Varenicline, e-cigarettes both effective smoking cessation options, researchers find

Key takeaways:

• Despite concerns about nicotine-containing e-cigarettes, researchers said they may have a role in smoking cessation.
• However, “it may be advisable to primarily recommend varenicline,” they added.

Both varenicline and e-cigarettes were effective as smoking cessation strategies compared with placebo, according to a study published in JAMA Internal Medicine.

Although varenicline has been shown to help patients stop smoking, less is known about how it compares with e-cigarettes — a more controversial smoking cessation strategy given the uncertainty around their long-term impact.

“To our knowledge, there are no previous randomized placebo-controlled trials comparing e-cigarettes and varenicline as a smoking cessation tool,” Anna Tuisku, PhD, from Lapland Central Hospital in Finland, and colleagues wrote.

So, the researchers conducted a single-center, randomized controlled trial in which participants from Finland were assigned to either varenicline (n = 152), nicotine-containing e-cigarettes (n = 153) or placebo (n = 153) for 12 weeks. The participants were aged 25 to 75 years and had smoked daily for longer than 10 years, with a minimum of 10 cigarettes daily for at least the past 5 years.

The primary outcome was self-reported 7-day cigarette smoking abstinence, which was confirmed by the exhaled carbon monoxide levels at weeks 26 and 52 of follow-up.

At 26 weeks, the primary outcome occurred in:

• 40.4% (95% CI, 32.8-48.3) of the e-cigarette group;
• 43.8% (95% CI, 36.1-51.7) of the varenicline group; and
• 19.7% (95% CI, 14-26.6) of the placebo group.

Although both e-cigarettes and varenicline differed statistically significantly from placebo in pairwise comparisons, there was no significant difference between the two, according to Tuisku and colleagues. In addition, no serious adverse effects were reported.

The researchers noted that future trials with multiple sites would help to confirm their results. They also pointed out that they could detect only short-term harms related to the treatments because the length of the follow-up period.

Even with the established harms of e-cigarettes and uncertainty around their long-term use, Tuisku and colleagues said they may have a role in smoking cessation among adults who have depended on nicotine for several years and have been unable to quit despite numerous attempts.

“However, it may be advisable to primarily recommend varenicline therapy to those adults who are hoping to terminate their smoking habit,” they wrote. “It seems to be at least as effective as nicotine-containing e-cigarettes with a good safety profile.”

They added that e-cigarettes may not be preferable for those who are willing to stop smoking “and refrain from nicotine addiction."