E-cigarettes outperform NRT in patients with unsuccessful quit history in recent study

The study findings suggest that for smokers who have failed to quit with stop-smoking medications in the past, recommending a refillable e-cigarette is a more effective approach than prescribing combination nicotine replacement therapy (NRT).

There are currently no medicinally licensed e-cigarettes in the UK. | GETTY IMAGES
There are currently no medicinally licensed e-cigarettes in the UK. | GETTY IMAGES

The study involved 135 adult smokers, previously unable to stop smoking with conventional treatments, who were randomised to NRT (a single product or a combination of products of their choice; n=67) or a refillable e-cigarette product of their choice (n=68) with minimal behavioural support.

Follow-up was conducted at one week, four weeks and six months to ascertain smoking status, cigarettes per day, and use of allocated and non-allocated products since the last visit. In addition, carbon monoxide (CO) readings were taken from patients who reported stopping smoking or reducing their cigarette use by at least half at the four-week and six-month follow-ups.

E-cigarettes more effective than NRT

E-cigarette use was associated with a significantly greater percentage of patients achieving a reduction in smoke intake of ≥50% at six months (confirmed by a reduction in end-expired CO levels of ≥50% compared to baseline) than NRT use (26.5% versus 6.0%, respectively; p=0.005).

CO-validated abstinence rates at six months were also significantly greater in the e-cigarette arm than in the NRT arm (19.1% versus 3.0%, respectively; p=0.01).

The researchers also report that although product use was high and equal in both groups initially, at six months allocated product use was significantly higher in the e-cigarette group than in the NRT group (47% versus 10%; p<0.001).

They conclude that in smokers who are unable to quit using conventional methods, e-cigarettes were more effective than NRT in facilitating validated long-term smoking reduction and smoking cessation, when limited other support was provided.

Guidance from NICE and PHE

Draft guidance issued recently by NICE in association with Public Health England (PHE) recommends that healthcare staff should give clear and up-to-date information on e-cigarettes to people who are interested in using them to stop smoking. 

The draft guidance states that there is evidence to show that nicotine-containing e-cigarettes can help people to quit smoking and are similarly effective to other cessation options such as a combination of short- and long-acting NRT. As such, the expert committee agreed that people should be able to use e-cigarettes as one of several options to support smoking cessation, if they so choose.

NICE proposes that people should be advised on where to find information on nicotine-containing e-cigarettes, and that while the use of e-cigarettes is substantially less harmful than smoking, the long-term health effects of these products are still uncertain. In addition, the draft guidance recommends that people should be advised how to use e-cigarettes correctly and instructed to stop smoking completely if they start using nicotine-containing e-cigarettes.

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