Text message intervention, varenicline aid in vaping cessation

Key takeaways:

• This finding emerged from a systematic review of randomized controlled trials of nicotine vapers assessing interventions for quitting.
• Low certainty evidence backed findings, signaling a need for more research.

Nicotine vaping cessation rates were elevated with use of a text message intervention or varenicline vs. no/minimal support or placebo, according to data published in Cochrane Database of Systematic Reviews.

“Clinicians increasingly report patients coming to them asking them for advice on how to quit vaping nicotine,” Jamie Hartmann-Boyce, MA, DPhil, assistant professor of health policy and promotion at University of Massachusetts Amherst, told Healio. “We hope this new review will serve as a point of reference for them in discussing options with their patients who vape.

“The best available evidence was for a text message-based intervention in adolescents and young adults,” Hartmann-Boyce continued. “There was also some evidence to support the use of varenicline, a prescription medication used for quitting smoking.”

After searching six databases, Hartmann-Boyce and colleagues examined nine randomized controlled trials (eight studies in adults; one study in teenagers) of 5,209 nicotine vapers assessing interventions for quitting published between Jan. 1, 2004, and April 24, 2024, to determine the best treatment method for this population.

Three of the trials had a high risk of bias, whereas three had a low risk of bias. The risk of bias in the remaining three studies was unclear, according to researchers.

Nicotine replacement therapy, cytisine, varenicline

One study (n = 16) evaluated combination nicotine replacement therapy (NRT) against no/minimal support. Between the two treatments, researchers found very low certainty evidence of “the possibility of no benefit and a potential benefit of control” with combination NRT for vaping cessation (RR = 2.57; 95% CI, 0.29-22.93).

When evaluating serious adverse events, none of the vapers experienced this type of event in a different study on this intervention (n = 508), but researchers rated the evidence as low certainty.

Cytisine vs. placebo was analyzed in one study (n = 159). Researchers could not make a conclusion on this treatment for quitting vaping as this outcome was not reported. Similar to above, none of the vapers experienced a serious adverse event, but the evidence was deemed low certainty.

Using one study (n = 140) that reported on vapers using varenicline vs. no/minimal support or placebo, researchers observed low certainty evidence of heightened cessation rates at month 6 with varenicline use (RR = 2; 95% CI, 1.09-3.68).

A serious adverse event with varenicline use was noted in one (n = 95) of three studies assessing this outcome with regards to this treatment option, but the evidence was rated as low certainty (RR = 2.6; 95% CI, 0.11-62.16), according to the study.

Nicotine/vaping reduction, text message intervention

In terms of behavioral interventions in this patient population, one study (n = 17) evaluated nicotine/vaping reduction against no/minimal support. Between the two treatments, researchers found very low certainty evidence of “the possibility of no intervention effect and higher cessation rates in the control arm” at 6 months with nicotine/vaping reduction (RR = 3.38; 95% CI, 0.43-26.3).

“Data exploring the effectiveness of combination NRT, cytisine and nicotine/vaping behavior reduction are inconclusive due to risk of bias and imprecision,” Hartmann-Boyce and colleagues wrote.

No judgement could be made on the rate of serious adverse events with this intervention because this outcome was not reported in the study, according to researchers.

The other behavioral intervention for vaping cessation reviewed in this analysis was a text message-based intervention (three studies). Based on two studies (n = 4,091) that reported on vapers aged 13 to 24 years receiving a text message-based intervention vs. no/minimal support, researchers observed higher cessation rates with the text message-based intervention (RR = 1.32; 95% CI, 1.19-1.47), but this evidence was deemed low certainty.

As Healio previously reported, a study published in JAMA found that receiving daily text messages as part of an e-cigarette cessation intervention led to a larger vaping abstinence rate at 7 months vs. a control treatment in adolescents.

Serious adverse events were captured in one (n = 508) of three studies. Although the evidence was low certainty, none of the vapers in this study who received either the text message-based intervention or no/minimal support experienced this type of event.

“I was pleasantly surprised by how many participants managed to quit vaping in some of the studies,” Hartmann-Boyce told Healio. “I’m used to reviewing studies in people who smoke, where quit rates are often quite low, even for the best available treatments.

“I was also really happy to see that this is now an active area of research with many studies currently underway, meaning we should have more evidence soon,” she continued.

Hartmann-Boyce told Healio information/data on additional treatments to aid vapers in quitting is also expected.

“Studies are underway which test many different treatments, some of which we don’t have evidence on yet,” she said. “In addition, as this research fields evolve, research questions will probably change from ‘what works for quitting vaping?’ to ‘how can we best optimize interventions for quitting vaping and get them to the people who need them?’”

Further, there were a lack of data on change in combustible tobacco smoking in the included randomized controlled trials, which should be addressed in future research, Hartmann-Boyce told Healio.

“I hope we’ll see more studies reporting whether these interventions for quitting vaping affect smoking behaviors,” Hartmann-Boyce said.

“A smattering of newspaper articles report people switching to smoking in order to quit vaping, including parents giving their teens cigarettes,” she added. “This is never advisable. The harm from smoking comes from the burning of tobacco, not from nicotine, and vaping doesn’t involve burning tobacco. Switching from vaping nicotine to smoking tobacco is likely to increase health risks.”

Reference:

• Ready to quit vaping in the new year? A new study uncovers the best ways. https://www.eurekalert.org/news-releases/1069598. Published Jan. 7, 2025. Accessed Jan. 7, 2025.

For more information:

Jamie Hartmann-Boyce, MA, DPhil, can be reached at jhartmannboy@umass.edu.