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Electronic cigarettes for smoking cessation

Lindson N et al (2024)

Cochrane Database of Systematic Reviews - 10.1002/14651858.CD010216.pub8

Evidence Categories

  • Care setting: Healthcare Setting
  • Care setting: Community setting
  • Care setting: Educational Setting
  • Population group: Military/ ex military
  • Population group: Adults
  • Population group: Pre existing health condition
  • Population group: Pregnancy/ post-partum
  • Intervention: Electronic Nicotine Delivery System
  • Outcome: Smoking cessation

Type of Evidence

Systematic Review

Aims

To examine the safety, tolerability and effectiveness of using electronic cigarettes (ECs) to help people who smoke tobacco achieve long-term smoking abstinence, in comparison to non-nicotine EC, other smoking cessation treatments and no treatment.

Findings

There is high certainty that nicotine EC increases quit rates compared to nicotine replacement therapy (NRT) (RR 1.59, 95% CI 1.29 to 1.93; I2= 0%; 7 studies, 2544 participants). In absolute terms, this might translate to an additional four quitters per 100 (95% CI 2 to 6 more).

There is moderate-certainty evidence, limited by imprecision, that nicotine EC increases quit rates compared to non-nicotine EC (RR 1.46,95% CI 1.09 to 1.96; I2 = 4%; 6 studies, 1613 participants). In absolute terms, this might lead to an additional three quitters per 100 (95% CI1 to 7 more).

Due to issues with risk of bias, there is low-certainty evidence that, compared to behavioural support only/no support, quit rates may behigher for participants randomized to nicotine EC (RR 1.88, 95% CI 1.56 to 2.25; I2 = 0%; 9 studies, 5024 participants). In absolute terms,this represents an additional four quitters per 100 (95% CI 2 to 5 more).

Conclusions

There is high-certainty evidence that ECs with nicotine increase quit rates compared to NRT and moderate-certainty evidence that theyincrease quit rates compared to ECs without nicotine. Evidence comparing nicotine EC with usual care/no treatment also suggests benefit,but is less certain due to risk of bias inherent in the study design.