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Nicotine replacement with e-cigarettes might help smokers quit
Clinical Question
Is switching to e-cigarettes effective help for smokers who want to quit?
Bottom line
For adults who wish to quit smoking, nicotine delivery via e-cigarettes, plus counseling, may be more effective than other means of nicotine replacement for long-term smoking cessation. There was no report of the percentage of patients who maintained e-cigarette use while remaining abstinent from smoking. 1a
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Foundation
Setting: Various (meta-analysis)
Synopsis
The investigators searched 3 databases, including Cochrane CENTRAL, and identified 5 randomized controlled trials studying a total of 3253 people who smoked and wished to quit. The studies were limited to those published in English or French. Two authors independently selected articles for inclusion and extracted the data. Two studies compared nicotine replacement with e-cigarettes plus counseling, nicotine-free e-cigarettes plus counseling, and counseling alone. three studies compared nicotine replacement with e-cigarettes plus counseling with either nicotine-free e-cigarettes or any conventional (ie, non-e-cigarette) smoking cessation therapy (eg, a patch). There were no studies of any comparison with varenicline or bupropion. Biochemically confirmed abstinence (via expired carbon monoxide levels) at 6 months (4 studies) or 1 year (1 study) was more likely with nicotine e-cigarette replacement than conventional therapy (relative risk 1.77; 95% CI 1.29 - 2.44), translating into a number needed to treat of 19 (10 - 51). Nicotine e-cigarettes were also more effective than nicotine-free e-cigarettes (relative risk = 1.56, 95% CI 1.13 to 2.15). There was no heterogeneity for these results among the studies. Study quality was generally high.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Impact assessment
Excellent
very informative I am going to use i use this information in
Informative
E cigarettes
I am skeptical about this.
They're probably just moving over to e-cigarettes though
The fact that there is no report of the percentage of patients who maintained e-cigarette use while remaining abstinent from smoking is a huge concern for me. I suspect that the vast majority of these people just swapped out cigarettes for e-cigarettes. Maybe that's good, but we just don't know about the long-term harms of e-cigarettes. I don't want to just tell patients to swap over from cigarettes to e-cigarettes without clear evidence on the harms of this.