‘Strong certainty’ that e-cigarettes are better than other nicotine replacement therapy for quitting smoking, review finds

A Cochrane review, published on 17 November 2022, has concluded that there is a “strong certainty” that people who use nicotine-containing e-cigarettes to help them stop smoking are more likely to quit than those who use other forms of nicotine replacement therapy.

Researchers from the international Cochrane Collaboration reviewed current evidence and included 78 studies (22,052 participants), of which half were randomised controlled trials.

Six trials (2,378 participants) compared nicotine e-cigarettes to nicotine replacement therapy, with the results showing that people using e-cigarettes were 63% more likely to have stopped smoking tobacco after six months of treatment (relative risk 1.63, 95% confidence interval 1.30 to 2.04). The researchers calculated this would lead to an additional 4 people stopping smoking for every 100 who used e-cigarettes instead of nicotine replacement therapy.

The researchers found “moderate-certainty evidence” that adverse effects were equally common in people using e-cigarettes or nicotine replacement therapy. Non-randomised studies showed that the most commonly-reported adverse effects were throat and mouth irritation, headache, cough and nausea.

The research also found “moderate-certainty evidence” that nicotine-containing e-cigarettes were more likely to lead to successful quitting than non-nicotine e-cigarettes, but only “very low certainty” evidence about e-cigarettes compared to behavioural support or no support, owing to a lack of randomised controlled trials.

There are currently no nicotine-containing e-cigarettes licensed by the Medicines and Health products Regulatory Agency for smoking cessation, although the agency updated its guidance on e-cigarettes in October 2021, which the Department of Health and Social Care said would “pave the way” for licensing applications.

The Pharmaceutical Journal reported in April 2022 that, since the guidance was updated, the medicines regulator had not received any applications from companies to licence e-cigarettes as medicines to aid smoking cessation.

Commenting on the Cochrane review, Hazel Cheeseman, deputy chief executive of the anti-smoking charity Action on Smoking and Health, said: “Pharmacists should have already been recommending vaping as a smoking cessation option following new guidance from the National Institute for Health and Care Excellence last year.

“The updated Cochrane review gives us even stronger confidence in the evidence and reaffirms the importance of ensuring smokers know that vaping is an effective way to stop smoking.”

In November 2021, guidance issued by the National Institute for Health and Care Excellence said that adults who smoke should be informed of and given access to a range of aids and therapies to help them stop, including nicotine-containing e-cigarettes.