• Rahul Bhatnagar, Emma K Keenan, Anna J Morley, Brennan C Kahan, Andrew E Stanton, Mohammed Haris, Richard N Harrison, Rehan A Mustafa, Lesley J Bishop, Liju Ahmed, Alex West, Jayne Holme, Matthew Evison, Mohammed Munavvar, Pasupathy Sivasothy, Jurgen Herre, David Cooper, Mark Roberts, Anur Guhan, Clare Hooper, James Walters, Tarek S Saba, Biswajit Chakrabarti, Samal Gunatilake, Ioannis Psallidas, Steven P Walker, Anna C Bibby, Sarah Smith, Louise J Stadon, Natalie J Zahan-Evans, Lee Y C Gary YCG From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C., John E Harvey, Najib M Rahman, Robert F Miller, and Nick A Maskell.
• From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St. Thomas' NHS Foundation Trust (L.A., A.W.), King's College School of Medicine, King's College University (L.A.), and the Institute for Global Health, University College London (R.F.M.), London, Great Western Hospitals NHS Foundation Trust, Swindon (A.E.S.), University Hospital of North Midlands NHS Trust, Stoke-on-Trent (M.H.), the School of Medicine, Keele University, Newcastle-under-Lyme (M.H.), North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees (R.N.H.), South Tees Hospitals NHS Foundation Trust, Middlesbrough (R.A.M.), Portsmouth Hospitals NHS Trust, Portsmouth (L.J.B.), Manchester University NHS Foundation Trust, Manchester (J. Holme, M.E.), Lancashire Teaching Hospitals NHS Foundation Trust, Preston (M.M.), Cambridge University Hospitals NHS Foundation Trust, Cambridge (P.S., J. Herre), Northumbria Healthcare NHS Foundation Trust, North Shields (D.C.), Sherwood Forest Hospitals NHS Foundation Trust, Sutton-in-Ashfield (M.R.), NHS Ayrshire and Arran, Ayr (A.G.), Worcester Acute Hospitals NHS Trust, Worcester (C.H.), Royal United Hospitals Bath NHS Foundation Trust, Bath (J.W.), Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool (T.S.S.), Aintree University Hospitals NHS Foundation Trust, Liverpool (B.C.), Hampshire Hospitals NHS Foundation Trust, Winchester (S.G.), and the Oxford Respiratory Trials Unit, University of Oxford (I.P., N.M.R.), the Oxford University Hospitals NHS Foundation Trust (I.P., N.M.R.), and the Oxford NIHR Biomedical Research Centre (N.M.R.), Oxford - all in the United Kingdom; and the Institute for Respiratory Health, University of Western Australia, and Sir Charles Gairdner Hospital, Perth, WA, Australia (Y.C.G.L.).
• N. Engl. J. Med. 2018 Apr 5; 378 (14): 1313-1322.

BackgroundMalignant pleural effusion affects more than 750,000 persons each year across Europe and the United States. Pleurodesis with the administration of talc in hospitalized patients is the most common treatment, but indwelling pleural catheters placed for drainage offer an ambulatory alternative. We examined whether talc administered through an indwelling pleural catheter was more effective at inducing pleurodesis than the use of an indwelling pleural catheter alone.MethodsOver a period of 4 years, we recruited patients with malignant pleural effusion at 18 centers in the United Kingdom. After the insertion of an indwelling pleural catheter, patients underwent drainage regularly on an outpatient basis. If there was no evidence of substantial lung entrapment (nonexpandable lung, in which lung expansion and pleural apposition are not possible because of visceral fibrosis or bronchial obstruction) at 10 days, patients were randomly assigned to receive either 4 g of talc slurry or placebo through the indwelling pleural catheter on an outpatient basis. Talc or placebo was administered on a single-blind basis. Follow-up lasted for 70 days. The primary outcome was successful pleurodesis at day 35 after randomization.ResultsThe target of 154 patients undergoing randomization was reached after 584 patients were approached. At day 35, a total of 30 of 69 patients (43%) in the talc group had successful pleurodesis, as compared with 16 of 70 (23%) in the placebo group (hazard ratio, 2.20; 95% confidence interval, 1.23 to 3.92; P=0.008). No significant between-group differences in effusion size and complexity, number of inpatient days, mortality, or number of adverse events were identified. No significant excess of blockages of the indwelling pleural catheter was noted in the talc group.ConclusionsAmong patients without substantial lung entrapment, the outpatient administration of talc through an indwelling pleural catheter for the treatment of malignant pleural effusion resulted in a significantly higher chance of pleurodesis at 35 days than an indwelling catheter alone, with no deleterious effects. (Funded by Becton Dickinson; EudraCT number, 2012-000599-40 .).

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