Source:

Borrelli B, O’Connor GT. N Engl J Med. 2019;doi:10.1056/NEJMe1816406.
Hajek P, et al. N Engl J Med. 2019;doi:10.1056/NEJMoa1808779.

February 21, 2019
3 min read
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E-cigarettes more effective than nicotine-replacement therapy for smoking cessation

Source:

Borrelli B, O’Connor GT. N Engl J Med. 2019;doi:10.1056/NEJMe1816406.
Hajek P, et al. N Engl J Med. 2019;doi:10.1056/NEJMoa1808779.

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Adults attempting to stop smoking were more likely to have sustained abstinence at 1 year when using e-cigarettes compared with nicotine-replacement products, according to a study published in the New England Journal of Medicine.

“The trial provides some indications of why e-cigarettes had better results than nicotine-replacement treatments,” Peter Hajek, PhD, of Queen Mary University of London, and colleagues wrote. “As in previous studies, e-cigarettes were more effective in alleviating tobacco withdrawal symptoms and received better ratings than nicotine-replacement therapy. They may also have allowed better tailoring of nicotine dose to individual needs.”

To compare the effectiveness of e-cigarettes vs. nicotine-replacement therapy as smoking-cessation aids, researchers conducted a two-group, pragmatic, multicenter, individually randomized, controlled trial at three national “stop-smoking” service sites in the U.K. from May 2015 through February 2018. Adults attending the “stop-smoking” service sites were randomly assigned to either the nicotine-replacement therapy group (n = 446; median age, 41 years; 47.8% women; median number of cigarettes per day, 15) or the e-cigarette group (n = 438; median age, 41 years; 48.2% women; median number of cigarettes per day, 15).

Participants in the nicotine-replacement group chose from a variety of products, including patch, gum, lozenge, nasal spray, inhalator, mouth spray, mouth strip or microtabs, which they then utilized for up to 3 months. Participants in the e-cigarette group were given an e-cigarette starter pack, which included a second-generation refillable e-cigarette with one bottle of nicotine e-liquid and a recommendation to later purchase their preferred flavor and strength of e-liquid.

For both groups, multisession behavioral support with local clinicians was provided for at least 4 weeks.

Researchers measured carbon monoxide levels at baseline, 4 weeks and 52 weeks. Use and ratings of trial products, ratings of withdrawal symptoms, adverse reactions and respiratory symptoms were also considered.

The primary outcome of the study was 1-year sustained abstinence.

Researchers found that the 1-year abstinence rate was 18% in the e-cigarette group and 9.9% in the nicotine-replacement group (RR = 1.83; 95% CI, 1.3-2.58) and that participants in the e-cigarette group were more likely to use their assigned product at 52 weeks than those in the nicotine-replacement group (80% vs. 9%).

Researchers also noted that throat or mouth irritation was reported more frequently in the e-cigarette group than the nicotine-replacement group (65.3% vs. 51.2%) but that nausea was more common in the nicotine-replacement group (37.9% vs. 31.3%).

When considering respiratory symptoms, researchers found that the e-cigarette group had greater declines in the incidence of cough and phlegm production from baseline to 52 weeks than the nicotine replacement group (RR for cough = 0.8; 95% CI, 0.6-0.9; RR for phlegm = 0.7; 95% CI, 0.6-0.9) but that there were no significant differences between the two groups in the incidence of wheezing or shortness of breath.

E-cigarette 
Adults attempting to stop smoking were more likely to have sustained abstinence at 1 year when using e-cigarettes compared with nicotine-replacement products.
Source: Adobe Stock

“Further trials are needed to determine whether our results generalize outside the U.K. services,” the researchers wrote. “In addition, e-cigarette studies are needed that compare different levels of support. This is important for focusing public health messages on either encouraging smokers to switch to e-cigarette use within support services or recommending use with less intensive or no support.”

In a related editorial, Belinda Borrelli, PhD, of Boston University, and George T. O’Connor, MD, of Boston University School of Medicine, wrote: “The use of e-cigarettes by pregnant women, who were excluded from the trial by Hajek et al, raises special safety concerns. Although nicotine-patch use during pregnancy is associated with a higher rate of smoking cessation and better child-development outcomes than placebo, there are no such reassuring data for e-cigarettes. An additional societal consideration is the effect of adult e-cigarette use on children and young adults. Adult use may not only expose children to e-cigarette vapor but also models addictive behavior. There is substantial evidence that e-cigarette use by youth increases the risk of smoking combustible tobacco cigarettes, and the U.S. Surgeon General has recently declared e-cigarette use among youth ‘an epidemic.’” by Melissa J. Webb

Disclosures: Hajek reports receiving grants and personal fees from Pfizer. Please see the study for all other authors’ relevant financial disclosures.

 

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