#401 Vape Expectations: Are electronic cigarettes the real deal for smoking cessation? (Update)
CLINICAL QUESTION
Are nicotine-containing e-cigarettes more effective than other available options for smoking cessation?
BOTTOM LINE
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
- 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.
- Versus NRT: 18% versus 10% (NRT), number needed to treat (NNT)=14.
- Adverse events:
- Versus NRT or nicotine-free e-cigarettes:1 No difference.
- Smoking cessation rates (6-12 months):
- Nicotine-free e-cigarettes:1
- Cessation rates (3-6 months):
- Versus NRT or behavioural/no support: No difference.
- Cessation rates (3-6 months):
- 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
- 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
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Great news validating what we do intuitively.
Very useful and interesting info.
Good information.
My concern is that the long-term harm of e-cigarettes may be worse than regular tobacco cigarettes. The other problematic aspect of e-cigarettes is that you have an entire generation hooked on them and are, by and large, the drivers/consumers of this modality – not the above population who wants to get off regular nicotine cigarettes. That “…70% still using e-cigarettes after 6 months” is a telling statistic. The addictive potential of e-cigarettes, in my view, makes tobacco cigarettes look like a child’s play. I’ve seen people using them on public transport, gas stations (while fueling!), movie theaters, etc. Due to the form factor, they’re easy to evade detection.