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Electronic cigarettes for smoking cessation.

Jamie Hartmann-Boyce1, Hayden McRobbie2, Nicola Lindson1

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The Cochrane Database of Systematic Reviews
|April 29, 2021
PubMed
Summary
This summary is machine-generated.

Electronic cigarettes (ECs) with nicotine aid smoking cessation more effectively than nicotine replacement therapy (NRT) or non-nicotine ECs. While generally safe, further research is needed on modern EC devices and long-term effects.

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Area of Science:

  • Public Health
  • Addiction Medicine
  • Respiratory Medicine

Background:

  • Electronic cigarettes (ECs) are widely used by smokers attempting to quit, but their efficacy and safety remain debated.
  • Regulatory bodies and healthcare providers require robust evidence on the effectiveness of ECs for smoking cessation.
  • This review is an update examining the latest evidence on ECs for achieving long-term smoking abstinence.

Purpose of the Study:

  • To evaluate the effectiveness of electronic cigarettes (ECs) in helping smokers achieve long-term abstinence.
  • To assess the tolerability and safety profile of EC use for smoking cessation.
  • To compare nicotine ECs against various control conditions, including nicotine replacement therapy (NRT) and non-nicotine ECs.

Main Methods:

  • A systematic review including randomized controlled trials (RCTs) and randomized cross-over trials.
  • Studies were included if they reported smoking abstinence at six months or longer and/or safety data.
  • Data were extracted and analyzed using fixed-effect Mantel-Haenszel models for dichotomous outcomes and mean differences for continuous outcomes.

Main Results:

  • Moderate-certainty evidence shows nicotine ECs increase quit rates compared to NRT (RR 1.69) and non-nicotine ECs (RR 1.70).
  • Nicotine ECs also showed higher quit rates compared to behavioral support alone/no support (RR 2.70), though with very low certainty.
  • Adverse events (AEs) were generally similar between nicotine ECs and controls, with common AEs like throat irritation tending to decrease over time. Serious adverse events (SAEs) were rare with no clear difference detected.

Conclusions:

  • Nicotine ECs demonstrate moderate-certainty effectiveness in increasing smoking cessation rates compared to non-nicotine ECs and NRT.
  • Evidence suggests potential benefit over usual care, but requires further confirmation with modern EC products.
  • While no clear harm was detected, the evidence base is limited by imprecision and small study numbers; ongoing research is crucial.