Assessing Nicotine Pharmacokinetics of New-Generation Tobacco Products and Conventional Cigarettes: A Systematic Review and Meta-analysis

Introduction:
This article provides a comprehensive summary of a systematic review and meta-analysis examining the nicotine pharmacokinetics (PK) of new-generation tobacco products (NGPs), including closed pod systems, refillable e-cigarettes (ECs), and heated tobacco products (HTPs), in comparison to conventional cigarettes (CCs). The study systematically reviewed and analyzed articles published between January 2013 and July 2023 to evaluate nicotine PK, including maximum nicotine concentration (Cmax), time to peak concentration (Tmax), and total nicotine exposure (area under the concentration-time curve, AUC).

Key Points:

* The meta-analysis incorporated 30 articles with 2728 participants.
* Cmax and AUC were significantly lower for NGPs, while Tmax demonstrated statistical similarity compared to CCs.
* Among three NGPs, Cmax, and AUC were lower for closed pod systems and refillable ECs. In HTPs, Cmax was statistically similar while AUC was lower compared to CCs.
* Tmax was statistically similar in closed pod systems and HTPs compared to that of CCs.
* No significant difference was observed in the comparisons of PK between each type of NGPs versus CCs.
* Subgroup analyses were conducted based on flavors, nicotine concentrations, age, gender, and continent characteristics.
* Publication bias was found in the analysis, suggesting the possibility of selective reporting or publication of studies.

Main Message:
The study suggests that NGPs deliver less nicotine than CCs but reach Cmax over a similar timeframe. This indicates that NGPs may serve as modified-risk alternatives with lower nicotine delivery to CCs for craving relief and smoking cessation. The findings highlight the value of NGPs in the field of tobacco harm reduction, offering smokers safer choices and potentially aiding in smoking cessation efforts. However, regulatory measures and comprehensive research are essential to comprehend and evaluate the full spectrum of potential benefits and risks associated with these nascent products.

Yue Cao, Xinru Liu, Zhongyi Hu, Jiaxuan Li, Xi Chen, Yuming Xiong, Fangzhen Zheng, Jianqiang Zhang, Lin Zhang, Xiaona Liu, Assessing Nicotine Pharmacokinetics of New-Generation Tobacco Products and Conventional Cigarettes: A Systematic Review and Meta-analysis, Nicotine & Tobacco Research, Volume 27, Issue 5, May 2025, Pages 783–793, https://doi.org/10.1093/ntr/ntae199