E-cigarettes versus nicotine replacement treatment as harm reduction interventions for smokers who find quitting difficult: randomized controlled trial.

Introduction:
This text is a summary of a randomized controlled trial that compares the effectiveness of e-cigarettes (EC) and nicotine replacement treatment (NRT) in helping smokers reduce or quit smoking. The study included smokers who had previously been unable to quit using conventional treatments. The trial aimed to determine if EC could be more effective than NRT in facilitating validated long-term smoking reduction and smoking cessation when limited other support was provided.

Key Points:

* The study was a randomized controlled trial of EC versus NRT with 6-month follow-up.
* Participants were smokers who had previously been unable to quit smoking with conventional treatments.
* Participants received either NRT of their choice or an EC starter pack and instructions to purchase further e-liquids of strength and flavours of their choice themselves.
* The primary outcome was biochemically validated reduction in smoke intake of at least 50% at 6 months, and the main secondary outcome was sustained validated abstinence at 6 months.
* Validated smoking reduction (including cessation) was achieved by 26.5% versus 6.0% of participants in the EC and NRT study arms, respectively.
* Sustained validated abstinence rates at 6 months were 19.1 versus 3.0% in the EC and NRT arms.
* Product use was high and equal in both study arms initially, but at 6 months allocated product use was 47% in the EC arm versus 10% in the NRT arm.
* adverse events were minor and infrequent.

Main Message:
The main message of this study is that in smokers unable to quit with conventional methods, e-cigarettes were more effective than nicotine replacement therapy in facilitating validated long-term smoking reduction and smoking cessation when limited other support was provided. These findings suggest that e-cigarettes may be a useful harm reduction tool for smokers who have been unable to quit using other methods. however, further research is needed to determine the long-term effects of e-cigarette use and to assess the potential risks and benefits of their use as a harm reduction strategy.

Myers Smith K, Phillips-Waller a, Pesola F, et al. E-cigarettes versus nicotine replacement treatment as harm reduction interventions for smokers who find quitting difficult: randomized controlled trial. addiction (abingdon, England). 2022;117(1):224-233. doi:10.1111/add.15628