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E-cigarettes more effective than nicotine replacement for cessation of tobacco use in adults
Clinical Question
Are e-cigarettes an effective way to help patients quit smoking?
Bottom line
Among adults who smoked a median of 15 cigarettes per day, those who were randomized to receive e-cigarettes were more likely to be abstinent at one year than those who received nicotine replacement (number needed to treat [NNT] = 12). They also had less cough and phlegm production. 1b
Reference
Study design: Randomized controlled trial (nonblinded)
Funding: Government
Setting: Outpatient (any)
Synopsis
Many of us have had patients who claimed to have stopped smoking by switching to e-cigarettes. But is this switch truly effective, and how durable are the effects? In this trial, adult smokers in the United Kingdom were recruited via social media, and randomized to receive nicotine replacement or e-cigarettes. All participants were not currently using either approach and expressed no preference. Those randomized to use nicotine replacement could choose their preferred method, including nasal spray, inhaler, mouth spray, microtabs, gum, or patch. Those randomized to use e-cigarettes received a starter kit, and were encouraged to experiment with different flavors and strengths of "e-liquids." The median age of participants was 41 years, approximately half were women, and the median number of cigarettes smoked per day was 15. Groups were balanced at the beginning of the study, and a total of 884 patients were randomized. The primary outcome, evaluated using the intention-to-treat principle, was self-reported abstinence confirmed by a carbon monoxide level of less than 8 ppm at one year. This occurred for 18% in the e-cigarette group and 9.9% in the nicotine replacement group (P < .05; NNT = 12). Short-term abstinence at 4 weeks was also higher with the use of e-cigarettes (43.8% vs 30.0%; P < .05; NNT = 7). Respiratory symptoms of cough and phlegm were somewhat less common among those in the e-cigarette group at 52 weeks. There was no difference in adverse events between groups, with nausea more common in the nicotine replacement group (number needed to treat to harm [NNTH] = 16) and throat irritation more common in the e-cigarette group (NNTH = 7). A total of 40% of the patients in the e-cigarette group were still using e-cigarettes at one year, so they were still hooked on nicotine, just not tobacco.
Reviewer
Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA
Comments
40% still addicted to e-cigarettes and nicotine one year later-.
Seems like a win for e-cigarette manufacturers. Individual still feels the need to hold something in their hand while inhaling an addictive substance. The title should be changed to reflect the exchange/ replacement of the addictive “tools”. Still no freedom from inhaled man-made addiction ?