Indwelling Pleural Catheter versus Pleurodesis for Malignant Pleural Effusions. A Systematic Review and Meta-Analysis

Iyer NP, Reddy CB, Wahidi MM, Lewis SZ, Diekemper RL, Feller-Kopman D, Gould MK, Balekian AA.

Ann Am Thorac Soc Vol 16, No 1, pp 124–131, Jan 2019; DOI: 10.1513/AnnalsATS.201807-495OC


What is the key question?

  • Previous studies suggest that the treatment of symptomatic malignant pleural effusions (MPE) with an Indwelling Pleural Catheter (IPC) has advantages over in-hospital pleurodesis due to reduction in hospital bed requirement and concomitant cost reduction. However, the rate of pleurodesis has varied in IPC clinical trials.
  • The authors thus compared IPCs and chemical pleurodesis using a systematic review and subsequent meta-analysis.

What is the bottom line?

  • Using standard literature search methodology and Cochrane risk of Bias tool, five randomized trials involving 545 patients were identified that met inclusion criteria that compared IPC and pleurodesis. However, the author state that high mortality rate in patients with MPE and lack of blinding inevitably result in an overall high risk of bias among these 5 studies. One trial compared IPC with doxycycline pleurodesis, and four with talc pleurodesis.
  • Regarding clinical outcomes:
    • There was no difference in overall survival at 3 months between the two groups.
    • There was also no difference in dyspnea scores between the two groups.
    • Total length of hospital stay was less in IPC group than pleurodesis group (although it was not possible to pool results hospital stay was reduced by 3-5 days).
    • The IPC group required 1/3 of repeat pleural procedures compared to pleurodesis group.
    • The risk of cellulitis was higher in IPC group however there was no difference in pleural infection.
    • No difference was noted in other adverse events

Why read on?

  • This is a well-structured review with robust meta-analysis methodology. The authors discuss the importance of these results further including economic impact and patient preference.