Summary
Introduction:
This text provides an analysis of a study comparing the effectiveness of e-cigarettes (EC) and nicotine replacement therapy (NRT) for smoking cessation. The study is a two-group pragmatic, multicenter, unblinded randomized control trial. The readers will learn about the study design, major findings, and the implications of the results.
Key Points:
* The study randomized 886 adult patients who smoke and sought smoking cessation services at local community health centers to use of e-cigarettes or nicotine replacement therapy.
* The study found an 8.1 absolute difference in 1-year abstinence rates in those who use e-cigarettes compared to nicotine replacement therapy.
* EC were associated with increased abstinence rates in each of the secondary outcomes compared to NRT.
* There were no significant increases in adverse events except for a 12% higher incidence of throat or mouth irritation in the EC group.
* 80% of patients in the EC group were still using EC at 1 year, suggesting that e-cigarettes may be a replacement for cigarettes instead of a strategy to quit using cigarettes.
* The study results may only apply to a select group of highly motivated individuals who want to stop smoking.
* The lack of blinding for patients, clinicians, and study personnel to treatment assignments could introduce bias in reporting and adjudication of outcomes.
* The health system in the UK facilitated free smoking cessation resources and intensive face-to-face behavioral counseling, which could limit its generalizability to patients who are not in health systems that can facilitate these resources.
Main Message:
The study found that e-cigarettes resulted in a modest increase in abstinence rates at 1 year with minor adverse effects compared to nicotine replacement therapy. however, the emerging concerns around vaping-induced lung injury and the fact that 80% of patients in the EC group were still using EC at 1 year suggest that more data are needed on the relative harms of EC or vaping before it can be routinely recommended for smoking cessation. The study results may only apply to a select group of highly motivated individuals, and the lack of blinding could introduce bias in reporting and adjudication of outcomes. Therefore, it is essential to consider these limitations before making any recommendations.
Citation
Jackson CD, Carter J, Kansagara D. E-Cigarettes Versus Nicotine Replacement Therapy for Smoking Cessation : hajek P, Phillips-waller a, Przulj D, et al. a Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy. N Engl J Med. 2019;380(7):629-637. Journal of general internal medicine. 2021;36(5):1481-1483. doi:10.1007/s11606-020-06408-7
