Cochrane Review Finds e-Cigs Are More Effective Than Patches or Gum

Peter Russell

October 16, 2020

Electronic cigarettes (ECs) are likely to be more effective at helping people stop smoking cigarettes than nicotine replacement therapy (NRT), according to an updated Cochrane review.

However, more evidence was needed about potential long-term harms from electronic cigarettes, researchers said.

The findings drew on 50 studies - of which 26 were randomised controlled trials - involving 12,430 adults who smoked.

The studies, from 13 countries, including the US, UK, and Italy, compared ECs with:

  • NRT, such as patches or gum

  • Varenicline

  • Nicotine‐free ECs

  • Behavioural support, such as advice or counselling

  • No support for smoking cessation

Three of the studies, involving 1498 people, compared nicotine-containing ECs with NRT.

The researchers found there was "moderate‐certainty evidence", which they said was "limited by imprecision", that nicotine-containing ECs were more likely to help smokers quit than NRT.

In a statement, they explained that if six people in 100 quit by using NRT, 10 people in 100 would quit by using ECs.

Evidence Lacking on Longer-term Side Effects

The study authors found no information about side effects of using ECs for more than 2 years. However, they said throat and mouth irritation, headache, cough, and nausea were the most commonly reported side effects by those using ECs for up to 2 years.

Jamie Hartmann-Boyce, who led the review, said: "The randomised evidence on smoking cessation has increased since the last version of the review and there is now evidence that electronic cigarettes with nicotine are likely to increase the chances of quitting successfully compared to nicotine gum or patches.

"Electronic cigarettes are an evolving technology. Modern electronic cigarette products have better nicotine delivery than the early devices that were tested in the trials we found, and more studies are needed to confirm whether quit rates are affected by the type of electronic cigarettes being used."

The efficacy and safety of ECs has been hotly debated since their introduction more than 10 years ago.

A report from Public Health England (PHE) earlier this year found a growing number of people wrongly believed that their use was more harmful than smoking tobacco.

In September, the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment said ECs were likely to reduce the harm to health if used as a replacement for conventional cigarettes. However, it said they still posed a risk to health and that the risk to health in the long-term remained unknown.

'An Effective Tool'

Commenting on the Cochrane review to the Science Media Centre, Prof Peter Hajek, director of the Tobacco Dependence Research Unit at Queen Mary University of London, said: "The results of this new review of randomised trials of vaping tally with other evidence from cohort and epidemiological studies, suggesting that for many smokers, e-cigarettes represent an effective tool for quitting smoking.

"It is also important to note that the studies detected no evidence of harm from vaping in people using e-cigarettes for up to 2 years."

John Britton, emeritus professor of respiratory medicine at the University of Nottingham, said it "endorses the UK policy of promoting electronic cigarettes as a consumer product that can help smokers quit smoking completely, and supports the recommendation of electronic cigarettes in the NHS".

Action on Smoking and Health (ASH) said the latest evidence reinforced the case for more smokers to be encouraged to use ECs as a quitting strategy.

Deborah Arnott, ASH's chief executive, said: "About a third of smokers have never even tried an e-cigarette and less than 20% are currently using one. If many more smokers could be encouraged to give e-cigarettes a go, the latest evidence indicates that many more might successfully quit.

"Health professionals have an important role to play. They can give smokers the confidence to try an e-cigarette, by letting them know that they can help them manage cravings and that they are a much safer alternative than continuing to smoke."


Dr Nick Hopkinson, reader in respiratory medicine at Imperial College London, and chair of ASH, said: "I would urge colleagues throughout the NHS to join me in encouraging those smokers who could benefit to try using an e-cigarette.

"The more smokers we can get to quit today, the fewer people will be in our clinics and hospitals tomorrow."


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