Nicotine Patches Used in Combination With E-Cigarettes (With and Without Nicotine) For Smoking Cessation: A Pragmatic, Randomized Trial

Summary of Study

Bottom Line: The use of nicotine e-cigarettes in addition to nicotine patches results in three to seven additional smokers quitting long-term per 100 versus those who use patches alone. These findings are consistent with a growing body of evidence from randomized trials on the efficacy, effectiveness and safety of e-cigarettes for smoking cessation.

This study finds that combining reduced-harm nicotine products, such as nicotine patches with a nicotine e-cigarette, can lead to a modest improvement in smoking cessation over and above that obtained from using patches plus a nicotine-free e-cigarette (or patches alone), with no indication of any serious harm in the short-term.

Verified continuous abstinence at 6 months after the agreed quit date was significantly higher in the patches plus nicotine e-cigarette group (7%) vs. the patches plus nicotine-free e-cigarette group (4%). Self-reported cessation outcomes were significantly higher at 1, 3, and 6 months after the agreed quit date in favor of the patches plus nicotine e-cigarette group.

There was little-to-no observed benefit among the patches plus nicotine-free e-cigarette group and the patches alone group. The former had a 6-month quit rate of 4% while the latter had a 6-month quit rate of 3%. This finding suggests that combining the use of a slow-release nicotine patch with a faster-acting oral nicotine product (in this case a nicotine e-cigarette) has a significant impact on smoking abstinence.

Further, the proportion of people reducing the number of cigarettes per day by more than 50% was significantly higher (at all time points) in the patches plus nicotine e-cigarette group than in the patches only group.

This study adds to the scarce trial evidence base on e-cigarettes as a smoking cessation tool and is the first to investigate the effectiveness and safety of combining nicotine patches and second-generation e-cigarettes (with and without nicotine) on smoking abstinence.

To date, seven clinical trials have investigated the efficacy and effectiveness of e-cigarettes for smoking cessation and overall suggest a net benefit.

E-cigarettes should be offered as one of the many smoking cessation aids available to people wanting to quit, but do not appear to be a solution for all. People using e-cigarettes should be encouraged to fully switch away from tobacco to e-cigarettes, with the aim of eventually also stopping vaping (if possible) given the lack of any long-term safety data for these devices.

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Impact of Nicotine Patches & E-Cigarette Use on Smoking Abstinence

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Findings:

  • Verified continuous abstinence at 6 months after the agreed quit date was significantly higher in the patches plus nicotine e-cigarette group (7%) vs. the patches plus nicotine-free e-cigarette group (4%). 
  • Self-reported cessation outcomes were significantly higher at 1, 3, and 6 months after the agreed quit date in favor of the patches plus nicotine e-cigarette group. 
  • Thes results suggest that combining reduced-harm nicotine products, such as nicotine patches with a nicotine e-cigarette, can lead to a modest improvement in smoking cessation.