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E-cigs Work Better than Nicotine Replacement Therapy

It’s a controversial topic here in Australia.

But a new UK study, just published in the New England Journal of Medicine, gives strong support the role of e-cigarettes as a smoking cessation therapy.

The randomised controlled trial of almost 900 adult smokers wanting to quit found the one-year abstinence rate was 18% among the e-cigarette users compared to 9.9% among those who were randomised to receive nicotine replacement therapy.

Much of the difference could be attributed to adherence to the assigned product. After 12 months, 80% of the e-cigarette group were still using the device whereas only 9% of the alternative group were still taking their nicotine replacement therapy despite being able to choose between the patch, gum, lozenge, nasal spray, inhalator, mouth spray, mouth strip, and microtabs (or any combination of these).

Participants in both groups underwent the same multi-session behavioural support as per best practice guidelines.

This study provides some of the strongest evidence to date that e-cigarettes are significantly better than nicotine replacement therapy in helping people quit smoking, the study authors suggest.

“This is particularly noteworthy given that nicotine replacement was used under expert guidance, with access to the full range of nicotine-replacement products and with 88.1% of participants using combination treatments,” they said.

The researchers suggested e-cigarettes had better adherence rate because they were more effective at reducing the symptoms of withdrawal when quitting smoking, because the refillable devices are better at delivering nicotine compared with options such as gum or patches. They also suggest the nicotine dose provided by e-cigarettes was easier to tailor to individual needs than other replacement options.

And even though people using the e-cigarettes were more likely to get mouth or throat irritation, this side effect was generally mild and tolerable especially compared to withdrawal symptoms such as constipation, mouth ulcers and weight gain.

In general, the researchers claim replacing cigarettes with e-cigarettes is a definite positive in terms of health outcomes and much better than other nicotine replacement options, but they suggest the high rate of adherence in the e-cigarette group may have some negative connotations.

“This can be seen as problematic if e-cigarette use for a year signals ongoing long-term use, which may pose as-yet-unknown health risks,” they said.

As an accompanying editorial points out, fundamentally nicotine is highly addictive. While electronic cigarettes have been proven to be a great tool in helping people get off normal cigarettes, there may be an issue if non-smokers, especially teenagers take up vaping, making them vulnerable to becoming smokers further down the track.

“The cigarette company may well see e-cigarettes as addictive bait that will lead young people toward smoking,” the US editorial authors suggest.

They suggest this potential problem could be relatively easily averted by ensuring e-cigarettes aren’t manipulated to enhance their appeal, specifically the authorities should not allow the manufacture of flavoured nicotine products.

However, they too acknowledge e-cigarettes have a significant role to play in solving this public health problem – ‘by helping people who are users of combustible tobacco products stop smoking by switching to vaping.’

References:

Hajek P, Phillips-Waller A, Przulj D, Pesola F, Smith KM, Bisal N, et al. A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy.  N Engl J Med. 2019 Jan 30;  DOI: 10.1056/NEJMoa1808779 [Epub ahead of print]

Drazen JM, Morrissey S, Campion EW. The Dangerous Flavors of E-Cigarettes. N Engl J Med. 2019 Jan 30. DOI: 10.1056/NEJMe1900484 [Epub ahead of print]