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Smoking cessation

E-cigarettes nearly twice as effective as nicotine-replacement therapy to stop smoking, study finds

One reason that e-cigarettes may be more effective for smoking cessation is because they allow smokers to tailor the nicotine dose to their needs, a study suggests.

Man using e-cigarette


After one year, 18.0% of participants in the e-cigarette group had stopped smoking, compared with 9.9% in the nicotine replacement therapy group

E-cigarettes are almost twice as effective as nicotine-replacement therapy (NRT) for smoking cessation when both are accompanied by behavioural support, according to a study from researchers at Queen Mary University of London.

The “groundbreaking” study, funded by the National Institute for Health Research (NIHR) and Cancer Research UK, also suggested that one reason for the success of e-cigarettes in smoking cessation was that they allowed smokers to tailor the nicotine dose to their needs.

In the trial, just under 900 participants who were already using UK NHS stop-smoking services were randomly assigned to either a NRT product of their choice, including combination treatments, or an e-cigarette starter pack. The starter pack contained a second-generation refillable e-cigarette with one bottle of nicotine e-liquid, plus a recommendation to purchase further e-liquids of the flavour and strength of their choice.

Both treatment groups also received weekly behavioural support for at least four weeks.

The researchers found that, after one year, 18.0% of participants in the e-cigarette group had stopped smoking, compared with 9.9% in the NRT group (relative risk 1.83; 95% confidence interval 1.30–2.58; P<0.001).

Furthermore, among those who had successfully quit smoking for one year, those in the e-cigarette group were significantly more likely to use their assigned product at 52 weeks than those in the NRT group (80% [63 of 79 participants] vs. 9% [4 of 44 participants], respectively).

The treatment groups also recorded their side effects. Throat or mouth irritation was reported more frequently in the e-cigarette group and nausea was reported more often in the NRT group, but the effects were mostly mild.

The researchers said that the trial provided some indication of why e-cigarettes had better results than NRT; namely, that e-cigarettes were more effective in alleviating tobacco withdrawal symptoms and may have allowed better tailoring of nicotine dose to individual needs.

They said the findings were likely to be valid for dependent smokers seeking help, but may not apply to smokers who are less dependent or who try e-cigarettes for reasons other than quitting smoking.

Hywel Williams, director of the NIHR health technology assessment programme, described the study as “groundbreaking”.

“Cigarette smoking is still a major cause of ill health and death in the UK, so this study will provide much needed evidence to help people and policymakers to make informed choices,” he said. 

Martin Dockrell, tobacco control lead at Public Health England, said: “All stop-smoking services should welcome smokers who want to quit with the help of an e-cigarette.”

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20206076

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