A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy
- PMID: 30699054
- DOI: 10.1056/NEJMoa1808779
A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy
Abstract
Background: 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.
Methods: We randomly assigned adults attending U.K. National Health Service stop-smoking services to either nicotine-replacement products of their choice, including product combinations, provided for up to 3 months, or an e-cigarette starter pack (a second-generation refillable e-cigarette with one bottle of nicotine e-liquid [18 mg per milliliter]), with a recommendation to purchase further e-liquids of the flavor and strength of their choice. Treatment included weekly behavioral support for at least 4 weeks. The primary outcome was sustained abstinence for 1 year, which was validated biochemically at the final visit. Participants who were lost to follow-up or did not provide biochemical validation were considered to not be abstinent. Secondary outcomes included participant-reported treatment usage and respiratory symptoms.
Results: A total of 886 participants underwent randomization. The 1-year abstinence rate was 18.0% in the e-cigarette group, as compared with 9.9% in the nicotine-replacement group (relative risk, 1.83; 95% confidence interval [CI], 1.30 to 2.58; P<0.001). Among participants with 1-year abstinence, those in the e-cigarette group were more likely than those in the nicotine-replacement group to use their assigned product at 52 weeks (80% [63 of 79 participants] vs. 9% [4 of 44 participants]). Overall, throat or mouth irritation was reported more frequently in the e-cigarette group (65.3%, vs. 51.2% in the nicotine-replacement group) and nausea more frequently in the nicotine-replacement group (37.9%, vs. 31.3% in the e-cigarette 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 (relative risk for cough, 0.8; 95% CI, 0.6 to 0.9; relative risk for phlegm, 0.7; 95% CI, 0.6 to 0.9). There were no significant between-group differences in the incidence of wheezing or shortness of breath.
Conclusions: E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy, when both products were accompanied by behavioral support. (Funded by the National Institute for Health Research and Cancer Research UK; Current Controlled Trials number, ISRCTN60477608 .).
Comment in
-
E-Cigarettes to Assist with Smoking Cessation.N Engl J Med. 2019 Feb 14;380(7):678-679. doi: 10.1056/NEJMe1816406. Epub 2019 Jan 30. N Engl J Med. 2019. PMID: 30699299 No abstract available.
-
E-cigarettes Best Other Cessation Tools.Cancer Discov. 2019 Apr;9(4):OF3. doi: 10.1158/2159-8290.CD-NB2019-018. Epub 2019 Feb 12. Cancer Discov. 2019. PMID: 30755410
-
E-cigarettes to help smoking cessation.Nat Med. 2019 Mar;25(3):358. doi: 10.1038/s41591-019-0395-5. Nat Med. 2019. PMID: 30842668 No abstract available.
-
E-cigarettes for smoking cessation.Nat Hum Behav. 2019 Apr;3(4):322. doi: 10.1038/s41562-019-0575-9. Nat Hum Behav. 2019. PMID: 30971799 No abstract available.
-
E-Cigarettes versus Nicotine-Replacement Therapy for Smoking Cessation.N Engl J Med. 2019 May 16;380(20):1973. doi: 10.1056/NEJMc1903758. N Engl J Med. 2019. PMID: 31091382 No abstract available.
-
E-Cigarettes versus Nicotine-Replacement Therapy for Smoking Cessation.N Engl J Med. 2019 May 16;380(20):1973-1974. doi: 10.1056/NEJMc1903758. N Engl J Med. 2019. PMID: 31091383 No abstract available.
-
E-Cigarettes versus Nicotine-Replacement Therapy for Smoking Cessation.N Engl J Med. 2019 May 16;380(20):1974. doi: 10.1056/NEJMc1903758. N Engl J Med. 2019. PMID: 31091384 No abstract available.
-
E-cigarettes were more effective than nicotine replacement for smoking cessation at 1 year.Ann Intern Med. 2019 May 21;170(10):JC50. doi: 10.7326/ACPJ201905210-050. Ann Intern Med. 2019. PMID: 31108512 No abstract available.
-
Are E-cigarettes more effective in supporting smoking cessation than nicotine-replacement therapy?Evid Based Nurs. 2020 Oct;23(4):120. doi: 10.1136/ebnurs-2019-103132. Epub 2019 Oct 19. Evid Based Nurs. 2020. PMID: 31630124 No abstract available.
-
Electronic Cigarettes: A Role in Smoking Cessation?Am J Respir Crit Care Med. 2020 Aug 15;202(4):595-597. doi: 10.1164/rccm.201908-1584RR. Am J Respir Crit Care Med. 2020. PMID: 32437241 Free PMC article. No abstract available.
-
E-cigarettes for smokers trying to quit.Eur Respir J. 2020 Oct 29;56(4):2002934. doi: 10.1183/13993003.02934-2020. Print 2020 Oct. Eur Respir J. 2020. PMID: 33122290 No abstract available.
-
Electronic cigarettes for smoking cessation: an opportunity to readdress smoking cessation treatment.Eur Respir J. 2020 Oct 29;56(4):2000098. doi: 10.1183/13993003.00098-2020. Print 2020 Oct. Eur Respir J. 2020. PMID: 33122291 No abstract available.
-
E-Cigarettes Versus Nicotine Replacement Therapy for Smoking Cessation : Hajek P, Phillips-waller A, Przulj D, et al. A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy. N Engl J Med. 2019;380(7):629-637.J Gen Intern Med. 2021 May;36(5):1481-1483. doi: 10.1007/s11606-020-06408-7. Epub 2021 Feb 9. J Gen Intern Med. 2021. PMID: 33564946 Free PMC article. No abstract available.
-
Another public health catastrophe.Lancet. 2021 Dec 18;398(10318):2243. doi: 10.1016/S0140-6736(21)02730-6. Lancet. 2021. PMID: 34922664 No abstract available.
Publication types
MeSH terms
Substances
Associated data
Grants and funding
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical