 · 11.9%Low 16 · 38.1%Moderate 9 · 21.4%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Pleurodesis failure rate in adults with malignant pleural effusion
Population: adults with malignant pleural effusion Interventions: talc poudrage, bleomycin, IPC – not daily drainage, doxycycline, placebo Comparator (reference): talc slurry Outcome: pleurodesis failure rate
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total studies: 55* Total participants: 3758 No. interventions in network: 21 | no estimate extracted | 55 participants | Ungraded |
Talc slurry (19 RCTs, 907 participants) | no estimate extracted | 19 studies · 907 participants | Moderate Downgraded: imprecision, indirectness |
Talc poudrage (9 RCTs, 530 participants) | no estimate extracted | 9 studies · 530 participants | Moderate Downgraded: risk of bias, indirectness |
Bleomycin (21 RCTs, 528 participants) | no estimate extracted | 21 studies · 528 participants | Low Downgraded: risk of bias, imprecision, indirectness |
IPC –not daily drainage (6 RCTs, 405 participants) | no estimate extracted | 6 studies · 405 participants | Moderate Downgraded: inconsistency |
Doxycycline (5 RCTs, 117 participants) | no estimate extracted | 5 studies · 117 participants | Low Downgraded: imprecision, indirectness |
Placebo (4 RCTs, 159 participants) | no estimate extracted | 4 studies · 159 participants | Moderate Downgraded: imprecision |
Adverse effects: procedure‐related fever in adults with malignant pleural effusion
Population: adults with malignant pleural effusion Interventions: talc poudrage, bleomycin, IPC – not daily drainage, doxycycline, placebo Comparator (reference): talc slurry Outcome: fever
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total studies: 30 * Total participants: 2004 No. interventions in network: 14 | no estimate extracted | 30 participants | Ungraded |
Talc slurry (9 RCTs; 823 participants) | no estimate extracted | 9 studies · 823 participants | Low Downgraded: imprecision, indirectness |
Talc poudrage (4 RCTs; 553 participants) | no estimate extracted | 4 studies · 553 participants | Low Downgraded: imprecision, indirectness |
Bleomycin (14 RCTs; 774 participants) | no estimate extracted | 14 studies · 774 participants | Low Downgraded: imprecision, indirectness |
IPC – not daily drainage (1 RCT; 101 participants) | no estimate extracted | 1 study · 101 participants | Low Downgraded: imprecision, indirectness |
Doxycycline (4 RCTs; 308 participants) | no estimate extracted | 4 studies · 308 participants | Low Downgraded: imprecision, indirectness |
Placebo (2 RCTs; 118 participants) | no estimate extracted | 2 studies · 118 participants | Low Downgraded: imprecision, indirectness |
Adverse effects: procedure‐related pain in adults with malignant pleural effusion
Population: adults with malignant pleural effusion Interventions: talc poudrage, bleomycin IPC – not daily drainage, doxycycline, placebo Comparator (reference): talc slurry Outcome: procedure‐related pain
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total studies: 31* Total participants: 2753 No. interventions in network: 14 | no estimate extracted | 31 participants | Ungraded |
Talc slurry (9 RCTs, 1320 participants) | no estimate extracted | 9 studies · 1320 participants | Low Downgraded: imprecision, indirectness |
Talc poudrage (4 RCTs, 886 participants) | no estimate extracted | 4 studies · 886 participants | Very low Downgraded: imprecision, inconsistency, indirectness |
Bleomycin (13 RCTs, 724 participants) | no estimate extracted | 13 studies · 724 participants | Low Downgraded: imprecision, indirectness |
IPC – not daily drainage (6 RCTs, 738 participants) | no estimate extracted | 6 studies · 738 participants | Low Downgraded: imprecision, indirectness |
Doxycycline (4 RCTs, 308 participants) | no estimate extracted | 4 studies · 308 participants | Low Downgraded: imprecision, indirectness |
Placebo | no estimate extracted | NR | No studies |
Patient‐reported control of breathlessness in adults with malignant pleural effusion
Population: adults with malignant pleural effusion Interventions: talc poudrage, bleomycin, IPC – not daily drainage, doxycycline, placebo Comparator (reference): talc slurry Outcome: postintervention patient‐reported control of breathlessness?
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Intervention Total studies: 4* Total participants: 379 | no estimate extracted | 4 participants | Ungraded |
Talc slurry (2 RCTs, 248 participants) | no estimate extracted | 2 studies · 248 participants | Moderate Downgraded: risk of bias |
Talc poudrage (1 RCT, 184 participants) | no estimate extracted | 1 study · 184 participants | Moderate Downgraded: risk of bias |
Bleomycin (1 RCT, 35 participants) | no estimate extracted | 1 study · 35 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
IPC –not daily drainage (2 RCTs, 160 participants) VAS scores at 42 days and 180 days | no estimate extracted | 2 studies · 160 participants | Low Downgraded: risk of bias, indirectness |
Doxycycline | no estimate extracted | NR | No studies |
Placebo | no estimate extracted | NR | No studies |
Overall mortality in adults with malignant pleural effusion
Population: adults with malignant pleural effusion Interventions: talc poudrage, bleomycin IPC – not daily drainage, doxycycline, placebo Comparator (reference): talc slurry Outcome: mortality
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total studies: 31* Total participants: 2816 No. interventions in network: 15 | no estimate extracted | 31 participants | Ungraded |
Talc slurry (13 RCTs, 1574 participants) | no estimate extracted | 13 studies · 1574 participants | Low Downgraded: imprecision, indirectness |
Talc poudrage (7 RCTs, 878 participants) | no estimate extracted | 7 studies · 878 participants | Very low Downgraded: imprecision, indirectness |
Bleomycin (9 RCTs, 664 participants) | no estimate extracted | 9 studies · 664 participants | Low Downgraded: imprecision, indirectness |
IPC – not daily drainage 6 RCTs, 587 participants | no estimate extracted | 6 studies · 587 participants | Low Downgraded: imprecision, indirectness |
Doxycycline (1 RCT, 80 participants) | no estimate extracted | 1 study · 80 participants | Very low Downgraded: imprecision, indirectness |
Placebo | no estimate extracted | NR | No studies |
Patient acceptability: need for repeat invasive pleural intervention in adults with malignant pleural effusion
Population: adults with malignant pleural effusion Interventions: talc poudrage, bleomycin, IPC – not daily drainage, doxycycline, placebo Comparator (reference): talc slurry Outcome: patient acceptability (need for repeat invasive pleural intervention)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Intervention Total studies: 9 Total participants: 883 | no estimate extracted | 9 participants | Ungraded |
Talc slurry (8 RCTs, 850 participants) | no estimate extracted | 8 studies · 850 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Talc poudrage (2 RCTs, 380 participants) | no estimate extracted | 2 studies · 380 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Bleomycin (1 RCT, 33 participants) | no estimate extracted | 1 study · 33 participants | Very low Downgraded: risk of bias, imprecision |
IPC –not daily drainage (3 RCTs, 343 participants) | no estimate extracted | 3 studies · 343 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Doxycycline | no estimate extracted | NR | No studies |
Placebo | no estimate extracted | NR | No studies |