Systematic review and meta-analysis of evidence on the efficacy of e-cigarette use for sustained smoking and nicotine cessation

Abstract

Objective: To systematically review and meta-analyse evidence regarding the efficacy of electronic nicotine delivery systems (ENDS) as smoking cessation aids. Data Sources: PubMed, Scopus, Web of Science, PsycINFO, MEDLINE and Cochrane Library were searched up to February-March 2020 (PROSPERO registration CRD42020170692). Study selection: Published peer-reviewed randomised controlled trials (RCTs) of the efficacy of ENDS for sustained cessation of combustible tobacco smoking and/or nicotine use, compared with no intervention, placebo or nicotine replacement therapy (NRT) by intention-to-treat, with a minimum of four months follow-up. Data Extraction: Data were extracted independently into a pre-specified template. Risk of bias was assessed with the Cochrane Collaboration′s tool and evidence quality rated using GRADE. Data Synthesis: From 3,973 titles identified, nine RCTs were identified; 330 of 5,445 smokers randomised quit. Smoking cessation did not differ significantly for randomisation to ENDS versus: no intervention (three studies, random-effects meta-analysis RR 1.95; 95%CI 0.90-4.22); placebo (three studies, 1.61; 0.93-2.78) or NRT (three studies; 1.25; 0.74-2.11). Fixed-effects sensitivity analyses showed significant results for ENDS vs NRT (1.43; 1.10-1.86). Smokers randomised to ENDS were substantially more likely than control to use nicotine at follow-up. Overall evidence quality was low. Considering only studies without potential competing interests further limited evidence but did not materially change conclusions. Conclusions: There is insufficient evidence that ENDS are efficacious for smoking cessation compared to no intervention, placebo or NRT. Results are promising, particularly for therapeutic use, but vary according to analytic method. ENDS may lead to greater ongoing nicotine exposure than other smoking cessation methods.

Prevalence and Risk Factors of E-cigarette Users in Thai College Student

“…Systematic review and meta-analysis found that nicotine containing Ecigarette provide more efficacy for smoking cessation when compared with nicotine-free E-cigarette and nicotine replacement therapy [24,25]. Another report found that there was not sufficient support for E-cigarette for smoking cessation [26]. In contrast to previous reports, Kalkhoran et al found that the odds of quitting cigarette in E-cigarette user was 28% lower than those who did not use E-cigarette [27].…”

NEAT (NicotinE As Treatment) Trial: Protocol of a randomised controlled trial of vaporised nicotine products compared with nicotine replacement therapy following discharge from residential withdrawal services

“…There continues to be some debate regarding the safety of NVPs with data suggesting they are harmful products coming from predominantly in vitro studies or clinical case studies reporting small numbers of burns, suspected acute lung injury or acute nicotine toxicity. [50] There is no evidence linking e-cigarettes to the highest burden diseases caused by or linked to tobacco smoking including cardiovascular disease, cancer, respiratory conditions, mental health, development in children and adolescents, reproduction, sleep, wound healing, neurological conditions other than seizures, and endocrine, olfactory, optical, allergic and haematological conditions. [50] Furthermore, all randomised controlled trials of NVPs have failed to identify safety issues.…”

“…[50] There is no evidence linking e-cigarettes to the highest burden diseases caused by or linked to tobacco smoking including cardiovascular disease, cancer, respiratory conditions, mental health, development in children and adolescents, reproduction, sleep, wound healing, neurological conditions other than seizures, and endocrine, olfactory, optical, allergic and haematological conditions. [50] Furthermore, all randomised controlled trials of NVPs have failed to identify safety issues. [25] Although not a safety trial, this trial will add to the evidence base of the safety of NVPs with reporting of adverse events in an otherwise high morbidity group.…”

Smoking cessation or initiation: The paradox of vaping

“… Villanti et al (2018) demonstrated that e-cigarettes could be used to decrease cigarette use; however, this review only included a limited number of studies, and most were not randomized control trials (RCTs) ( Villanti et al, 2018 ). Banks et al (2020) concluded that there is insufficient evidence to support the efficacy of electronic nicotine delivery systems (ENDS) (vs. no intervention) for smoking cessation ( Banks et al, 2020 ). They also noted the quality of the evidence was low and the consideration of studies with no potential competing interest further limits the evidence ( Banks et al, 2020 ).…”

“… Banks et al (2020) concluded that there is insufficient evidence to support the efficacy of electronic nicotine delivery systems (ENDS) (vs. no intervention) for smoking cessation ( Banks et al, 2020 ). They also noted the quality of the evidence was low and the consideration of studies with no potential competing interest further limits the evidence ( Banks et al, 2020 ).…”