Efficacy and Safety of E-Cigarette Use for Smoking Cessation: a Systematic Review and Meta-analysis of Randomized Controlled Trials.

Introduction:
This text is a systematic review and meta-analysis of randomized controlled trials (RCTs) examining the efficacy and safety of electronic cigarettes (e-cigarettes) for smoking cessation. It highlights the findings of five RCTs with a total of 3253 participants, comparing the use of nicotine e-cigarettes, non-nicotine e-cigarettes, and conventional smoking cessation therapies. The review aims to provide evidence-based information on the potential benefits and risks of e-cigarettes as a smoking cessation aid.

Key Points:

* The study found that nicotine e-cigarettes were more effective in achieving the most rigorous criterion of biochemically validated abstinence compared to conventional smoking cessation therapies (RR 1.77; 95% CI, 1.29-2.44).
* Nicotine e-cigarettes also outperformed non-nicotine e-cigarettes in increasing the risk of abstinence (RR 1.56; 95% CI, 1.13-2.15).
* There were no significant differences in the change in daily cigarette consumption at maximum follow-up across treatments.
* The incidence of death or serious adverse events was low across all trials, and comparisons between smoking cessation therapies across all safety endpoints were inconclusive due to sparse data.
* Sensitivity analyses excluding studies at high risk of bias and using a Mantel-haenszel fixed-effect approach did not change the results of any of the primary efficacy endpoints.
* Previous systematic reviews and meta-analyses have suggested that nicotine e-cigarettes are associated with increased abstinence compared with non-nicotine e-cigarettes and have potential benefits compared with conventional smoking cessation therapies.
* The long-term health effects of e-cigarette use and their potential as a harm-reduction tool over long-term use require further investigation.

Main Message:
The study supports the use of nicotine e-cigarettes as a more efficacious smoking cessation aid compared to conventional nicotine replacement or behavioral smoking cessation therapies. While the absolute risk of serious adverse events is low, further research is needed to better understand the long-term health effects of e-cigarette use. The potential benefits of e-cigarettes as a harm-reduction tool over long-term use should be weighed against the risks, particularly in terms of their appeal to youth and potential gateway effect. Public health simulation models generally support the use of e-cigarettes as a net benefit to the population.

Levett JY, Filion KB, Reynier P, Prell C, Eisenberg MJ. Efficacy and Safety of E-Cigarette Use for Smoking Cessation: a Systematic Review and Meta-analysis of Randomized Controlled Trials. The american journal of medicine. Published online May 5, 2023. doi:10.1016/j.amjmed.2023.04.014