TOPLINE:
Among adults motivated to quit smoking, electronic cigarettes are more effective than nicotine chewing gum and as effective as varenicline in achieving sustained abstinence at 6 months, a randomized trial found. Questions about the long-term safety of e-cigarettes remain, however, according to the researchers.
METHODOLOGY:
The study included 1068 participants in China who were smoking at least 10 cigarettes per day.They were randomly assigned to undergo 12 weeks of treatment with a cartridge-based e-cigarette, varenicline, or nicotine chewing gum.
TAKEAWAY:
At 6 months, the biochemically validated rate of quitting was 15.7% for those who received e-cigarettes, 14.2% for those who received varenicline, and 8.8% for those who chewed nicotine gum.At 6 months, 62.8% of participants in the e-cigarette arm were still using the devices, whereas those in the other study arms had not continued their treatments.Adverse reactions with e-cigarettes and nicotine chewing gum included irritation of the throat and mouth, which occurred in 7%-8% of participants.In the varenicline group, 8.8% experienced nausea.No serious adverse events were reported.
IN PRACTICE:
“A moderate approach would be to recommend approved medications as the first step and, if that fails, then inform the patient of the evidence regarding the use of electronic cigarettes as a possible approach, acknowledging all its caveats,” wrote Dorothy K. Hatsukami, PhD, with the University of Minnesota in Minneapolis, and Judith J. Prochaska, PhD, MPH, with Stanford University in Stanford, California, in an invited commentary.
SOURCE:
Zhao Liu, PhD, with the China-Japan Friendship Hospital in Beijing, was the corresponding author for the study. The study was published online on January 29, 2024, in JAMA Internal Medicine.
LIMITATIONS:
The trial had an open-label design, so participants’ expectations about their assigned treatment may have influenced the results.The study did not include participants older than 45 years, so it is unclear how the results apply to older populations.More studies are needed to see whether continued use of e-cigarettes is beneficial or harmful, the researchers wrote.Combining forms of nicotine replacement therapy, such as gum plus a patch, may be more effective than a single form, but the trial did not assess a combined approach, the commentary authors noted. The dose of nicotine gum for some participants may have been suboptimal, they added.
DISCLOSURES:
The study was supported by the Scientific Research Project Fund of China-Japan Friendship Hospital. The researchers had no conflict of interest disclosures. Prochaska disclosed receiving fees from Achieve Life Sciences, OneLeaf, and attorneys who are involved in litigation against tobacco companies.
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