E-cigarettes containing nicotine help more smokers to quit than traditional nicotine replacement therapies. This is the conclusion reached by the global research organisation Cochrane in yet another update to its ongoing systematic review.
At the same time, the findings are beginning to have a greater impact beyond the research community. In the US, doctors are advised to discuss e-cigarettes with patients who smoke, whilst the British authorities have been distributing starter kits to smokers for several years.
The international research organisation Cochrane has once again updated its review of the research on e-cigarettes as an aid to smoking cessation. The latest analysis covers 80 randomised controlled trials involving a total of 29,861 participants. Nine of the studies have been added since the last update.
However, according to the researchers, the findings do not alter the previous conclusion.
– We have very strong evidence that regulated e-cigarettes containing nicotine are significantly less harmful than smoking. Given how consistent the results are, it is clear that they are a proven and useful alternative for people who want to give up smoking traditional cigarettes,’ says Jamie Hartmann-Boyce, a professor at the University of Massachusetts Amherst and one of the lead authors of the review.
More people are giving up smoking
According to Cochrane, there is high-certainty evidence that e-cigarettes containing nicotine lead to more people giving up smoking than nicotine replacement therapies, such as patches and chewing gum.
In absolute terms, the difference corresponds to approximately four additional people who give up smoking for every 100 people who use e-cigarettes instead of nicotine replacement therapy.
Even when compared with nicotine-free e-cigarettes, the results are better. In that case, the difference corresponds to roughly two additional people giving up smoking per 100 people.
When e-cigarettes are compared with behavioural support alone or no support at all, the results also favour e-cigarettes, but Cochrane rates the certainty of this evidence as lower.
The conclusion has stood the test of time
The Cochrane review is what is known as a ”living systematic review”, which means that the researchers are constantly searching for new studies and updating the analysis as the body of evidence grows.
Vejpkollen has been tracking the review since 2020. Even then, the researchers assessed that e-cigarettes containing nicotine were likely to help more people quit smoking than nicotine replacement therapies. In subsequent updates, the number of studies and participants has increased, whilst the certainty of parts of the evidence has been strengthened.
The latest update does not alter the main finding.
“This update includes nine new studies, and our main conclusions remain unchanged,” says Jamie Hartmann-Boyce.
At the same time, the researchers found no evidence that using e-cigarettes to quit smoking increased the risk of serious adverse effects. However, they emphasise that larger and longer-term studies are still needed to assess rare and long-term effects.
Is beginning to influence the recommendations
Whilst Cochrane has continued to update the evidence, the issue of e-cigarettes as an aid to smoking cessation has begun to gain greater traction within healthcare and public health work.
In July, the medical journal JAMA published new recommendations from an international group of researchers within the Society for Research on Nicotine and Tobacco. The group believes that US doctors should include e-cigarettes when discussing various options for quitting smoking with adult patients.
Among other things, the researchers point out that e-cigarettes containing nicotine have been shown to be more effective in helping people give up smoking than nicotine replacement therapies approved by the US Food and Drug Administration (FDA).
The recommendation does not imply that e-cigarettes should be the first choice for all smokers. Instead, the researchers suggest that doctors should be able to discuss the risks and benefits alongside other established methods and help patients who choose e-cigarettes to use them in a way that increases their chances of giving up cigarettes altogether.
The UK is handing out e-cigarettes
In the UK, e-cigarettes have already been given a more direct role in the national strategy to reduce smoking.
Through the ”Swap to Stop” initiative, smokers in England have been offered free starter packs containing e-cigarettes, along with support to help them give up smoking.
A study by King’s College London and University College London, published earlier this year, estimated that around 125,000 more people used e-cigarettes in an attempt to give up smoking during the year following the scheme’s introduction.
The researchers used data from the UK Smoking Toolkit Study and found a clear increase in the use of e-cigarettes amongst those trying to give up smoking following the launch of the initiative.
”The most important comparison”
At the same time, Cochrane emphasises that the findings apply to regulated e-cigarettes containing nicotine and not to illegal products or products containing other substances, such as THC.
Nor do the researchers describe e-cigarettes as risk-free.
– “Although e-cigarettes containing nicotine are unlikely to be entirely risk-free, they are less harmful than smoking. That is the most important comparison for people who still smoke tobacco,” says Nicola Lindson, lead author of the review and a researcher at the University of Oxford.
At the same time, Cochrane continues to monitor the research. New studies are added to the review on an ongoing basis, with a particular focus on longer-term follow-up and newer types of e-cigarettes.
”Further randomised controlled trials are currently underway. To ensure that this review continues to provide up-to-date information, it is a rolling systematic review. We carry out and review searches every month and update the review as new relevant evidence becomes available,” write the researchers behind the review.
