Pleural effusion: pleurodesis: mepacrine was a better agent than bleomycin.

Clinical bottom line (level 1b)

  1. In patients with malignant pleural effusion who had pleurodesis, mepacrine was a better sclerosing agent than bleomycin at preventing recurrent effusion (NNT = 3 at 30 days) .
  2. Pain and fever were common side-effects of pleurodesis, but there was no clear difference between the two treatments.
Koldsland et al: Thorax 1993; 48: 790-793
Expires October 2001

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: university hospital, Norway

40 patients (aged ?, ?% male) malignant pleural effusion (proven histologically)

Excluded if
  • life expectancy less than one month
  • renal failure
  • needing continuous oxygen


    • Control Group: (n = 20, 20 analysed): bleomycin 60 mg in 100 ml normal saline
    Experimental Group: (n = 20, 20 analysed): mepacrine 800 mg in 20 ml normal saline
    All patients had a 28 or 32-French chest tube inserted under local anaesthetic: suction was maintained until ~100 ml of fluid was drained a day, and chest x-ray was clear. The sclerosing agent was instilled for two hours with the patient rolling frequently. The chest tube was removed when 100 ml or less of fluid was drained a day.
    100% followed for 30 days
    Outcome notes:
    • treatment failure : reaccumulation of fluid with severe dyspnoea needing thoracentesis

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    treatment failure 30 days 10
    (50.0%)    		 4
    (20.0%)    		 60%
    (-7% to 85%)    		 30.0%
    (1.94% to 58.1%)    		 3
    (2 to 52)
    fever 24 hours 11
    (55.0%)    		 14
    (70.0%)    		 -27%
    (-108% to 22%)    		 -15.0%
    (-44.6% to 14.6%)    		 -7
    (NNT = 7 to infinity;
    NNH = 2 to infinity)
    pain 24 hours 13
    (65.0%)    		 16
    (80.0%)    		 -23%
    (-82% to 17%)    		 -15.0%
    (-42.3% to 12.3%)    		 -7
    (NNT = 8 to infinity;
    NNH = 2 to infinity)

    Comments

    1. Mepacrine is an anti-malarial drug.

    Citation

    1. Koldsland S, Svennevig JL, Lehne G, et al: chemical pleurodesis in malignant pleural effusions: a randomised prospective study of mepacrine versus bleomycin. Thorax 1993; 48: 790-793
    Search Terms: pleural effusion in Cochrane
    Contributor: Chris Ball and Clare Wotton, October 2000
    Reviewer:

    Clinical Question.
    Patient malignant pleural effusion
    Intervention or Exposure mepacrine
    Comparison bleomycin
    Outcome recurrent effusion