Nicotine E-Cigarettes May Play a Key Role in Smoking Cessation

Using a combination of nicotine patches with a nicotine e-cigarette may be a more effective smoking cessation technique than using patches alone or a combination of patches and nicotine-free e-cigarettes, according to a new study.

“Combining reduced-harm nicotine products, such as nicotine patches with a nicotine e-cigarette, can lead to a modest improvement in smoking cessation over and above that obtained from using patches plus a nicotine-free e-cigarette (or patches alone), with no indication of any serious harm in the short-term,” according to the study authors.

To conduct their study, the researchers enrolled 1124 adult smokers from New Zealand who were e-cigarette naïve and motivated to quit smoking. Between March 17, 2016, and November 30, 2017, the participants were randomly assigned to receive 14 weeks (2 weeks before the agreed quit date) of 24-hour nicotine patches, 21 mg (n=125); patches plus a nicotine e-cigarette, 18 mg/L (n=500); or patches plus a nicotine-free e-cigarette (n=499).

The participants were instructed to use 1 patch daily and their e-cigarette whenever needed or desired. The participants were also offered 6 weeks of telephone-delivered behavioral support

By month 6, 50% of the participants in the patches-only group had withdrawn or had been lost to follow-up. Meanwhile, 32% of the participants in the patches plus nicotine e-cigarette group and 33% of the participants in the patches plus nicotine-free e-cigarette group had withdrawn or had been loss to follow-up by month 6.

Among the remaining participants, 7% of those in the patches plus nicotine e-cigarette group, 4% of those in the patches plus nicotine-free e-cigarette group, and 2% of those in the patches-only group had carbon monoxide–verified continuous abstinence at 6 months.

According to the study authors, there were no significant between-group differences for serious adverse events (AEs), and none of the serious AEs were treatment-related.

“Future e-cigarette trials should focus on their use alone or in combination with usual smoking cessation support, given issues with differential loss to follow-up and withdrawal if a usual care group is used as a comparator,” the researchers concluded.

—Colleen Murphy

Reference:

Walker N, Parag V, Verbiest M, Laking G, Laugesen M, Bullen C. Nicotine patches used in combination with e-cigarettes (with and without nicotine) for smoking cessation: a pragmatic, randomised trial. Lancet Respir Med. 2020;8(1):54-64. https://doi.org/10.1016/S2213-2600(19)30269-3.