CLINICAL QUESTION

For smokers who want to quit, do electronic nicotine-delivery systems increase the likelihood of abstinence at 6 months?

BOTTOM LINE

Adult smokers who are given e-cigarettes are significantly more likely to be abstinent at 6 months (number needed to treat [NNT] = 6 to 8). The study paid for the cost of the e-cigarettes; therefore, in the real world where patients would have to buy their own e-cigarettes, the results may be less favorable. (Level of Evidence = 1b−)

SYNOPSIS

Swiss adults who smoked at least five cigarettes per day and were interested in quitting were randomized to two groups. The control group received smoking cessation counseling, which included cognitive behavior therapy, motivational interviewing, and shared decision-making for the use of medications that support smoking cessation, including nicotine replacement therapy and smoking cessation medications. They also received $50 vouchers that could be used for any purpose. The intervention group received the same protocol as the control group plus two e-cigarette starter kits, replacement coils, and e-liquids containing nicotine, 0 to 19.6 mg (participants could choose the dose of nicotine they preferred). The groups were similar at baseline, with a median age of 38 years, a median age of 16 years when they started smoking, a median of 15 cigarettes smoked per day; 47% of both groups were female. Allocation to groups was concealed, but it was an open-label trial. A total of 1,246 participants were randomized, and analysis was by intention to treat. The primary outcome was biochemically verified continuous abstinence from tobacco use from the target quit date to 6 months. This occurred significantly more often in the intervention group (28.9% vs. 16.3%; absolute difference = 12.6%; 95% CI, 8% to 17.2%; NNT = 8); however, abstinence from any nicotine use was higher in the control group (33.7% vs. 20.1%; NNT = 8). Not all patients underwent biochemical verification, but when patients self-reported their cessation, the quit rates were even higher (38.1% vs. 23.4%; NNT = 7). Abstinence that was not continuous but had been present for the past 7 days with biochemical verification was also greater with the intervention group (39.4% vs. 21.3%; NNT = 6). More patients in the intervention group reported absence of cough (41% vs. 34%) and phlegm (62% vs. 51%), although the differing response rates between the two groups could have biased these results. Serious adverse events were uncommon and similar between groups.