Clinical Question

Is switching to e-cigarettes effective for helping smokers who want to quit?

Bottom Line

For adults who want to quit smoking, nicotine delivery via e-cigarettes plus counseling may be more effective than other means of nicotine replacement for long-term smoking cessation. There was no report of the percentage of patients who maintained e-cigarette use while remaining abstinent from smoking. (Level of Evidence = 1a)

Synopsis

The investigators searched three databases, including Cochrane CENTRAL, and identified five randomized controlled trials that studied a total of 3,253 people who smoked and wanted to quit. The studies were limited to those published in English or French. Two authors independently selected articles for inclusion and extracted the data. Two studies compared nicotine replacement with e-cigarettes plus counseling, nicotine-free e-cigarettes plus counseling, and counseling alone. Three studies compared nicotine replacement with e-cigarettes plus counseling with nicotine-free e-cigarettes and any conventional smoking cessation therapy (e.g., a patch). There were no studies of any comparison with varenicline (Chantix) or bupropion. Biochemically confirmed abstinence (via expired carbon monoxide levels) at six months (four studies) or one year (one study) was more likely with nicotine replacement with e-cigarettes than conventional therapy (relative risk = 1.77; 95% CI, 1.29 to 2.44), with a number needed to treat of 19 (95% CI, 10 to 51). e-Cigarettes with nicotine were also more effective than nicotine-free e-cigarettes (relative risk = 1.56; 95% CI, 1.13 to 2.15). There was no heterogeneity for these results among the studies. Study quality was generally high.