High abstinence odds with e-cigarettes vs. nicotine gum

Key takeaways:

• More individuals using e-cigarettes vs. nicotine gum achieved 6-month smoking abstinence.
• This rate was similar between e-cigarette users and varenicline users.

Individuals using e-cigarettes for smoking cessation had a higher 6-month abstinence rate than nicotine replacement therapy users and a similar rate to varenicline users, according to results published in JAMA Internal Medicine.

“[E-cigarettes] were as effective in helping smokers quit as varenicline and more effective than nicotine chewing gum when all three products were provided with minimal behavioral support,” Hao-Xiang Lin, DrPH, of the Institute for Global Health and Development at Peking University in China, and colleagues wrote.

In a multicenter, randomized clinical trial in China, Lin and colleagues assessed 1,068 individuals (mean age, 33.9 years; 33.5% women) smoking a daily minimum of 10 cigarettes to determine how e-cigarette use for 12 weeks compares with 12-week nicotine replacement therapy (NRT) and varenicline (Chantix, Pfizer) in terms of sustained abstinence at 6 months.

Of the total cohort, 409 (38.3%) individuals received a cartridge-based e-cigarette with a 30 mg/mL nicotine salt dose for the first 2 weeks and then a 50 mg/mL dose. The varenicline group also consisted of 409 individuals, and the dosing of this drug started as 0.5 mg once daily for 3 days, followed by 0.5 mg twice daily for 4 days and 1 mg twice daily for the remainder of the time.

Fewer patients randomly received nicotine chewing gum (n = 250; 23.4%), and the dose of this therapy was based on level of smoking (2 mg ≤ 20 cigarettes/day, n = 197; 4 mg, > 20 cigarettes/day, n = 53).

Researchers additionally noted that each smoker was invited to join a self-help internet forum regardless of their cessation method group.

Around 80% of individuals from each group had 6-month follow-up data.

Using an expired-air carbon monoxide reading (< 8 parts per million), individuals using e-cigarettes had the highest abstinence rate at 6 months (15.7%), followed closely by varenicline users (14.2%) and then nicotine gum users (8.8%).

Between the e-cigarette group and the varenicline group, researchers found similar quit rates (absolute risk reduction, 1.47%; 95% CI, –1.41% to 4.34%). However, when compared with the nicotine gum group, e-cigarette users had a higher likelihood of quitting (OR = 1.92; 95% CI, 1.15-3.21).

Researchers continued to see the above results after controlling for education level and Fagerstrom Test for Cigarette Dependence baseline scores, with similar quit rates between e-cigarette users and varenicline users (absolute risk reduction, 1.47%; 95% CI, –1.41% to 4.34%) and increased odds for quitting among e-cigarette users vs. nicotine gum users (adjusted OR = 1.89; 95% CI, 1.13-3.17).

Similar to the relationship between e-cigarettes and nicotine gum, use of varenicline vs. nicotine gum was linked to elevated odds for abstinence (adjusted OR = 1.82; 95% CI, 1.07-3.08).

Within the first 3 months of treatment, all three groups had comparable adherence rates.

The varenicline and nicotine gum groups stopped using these delivery methods at 3 months. But 62.3% of individuals using e-cigarettes continued to use their assigned treatment at 6 months, including 67.2% of those who achieved 6-month sustained abstinence.

Researchers did not find any serious adverse event reports in the total cohort but did find adverse reactions. Throat irritation and mouth irritation occurred frequently among individuals using e-cigarettes (7.8%; 6.9%) and individuals chewing nicotine gum (8%; 8.8%). In contrast, individuals using varenicline commonly reported nausea (8.8%).

“As 63% of participants in the [e-cigarette] arm still used their products at 6 months, further studies are needed to assess whether such use is beneficial or harmful,” Lin and colleagues wrote.