E-cigarettes beat out nicotine replacement to quit smoking

A 1-year randomized trial in 886 adults living in the United Kingdom showed that electronic cigarettes (e-cigarettes) are more effective for smoking cessation than nicotine-replacement therapy.

Participants in the nicotine-replacement group selected from a range of products-patch, gum, lozenge, nasal spray, inhalator, mouth spray, mouth strip, and microtabs-and were encouraged to use combinations. Those in the refillable e-cigarette group were given a starter pack along with a bottle of e-liquid containing nicotine at a concentration of 18 mg per milliliter. Investigators encouraged participants to experiment with e-liquids of different strengths and flavors. They provided limited supplies to both groups at the start of the trial; participants were then expected to purchase their own for the remainder of the 1-year trial.

Participants in both groups received weekly one-on-one support sessions with clinicians, who also monitored expired carbon monoxide levels for at least 4 weeks after the participant quit smoking regular cigarettes. Participants also were contacted at both 26 and 52 weeks to confirm if they had remained abstinent, which was validated biochemically at the final visit.

The 1-year abstinence rate was 18% in the e-cigarette group compared with 9.9% in the nicotine-replacement group. E-cigarette use also was associated with less throat or mouth irritation and nausea, and greater declines in cough and phlegm production (Hajek P, et al. N Engl J Med. 2019;380(7):629-637).

Thoughts from Dr Burke

This study may justify e-cigarette use in a select group of adults addicted to combustible cigarettes, although these adults were still addicted to nicotine at the end of the study. However, this is not adequate justification for making e-cigarettes available to children, nor is it reason enough for marketing flavored solutions to young people. We need to maintain focus on the rapidly increasing threat to children of vaping/juuling/e-cigarette use.