A Randomized Trial of E-Cigarettes Versus Nicotine-Replacement Therapy

Summary of Study

Bottom Line: A trial evaluated the 1-year efficacy of refillable e-cigarettes as compared with nicotine replacement when provided to adults seeking help to quit smoking and combined with face-to-face behavioral support. The 1-year abstinence rate was 18.0% in the e-cigarette group, as compared with 9.9% in the nicotine-replacement group. This finding is particularly noteworthy because nicotine replacement was used under expert guidance, with access to the full range of nicotine-replacement products. 

E-cigarettes are commonly used in attempts to stop smoking, but evidence is limited regarding their effectiveness as compared with that of nicotine products approved as smoking-cessation treatments. A Cochrane review showed that e-cigarettes with nicotine were more effective for smoking cessation than nicotine-free e-cigarettes.

The effectiveness of e-cigarettes and nicotine-replacement therapy were compared in this randomized trial of 886 participants. The trial evaluated the 1-year efficacy of refillable e-cigarettes as compared with nicotine replacement when provided to adults seeking help to quit smoking and combined with face-to-face behavioral support.

Findings include: 

  • The 1-year abstinence rate was 18.0% in the e-cigarette group, as compared with 9.9% in the nicotine-replacement group.
  • Among participants in whom full abstinence was not achieved, more had a carbon monoxide–validated reduction of smoking by at least 50% in the e-cigarette group than in the nicotine replacement group.
  • E-cigarettes were used more frequently and for longer than nicotine replacement.
  • E-cigarettes provided greater satisfaction and were rated as more helpful to refrain from smoking than nicotine replacement products.
  • E-cigarette users had less severe urges to smoke than did those in the nicotine-replacement group.
  • E-cigarette users also reported a smaller increase from baseline in irritability, restlessness, and inability to concentrate than those in the nicotine-replacement group.
  • The e-cigarette group reported greater declines in the incidence of cough and phlegm production from baseline to 52 weeks than did the nicotine-replacement group.
  • There were no significant between-group differences in the incidence of wheezing or shortness of breath.
  • Throat or mouth irritation was reported more frequently in the e-cigarette group than the nicotine-replacement group.
  • Nausea was more frequently reported in the nicotine-replacement group than the e-cigarette group.

Read the full report here.