Vaping More Effective Than Conventional Smoking Cessation Therapies

Vaping using nicotine e-cigarettes is more effective for smoking cessation than conventional nicotine replacement behavioral smoking cessation therapies, according to findings published in The American Journal of Medicine.

Investigators conducted a systematic review and meta-analysis to determine how the safety and efficacy of vaping, with both nicotine and non-nicotine e-cigarettes, compared with that of conventional strategies for smoking cessation. A primary outcome was how nicotine e-cigarettes compared with non-e-cigarette smoking cessation therapies with respect to continuous abstinence from conventional cigarettes at 12 months; continuous abstinence at 6 months; point prevalence abstinence at 12 months; and point prevalence abstinence at 6 months. Change in daily cigarette consumption from baseline to 6 months, 12 months, and longest available follow-up were secondary outcomes.

The investigators searched the Cochrane CENTRAL, EMBASE, and MEDLINE databases from inception to January 2022 for randomized controlled trials (RCTs) published between 2013 and 2020 comparing the use of either nicotine or non-nicotine e-cigarettes with any conventional smoking cessation therapy (including behavioral counselling alone, gum, nicotine patches, or other nicotine replacement products).

The reviewers found 5 studies (3 with low risk of bias, 1 with high risk of bias) with follow-up lasting for at least 22 weeks, with 1 trial reporting 1 year of follow-up data.

Included RCTs involved adults who currently smoked, had at least 1 biochemically validated outcome of interest, and had a treatment period of at least 10 weeks. E-cigarette nicotine concentration in treatment arms ranged from 8 mg/mL to 18 mg/mL.

The pooled trial included 3253 adults (58% women; mean/median age, 41 to 52 years), with 426 individuals using nicotine e-cigarettes, 769 individuals using non-nicotine e-cigarettes, and 1058 individuals using conventional smoking cessation therapies. 58% women, mean/median age ranging 41 to 52 years, mean smoking history duration 22 to 35 years, mean 17.4 cigarettes/day.  Participants had a mean smoking history of 22 to 35 years, smoked a mean of 17.4 cigarettes per day, and 32% to 52% had additional individuals who smoked in their households.

Investigators found that use of nicotine e-cigarettes was associated with increased abstinence (as defined by the most rigorous abstinence criterion) vs conventional smoking cessation therapies (relative risk [RR], 1.77; 95% CI, 1.29-2.44). Additionally, compared with non-nicotine e-cigarettes, the use nicotine e-cigarettes increased abstinence (RR, 1.56; 95% CI, 1.13-2.15). Compared with conventional smoking cessation therapies, non-nicotine e-cigarettes increased abstinence (RR, 1.37; 95% CI, 0.66-2.85). At maximum follow-up, all trials reported low incidence of severe adverse effects or death.

Use of nicotine e-cigarettes vs non-e-cigarette smoking cessation therapy was associated with increased continuous abstinence at 6 months (RR, 1.45; 95% CI, 1.15-1.84), point prevalence abstinence at 6 months (RR, 1.43; 95% CI, 1.10-1.85), and point prevalence at maximum follow-up (RR, 1.51; 95% CI, 1.19-1.92).

Systematic review and meta-analysis limitations include lack of follow-up beyond 12 months, heterogeneity between included RCTs, and risk of publication bias.

“Among individuals attempting to quit smoking, nicotine e-cigarettes are more efficacious than conventional nicotine replacement or behavioral smoking cessation therapies and may prove beneficial in reducing smoking-related health risks,” investigators concluded. They added “Nicotine e-cigarettes were also superior to non-nicotine e-cigarettes in the risk of abstinence, and both outperformed conventional smoking cessation therapies.”

This article originally appeared on Pulmonology Advisor