Efficacy and safety of electronic cigarettes as a smoking cessation intervention: A systematic review and network meta-analysis

Abstract

INTRODUCTION This systematic review of randomized controlled trials (RCTs) evaluated the efficacy and safety of electronic cigarettes (e-cigarettes, ENDS) in helping people who smoke to achieve abstinence compared with electronic non-nicotine delivery systems (ENNDS, no nicotine) or any smoking cessation comparator treatment or combination of treatments at 24–26 weeks and at 52 weeks. METHODS Systematic review techniques involved searches of three databases in February 2020 with update searches run on 14 May 2021, two-person independent screening, two-person independent assessment of bias, formal extraction of data with verification by a second person, a feasibility assessment to decide if meta-analysis was appropriate, and network meta-analysis (NMA) of data at 24–26 weeks. Data at 52 weeks were narratively summarized. RESULTS Ten RCTs met the inclusion criteria, eight for efficacy and ten for safety. Eight of the nine RCTs were assessed as at high risk of bias. The sample sizes of the RCTs were 30–2012. Using nicotine replacement therapy (NRT) as the reference treatment, the incidences of smoking cessation at 24–26 weeks were comparable between ENDS and NRT groups (RR=1.17; 95% CrI: 0.66–1.86). Three sensitivity analyses were carried out indicating the main findings for 24–26 weeks were robust to assumptions. The findings at 52 weeks were inconclusive. CONCLUSIONS This systematic review and NMA indicates that there is no clear evidence of a difference in effect between nicotine containing e-cigarettes and NRT on incidences of smoking cessation at 24–26 weeks, and substantial uncertainty remains.

Saudi Heart Association Guidelines on Best Practices in the Management of Chronic Coronary Syndromes

“…One study actually suggests that e-cigarettes ensure a higher rate of sustained 1-year smoking abstinence compared to nicotine replacement therapy [ 122 ]. However, the evidence supporting the superiority of e-cigarettes to placebo or nicotine replacement therapy remains limited or of low quality [ 123 – 125 ].…”

Electronic Cigarettes: Are They Smoking Cessation Aids or Health Hazards?

“…Furthermore, a systematic review of 38 studies found that the probability of quitting cigarettes was 28% lesser among those who utilized e-cigs compared with those who did not utilize e-cigs [ 11 ]. On the contrary, e-cig use has been shown to be more effective in smoking cessation than other nicotine replacement therapies [ 12 ], and there may be a positive correlation between e-cig use and smoking cessation. However, the low-quality data in the current published research due to the lack of well-designed randomized controlled trials and longitudinal population studies makes the evidence inconclusive [ 13 ].…”

Sex-Related Differences in Oxidative, Platelet, and Vascular Function in Chronic Users of Heat-not-Burn vs. Traditional Combustion Cigarettes

“…In the past, much effort was put into identifying effective strategies to enable cessation and effective abstinence from traditional combustion cigarettes (TCCs), ranging from nicotine replacement therapies to modified risk products (MRPs), e.g., electronic vaping cigarettes (EVCs) and heat-not-burn cigarettes (HNBCs) [ 4 , 5 , 6 , 7 , 8 , 9 ]. Indeed, MRPs have substantial potential in supporting smokers to discontinue TCCs, with the hopeful eventual abstinence from smoking any tobacco-related product by scalar reduction of nicotine dosage while maintaining the behavioral aspects of the habit [ 10 , 11 , 12 ].…”