E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy according to this randomized study recently published in the New England Journal of Medicine (NEJM). Both must be accompanied by medical and psychological support for optimal results.

While e-cigarettes are commonly used as a smoking cessation strategy, evidence is limited regarding their effectiveness as compared with other strategies such as approved nicotine products (chewing gum, candy, patches, etc.) that act as nicotine replacement to help patients stop smoking permanently.

A total of 886 participants attending dedicated U.K. stop-smoking services underwent randomization to either nicotine-replacement products (different combinations or presentations) for 3 months or an e-cigarette (a second-generation refillable e-cigarette with one bottle of nicotine e-liquid [18 mg/mL]). Flavor and strength were left to the patients’ choice. Treatment was to be followed for at least 4 weeks.

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For both treatment arms, treatment included counseling follow-up for at least 4 weeks.

The primary outcome was sustained abstinence for one year, which was validated biochemically at the final follow-up visit. Participants who were lost to follow-up or did not access biochemical validation were considered to not be abstinent.

The abstinence rate at one year was 18% in the e-cigarette group vs. 9.9% in the nicotine-replacement group (relative risk [RR]: 1.83; 95% confidence interval [CI]: 1.30 to 2.58; p < 0.001). While the abstinence rate for e-cigarettes almost doubled the rate for nicotine-replacement therapy, 18% is still very low and we should insist so that more patients can quit smoking for good.

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The most frequently reported events were throat or mouth irritation for the e-cigarette group and nausea for the nicotine-replacement group.

Symptoms such as cough and phlegm production were also minor in the e-cigarette group.

There were no differences between groups in the incidence of bronchospasm or dyspnea.

Conclusion

E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy when both were accompanied by psychological and medical advice.

Original title: A Randomized Trial of E-Cigarettes Versus Nicotine-Replacement Therapy.

Reference: Peter Hajek et al. N Engl J Med. 2019 Feb 14;380(7):629-637.

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