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#401 Vape Expectations: Are electronic cigarettes the real deal for smoking cessation? (Update)


CLINICAL QUESTION
QUESTION CLINIQUE
 Are nicotine-containing e-cigarettes more effective than other available options for smoking cessation?

BOTTOM LINE
RÉSULTAT FINAL
 For smoking cessation, nicotine e-cigarettes appear more effective than nicotine replacement therapy (NRT) (cessation rates: 18% versus 10% at 6-12 months). Nicotine-containing e-cigarettes have better cessation rates (10-11%) than nicotine-free e-cigarettes (~9.5%) and similar efficacy to varenicline. Short-term adverse effects of nicotine e-cigarettes are similar to comparators while long-term harms remain unknown. 


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EVIDENCE
DONNÉES PROBANTES
  • Differences statistically significant unless stated.
  • Focusing on largest systematic review of 47 randomized controlled trials (RCTs) and notable RCTs since systematic review. Patients’ motivation to quit varied.  Cessation rates: biochemically-validated.
  • Nicotine e-cigarettes:1
    • Smoking cessation rates (6-12 months):
      • Versus NRT: 18% versus 10% (NRT), number needed to treat (NNT)=14.
        • 6 of 7 RCTs: Publicly funded.
      • Versus nicotine-free e-cigarettes: 11% versus 9.6% (nicotine-free e-cigarettes), NNT=75.
      • Versus behavioural/no support: 10% versus 6.3% (control), NNT=25.
    • Adverse events:
      • Versus NRT or nicotine-free e-cigarettes:1 No difference.
  • Nicotine-free e-cigarettes:1
    • Cessation rates (3-6 months):
      • Versus NRT or behavioural/no support: No difference.
  • Other systematic reviews: Similar.2-7 Exception:
    • Throat irritation: 55% (nicotine e-cigarettes) versus 44% (NRT), number needed to harm=9 (3-12 months).2
  • Publicly funded, open-label RCT comparing standard-of-care counselling plus nicotine e-cigarettes or counselling alone (possibly including medications), 1246 patients (mean: 38 years, ~15 cigarettes/day for 25 years).8 At 6 months:
    • Abstinence: 29% versus 16% (control), NNT=8.
    • Adverse effects: 44% versus 37% (control), NNH=15.
      • Serious (including respiratory): Similar.
  • Industry-supported, double-blind RCT comparing 12-week use of nicotine e-cigarettes, varenicline or placebo, 458 patients (mean: 50 years, ~33 years smoking).9 At six months:
    • Abstinence 44% (varenicline), 40% (e-cigarettes), versus 20% (placebo).
    • Stopping due to adverse effects: 18% (varenicline), 9.9% (e-cigarettes), 9.2% (placebo) (no statistics reported).
 
CONTEXT
CONTEXTE
  • In Canada:
    • 11% currently smoke.10
    • Nicotine e-cigarettes not approved for smoking cessation.11
    • Guidelines do not recommend nicotine e-cigarettes as first line.11
  • Long-term harms unknown.12
    • Hospitalization and deaths from vaping-induced lung injuries reported, most with THC-containing e-cigarettes.13,14
  • Among those quitting tobacco cigarettes with nicotine e-cigarettes, 70% still using e-cigarettes after 6 months.15

Edward Papp November 10, 2025

Great news validating what we do intuitively.

Elaina Kaufman November 12, 2025

Very useful and interesting info.

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#401 Vape Expectations: Are electronic cigarettes the real deal for smoking cessation? (Update)

Are nicotine-containing e-cigarettes more effective than other available options for smoking cessation?
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Author(s)
Auteur(s)
  • Steven Piotrowski MSc MPAS CCPA
  • Mike Kolber MD MSc CCFP
  • Samantha Moe PharmD

1. Lindson N, Butler AR, McRobbie H, et al. Cochrane Database Syst Rev. 2024 Jan 8;1(1):CD010216.

2. Li J, Hui X, Fu J, et al. Tob Induc Dis. 2022 Oct 20:20:90.

3. Grabovac I, Oberndorfer M, Fisher J, et al. Nicotine Tob Res. 2021 Mar 19;23(4):625-634.

4. Hanewinkel R, Niederberger K, Pedersen A, et al. Eur Respir Rev. 2022 Mar 23;31(163): 210215.

5. Levett JY, Filion KB, Reynier P, et al. Am J Med. 2023 Aug;136(8):804-813.e4.

6. Vanderkam P, Bonneau A, Kinouani S, et al. Front Psychiatry. 2022 Aug 4:13:915946.

7. Pound CM, Zhang JZ, Kodua AT, et al. BMJ Open. 2021 Feb 22;11(2):e044222

8. Auer R, Schoeni A, Humair JP, et al. N Engl J Med. 2024 Feb 15;390(7):601-610

9. Tuisku A, Rahkola M, Nieminen P, et al. JAMA Intern Med. Aug 2024;184(8):915-921

10. Government of Canada. Canadian Tobacco and Nicotine Survey (CTNS): summary for 2022. Available at: https://www.canada.ca/en/health-canada/services/canadian-tobacco-nicotine-survey/2022-summary.html. September 19, 2023. Accessed: Oct 22, 2025.

11. Thombs BD, Traversy G, Reynolds DL, et al. CMAJ. 2025 Aug 25;197(28):E846-E861

12. Banks E, Yazidjoglou A, Brown S, et al. Med J Aust. 2023 Apr 3;218(6):267-275

13. Werner AK, Koumans EH, Chatham-Stephens K, et al. N Engl J Med. 2020 Apr 23;382(17):1589-1598.

14. Roslly MZ, Rozhan SAAS. N Engl J Med. 2025 Aug 7;393(6):592.

15. Butler AR, Lindson N, Fanshawe TR, et al. Prev Med. 2022; Dec;165(Pt B):107182

Authors do not have any conflicts of interest to declare.