1. The use of nicotine e-cigarettes in addition to conventional nicotine patches may result in a modest improvement in smoking cessation when compared to patches alone or patches used in combination with nicotine-free e-cigarettes.
Evidence Rating Level: 2 (Good)
Nicotine replacement therapy (NRT) has been shown to reduce nicotine withdrawal symptoms in individuals trying to quit smoking. While various formulations, such as gum and nicotine patches, are available, the use of these NRT products does not allow for the rapid delivery of nicotine in the high concentrations that cigarette smokers are accustomed to. E-cigarettes, may represent an alternative NRT strategy, enabling users to obtain nicotine rapidly, in high concentrations, comparable to cigarettes. And while previously conducted studies indicate limited efficacy and effectiveness of e-cigarettes with respect to smoking cessation, the current randomized controlled trial aimed to examine whether conventional NRT combined with nicotine e-cigarette use is more effective in smoking cessation than NRT plus a nicotine-free e-cigarette, or conventional NRT alone. As part of the study, 1124 smokers age 18 years or older were randomized to receive nicotine patches only, nicotine patches plus a nicotine e-cigarette, or patches plus a nicotine-free e-cigarette. Participants were subsequently followed up for 6 months after the agreed quit date. Individuals were excluded if they had used an e-cigarette for smoking cessation for more than 1 week any time in the past year, if they were currently using smoking cessation medication, or if they were already enrolled in another smoking cessation program or study. Of note, approximately half of participants in the patches only group either withdrew from the study or were lost to follow-up. 32% and 33% of participants from the patches plus nicotine e-cigarette group and patches plus nicotine-free e-cigarette group withdrew or were lost to follow-up, respectively. Researchers found that a greater proportion of participants in the patches plus nicotine e-cigarette group, 7%, achieved carbon monoxide (CO)-verified continuous abstinence at 6 months of follow-up, when compared to those in the patches plus nicotine-free e-cigarette group (4%) and the patches only group (2%). This was, however, a modest improvement, particularly between the two e-cigarette groups (risk difference, RD 2.99, 95% CI 0.17 to 5.81). Serious adverse events occurred in 4% and 5% of participants in the patches plus nicotine e-cigarette group and patches plus nicotine-free e-cigarette group, respectively. This study therefore shows that the use of nicotine e-cigarettes in addition to conventional NRT patches may result in a modest improvement in smoking cessation when compared to patches alone or patches used in combination with nicotine-free e-cigarettes.
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