In adults, vaping makes smoking cessation easier vs other nicotine replacements

  • Hajek P & al.
  • N Engl J Med
  • 14 Feb 2019

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • In adults, e-cigarettes are more effective than alternative nicotine-containing products in supporting smoking cessation.
  • Editorial  points out comparable cessation rates with medication, raises concerns about long-term vaping, advises use for cessation only if FDA-approved treatments fail and with "clear timeline and ‘off ramp’ for use."

Why this matters

  • Evidence has been inadequate about efficacy of e-cigarettes vs other nicotine-replacement products (NRPs) for smoking cessation in adults.

Key results

  • Abstinence, e-cigarettes vs NRP groups:
    • 18.0% vs 9.9%.
    • Relative risk, 1.83 (95% CI, 1.30-2.58); P<.001.>
    • Number needed to treat: 12.
    • Similar results in multiple sensitivity analyses and after multivariate adjustment.
  • Among those not achieving full abstinence, more in e-cigarette group had ≥50% reduction in smoking.
  • Among those achieving abstinence, continued product use was 80% with e-cigarettes vs 9% with NRPs.
  • No serious adverse events attributed to product use.

Study design

  • Randomized pragmatic clinical trial (n=886).
  • Adults who wanted to quit smoking were randomly assigned to nicotine-replacement product(s) of their choice vs e-cigarettes. 
  • 4 weeks’ face-to-face support provided.
  • Outcome: self-reported abstinence sustained ≥1 year, validated via expired carbon monoxide levels.
  • Funding: National Institute for Health Research; Cancer Research UK.

Limitations

  • Incomplete follow-up.
  • May not generalize to less motivated or less dependent smokers.

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