E-cigarette use vs. nicotine replacement therapy leads to higher quit rates
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Key takeaways:
- Researchers found higher quit rates for smoking with e-cigarette use vs. nicotine replacement therapy.
- It is likely that nicotine e-cigarettes aid more individuals in quitting than non-nicotine e-cigarettes.
Individuals using nicotine e-cigarettes have a higher likelihood of quitting smoking compared with nicotine replacement therapy users, according to data published in Cochrane Database of Systematic Reviews.
“Vaping (using e-cigarettes) is not risk free but is considerably less harmful than smoking,” Jamie Hartmann-Boyce, MA, DPhil, assistant professor of health policy and promotion in the School of Public Health and Health Sciences at University of Massachusetts Amherst, told Healio. “Evidence from well-conducted randomized controlled trials [RCTs] shows that nicotine e-cigarettes can help people quit smoking and are more effective at doing so than nicotine replacement therapies.”
In this update of a living systematic review, Hartmann-Boyce and colleagues investigated how e-cigarettes compare with nicotine replacement therapy (NRT), non-nicotine e-cigarettes and behavioral support/no treatment in terms of 6-month smoking abstinence. This review was last updated in 2022.
To find relevant studies, researchers looked through the Cochrane Tobacco Addiction Group’s Specialized Register up until February 2023, as well as MEDLINE, Embase and PsycINFO up until July 2023.
Researchers also consulted the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform, all through Issue 6 of CENTRAL 2023.
Ten of the 88 trials/studies (n = 27,235; 47 RCTs) included in this analysis were published since the 2022 update
More than half of the trials (58 studies) had a high risk for bias, whereas 10 studies had a low risk for bias. The risk for bias in the rest of the studies was unclear, according to researchers.
NRT vs. e-cigarettes
Seven studies (n = 2,544) evaluated nicotine e-cigarettes against nicotine replacement therapy. Between the two treatments, researchers found high certainty evidence of heightened quit rates with nicotine e-cigarette use (RR = 1.59; 95% CI, 1.29-1.93), and this may equate to an achievement of four more quitters per 100.
Researchers further found a comparable rate of adverse events among those using e-cigarettes and those using NRT (RR = 1.03; 95% CI, 0.91-1.17) in five of the studies (n = 2,052), which was supported by moderate certainty evidence.
When evaluating serious adverse events between the two sets of individuals, the current evidence was not enough to make a conclusion on this outcome. Notably, individuals from all study arms rarely reported these events, according to researchers.
Non-nicotine e-cigarettes vs. nicotine e-cigarettes
Using six studies (n = 1,613) that reported on quit rates between non-nicotine e-cigarette users and nicotine e-cigarette users, researchers again found higher quit rates with nicotine e-cigarettes (RR = 1.46; 95% CI, 1.09-1.96), which may mean three more quitters per 100. Notably, there was only moderate certainty evidence to support this outcome.
“This is a living systematic review, which means we are constantly looking for new evidence and regularly updating the review,” Hartmann-Boyce said. “From that perspective, the results themselves are actually really consistent with the picture that’s been emerging over the past 5 years or so — namely that the evidence is clear that e-cigarettes with nicotine can help people quit smoking.”
The rate of adverse events and serious adverse events between the two treatments was similar to that observed between NRT and e-cigarettes. Five studies (n = 1,840) showed moderate certainty evidence of a comparable rate of adverse events among the two sets of e-cigarette users (RR = 1.01; 95% CI, 0.91-1.11), whereas there was not enough evidence to make a conclusion on differences in serious adverse events.
Behavioral support/no support vs. e-cigarettes
Nine studies (n = 5,024) reported on quit rates between those receiving behavioral support/no support and those using nicotine e-cigarettes. Evidence from these studies was of low certainty, so researchers could only conclude that the e-cigarette group may have greater quit rates (RR = 1.88; 95% CI, 1.56-2.25), which could lead to four more quitters per 100.
When placed against behavioral support/no support, more nicotine e-cigarette users experienced adverse events (RR = 1.22; 95% CI, 1.12-1.32) based on four studies (n = 765), but this evidence was of low certainty.
For the third time, researchers could not compare the rate of serious adverse events between those receiving behavioral support/no support and those using nicotine e-cigarettes because of a lack of evidence.
When asked about future studies, Hartmann-Boyce said different e-cigarette models and flavors need to be researched.
“We need more studies testing newer types of e-cigarettes and investigating how differences in their characteristics — such as flavors — may impact their effects,” Hartmann-Boyce told Healio. “Fortunately, there are some studies in the pipeline which will help answer these questions.”
Although this systematic review focuses on comparing e-cigarettes to other smoking cessation treatment options, it serves as a reminder that e-cigarettes do not put individuals at as much harm as cigarettes.
As Healio previously reported, many U.S. adults appear to believe that e-cigarettes contain a larger amount of dangerous chemicals than cigarettes, but Hartmann-Boyce told Healio this is not the case.
“Nicotine e-cigarettes don’t involve burning tobacco,” she said. “The harm from smoking traditional cigarettes comes not from the nicotine but from all the chemicals that are released when tobacco is burned. This harms people who smoke and can harm the people around them, too.”
Reference:
- E-cigarettes help more tobacco smokers quit than traditional nicotine replacement. https://www.umass.edu/news/article/e-cigarettes-help-more-tobacco-smokers-quit-traditional-nicotine-replacement. Published Jan. 8, 2024. Accessed Jan. 8, 2024.