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28-02-2024 | Smoking and Nicotine Detoxification | Editor's Choice | News

E-cigarettes enhance smoking cessation chances in randomized trial

Author: Sara Freeman


medwireNews: E-cigarettes used in addition to standard smoking-cessation counseling may enable significantly more adults to stop smoking than standard counseling alone, show the results of the ESTxENDS randomized controlled trial.

Adult smokers were significantly more likely to have abstained from tobacco use at 6 months if they had used e-cigarettes (n=622) than if they had not (n=624). A respective 28.9% and 16.3% were continuously abstinent since their individual quit date and there was no biochemical evidence that they had smoked. The latter was defined as an anabasine level of 3 ng/mL or less in a urine sample, of if such data were unavailable, an exhaled carbon monoxide level of no more than 9 ppm.

Moreover, 38.1% of e-cigarette users and 23.4% of participants receiving counseling alone were continuously abstinent without biochemical validation, and 53.4% and 32.1% reported being abstinent in the week before their 6-month assessment.

“The percentage of participants who abstained from smoking was high in the intervention group, but the ongoing use of e-cigarettes with nicotine was also high,” the study’s investigators say in The New England Journal of Medicine.

Reto Auer (University of Bern, Switzerland) and fellow researchers report that only one in five (20.1%) of the e-cigarette users abstained from any nicotine use. By comparison, one in three (33.7%) of those in the counseling only group reported no nicotine use.

As for adverse events, 43.7% of e-cigarette users and 36.7% of participants in the counseling only group experienced any adverse event, such as confirmed COVID-19, but there was no difference in the rate of serious adverse events (4.0% and 5.0%, respectively).

The researchers suggest that their safety data “could be pooled with those of other randomized, controlled trials that assess e-cigarettes for smoking cessation to better detect differences in serious and nonserious adverse events.”

In a related editorial, Nancy Rigotti, from Massachusetts General Hospital and Harvard Medical School in Boston, USA, comments that the study “adds valuable new data” on the use of e-cigarettes as potential smoking cessation aids.

The trial recruited 1246 adults who smoked at least five cigarettes a day for 1 year who wanted to stop smoking within 3 months of enrollment, but Rigotti observes that “the enrollment criteria were otherwise broad, which strengthens the generalizability of the findings.”

The median age of the study participants was 38 years, 47% identified as being of female gender, and 73% were employed. The median age at which the participants’ started smoking was 16 years, with a median of 15 cigarettes smoked per day, and 85% of participants had previously tried to quit smoking at least once.

The participants were randomly allocated to receive standard smoking cessation counseling with or without the addition of refillable e-cigarettes. The latter were provided for free in a variety of nicotine doses and flavors. Counseling was delivered by trained nurses and consisted of an office visit and five follow-up telephone calls, the first on their target quit date and then 1, 2, 4, and 8 weeks later. Outcomes were assessed at 6 months.

“The trial cannot assess how long e-cigarette use will last after e-cigarette provision ends or whether the marginal efficacy of e-cigarettes over standard care will persist,” says Rigotti, but as the researchers will be following up the participants for 5 years they “are well positioned to address these questions in future work.”

Rigotti proposes that clinicians should be prepared to have a risk–benefit discussion with their patients and to recommend a trial of e-cigarettes in appropriate situations.

“The evidence has brought e-cigarettes to a tipping point,” she says. “The burden of tobacco-related disease is too big for potential solutions such as e-cigarettes to be ignored.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2024 Springer Healthcare Ltd, part of the Springer Nature Group

N Engl J Med 2024; 390: 601–610
N Engl J Med 2024; 390: 664–665


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