#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.
Thank you for this but concerned about the long term effects of vaping. Varenicline has similar benefits as per the study above so will stick with this of tolerated