AVA SYNOPSIS
Researchers analyzed 886 randomized study participants to examine the effectiveness of e-cigarettes and nicotine replacement therapy products on smoking cessation. Participants were more mostly middle-aged smokers and were separated into two groups including an NRT group and an e-cigarette group. More than 78 percent of participants completed the 52-week follow up conducted by the researchers.
Of the 100+ participants that reported abstinence during the 52-week follow up, researchers found that 80 percent of those participants were using e-cigarettes and 9 percent were using NRT products. Overall, researchers found that e-cigarette users reported a higher abstinence rate at 18.0 percent, compared to the NRT group, which reported a 9.9 percent one-year abstinence rate. The researchers concluded that e-cigarettes are twice as effective as NRT in helping smokers quit.
Implications: Researchers outside the United States continue to provide data that indicate e-cigarettes are successful tools in smoking cessation. It is imperative policymakers consider this data when regulating e-cigarette and vapor products to ensure they are promoting tobacco harm reduction products that can reduce the costs attributed to combustible tobacco.
ABSTRACT
Background: E-cigarettes are commonly used in attempts to stop smoking, but evidence is limited regarding their effectiveness as compared with that of nicotine products approved as smoking-cessation treatments.
Methods: We randomly assigned adults attending U.K. National Health Service stop-smoking services to either nicotine-replacement products of their choice, including product combinations, provided for up to 3 months, or an e-cigarette starter pack (a second-generation refillable e-cigarette with one bottle of nicotine e-liquid [18 mg per milliliter]), with a recommendation to purchase further e-liquids of the flavor and strength of their choice. Treatment included weekly behavioral support for at least 4 weeks. The primary outcome was sustained abstinence for 1 year, which was validated biochemically at the final visit. Participants who were lost to follow-up or did not provide biochemical validation were considered to not be abstinent. Secondary outcomes included participant-reported treatment usage and respiratory symptoms.
Results: A total of 886 participants underwent randomization. The 1-year abstinence rate was 18.0% in the e-cigarette group, as compared with 9.9% in the nicotine-replacement group (relative risk, 1.83; 95% confidence interval [CI], 1.30 to 2.58; P<0.001). Among participants with 1-year abstinence, those in the e-cigarette group were more likely than those in the nicotine-replacement group to use their assigned product at 52 weeks (80% [63 of 79 participants] vs. 9% [4 of 44 participants]). Overall, throat or mouth irritation was reported more frequently in the e-cigarette group (65.3%, vs. 51.2% in the nicotine-replacement group) and nausea more frequently in the nicotine-replacement group (37.9%, vs. 31.3% in the e-cigarette group). The e-cigarette group reported greater declines in the incidence of cough and phlegm production from baseline to 52 weeks than did the nicotine-replacement group (relative risk for cough, 0.8; 95% CI, 0.6 to 0.9; relative risk for phlegm, 0.7; 95% CI, 0.6 to 0.9). There were no significant between-group differences in the incidence of wheezing or shortness of breath.
Conclusions: E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy, when both products were accompanied by behavioral support. (Funded by the National Institute for Health Research and Cancer Research UK; Current Controlled Trials number, ISRCTN60477608. opens in new tab.)
FURTHER READING
Science Media Centre, expert reaction to randomised, controlled trial of ecigs vs NRT in smoking cessation, 2019
Tobacco Truth, Don’t ‘Narrow The Off-Ramp’ For Smokers Who Want to Quit, 2019
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