E-cigarettes are more effective than nicotine replacement treatments in achieving long term smoking reduction and cessation, according to the results of a clinical trial by Queen Mary University of London.
Some 80% of smokers receiving intensive treatment continue to smoke after a year. Smokers could benefit from approaches that reduce the harm from smoking without ceasing nicotine use, with an option to stop nicotine later on.
Nicotine replacement treatments (NRT), such as nicotine patches, chewing gum, nasal/mouth spray and inhalators, have been licenced to do this for over 30 years. They work, especially if behavioural support is also provided, but the results are modest.
In the first study of its kind, researchers enrolled 135 smokers who had been unable to stop smoking with conventional treatments.
They were randomised to receive either an eight-week supply of NRT of their choice, or an e-cigarette starter pack, with instructions to purchase further e-liquids of strength and flavours of their choosing for themselves. Products were accompanied by minimal behavioural support to quit smoking.
The results, published in the journal Addiction, found a significant difference in smoking reduction (including quitting altogether) in the e-cigarette group. After six months, in the e-cigarette group, 27% of the participants had reduced their smoking by at least half, compared to 6% of participants in the NRT group.
A significant difference was also found in rates of stopping smoking altogether, confirmed by carbon monoxide readings from participants' breath – 19% of participants in the e-cigarette group had stopped smoking versus 3% in the NRT group.
The results suggest that recommending a refillable e-cigarette with an e-liquid with a strength and flavour of the patient's choice is a more effective approach for dependent smokers than prescribing NRTs. The e-cigarette starter pack also costs much less than NRTs.
Lead researcher and Health Psychologist Dr Katie Myers Smith from Queen Mary University of London, said: "These results have important clinical implications for smokers who have previously been unable to stop smoking using conventional treatments.
“E-cigarettes should be recommended to smokers who have previously struggled to quit using other methods, particularly when there is limited behavioural support available."
Michelle Mitchell, Chief Executive of Cancer Research UK, which funded the study, said: "This study shows e-cigarettes can be a very effective tool for people who want to stop smoking, including those who've tried to quit before.
“And research so far shows that vaping is far less harmful than smoking. But e-cigarettes aren't risk free, and we don't yet know their long term effects, so people who have never smoked shouldn't use them.
"It's important to switch over completely to get the benefits and reduce your risk of cancer. Talk to your GP or free, local stop smoking service about finding the best option for you."
E-cigarettes versus nicotine replacement treatment as harm reduction interventions for smokers who find quitting difficult: Randomised controlled trial
Katie Myers Smith, Anna Phillips-Waller, Francesca Pesola, Hayden McRobbie, Dunja Przulj, Marzena Orzol and Peter Hajek
Author affiliations: Health and Lifestyle Research Unit at Queen Mary University of London; and National Drug and Alcohol Research Centre at the University of New South Wales in Australia.
Published in Addiction on 29 June 2021.
Abstract
The majority of smokers accessing the current best treatments continue to smoke. We aimed to test if e-cigarettes (EC) compared with nicotine replacement treatment (NRT) can help such smokers reduce smoking.
Design
Randomised controlled trial of EC (n=68) vs NRT (n=67) with 6-month follow-up.
Setting
Stop smoking service in London, UK.
Participants
135 smokers (median age=40, 51% males) previously unable to stop smoking with conventional treatments.
Interventions
Participants received either NRT of their choice (8 week supply), or an EC starter pack and instructions to purchase further e-liquids of strength and flavours of their choice themselves. Products were accompanied by minimal behavioural support.
Measurements
Participants who reported that they stopped smoking or reduced their daily cigarette consumption by at least 50% at six-month follow-up were invited to provide a carbon monoxide (CO) reading.
The primary outcome was biochemically validated reduction in smoke intake of at least 50% at 6 months and the main secondary outcome was sustained validated abstinence at 6 months. Drop-outs were included as ‘non-reducers’.
Findings
Validated smoking reduction (including cessation) was achieved by 26.5% vs 6.0% of participants in the EC and NRT study arms, respectively (relative risk (RR)=4.4, p=0.005, 95% confidence interval (CI):1.6 to 12.4). Sustained validated abstinence rates at 6 months were 19.1% vs 3.0% (RR=6.4, p=0.01, 95%CI: 1.5 to 27.3).
Product use was high and equal in both study arms initially, but at 6 months allocated product use was 47% in the EC arm vs 10% in the NRT arm (chi(1)=22.0, p<.001), respectively. Adverse events were minor and infrequent.
Conclusions
In smokers unable to quit using conventional methods, e-cigarettes were more effective than nicotine replacement therapy in facilitating validated long-term smoking reduction and smoking cessation, when limited other support was provided.
See also from the MedicalBrief archives
Starter e-cigarette packs to be offered by hospitals to help smokers quit – UK study
E-cigarettes: What we know and what we don’t – Cancer Research UK
Australian GPs willing to prescribe e-cigarettes to help patients quit
Oxford review: E-cigarettes versus traditional nicotine replacement therapies
E-cigarettes are no better than alternative aids to quit smoking – US study