At six months, these interventions were similarly effective for helping people quit conventional cigarettes.

Nicotine-­containing electronic cigarettes (e-­cigarettes) help people abstain from conventional cigarettes (NEJM JW Gen Med Mar 1 2024 and N Engl J Med 2024; 390: 601-­610). Still, their role in smoking cessation remains uncertain, in part due to a paucity of trials directly comparing e-­cigarettes to first­ line smoking cessation aids.

To compare the effectiveness of varenicline versus nicotine-containing e­-cigarettes for smoking cessation, researchers in Finland recruited 460 adults who smoked daily (median smoking history, 30 years) and were motivated to quit. Participants were randomised to one of three 12­-week interventions: nicotine-containing e-cigarettes with placebo tablets, varenicline tablets with nicotine­-free e­-cigarettes or placebo tablets with nicotine-free e-­cigarettes.

At six months, seven-­day abstinence from conventional cigarettes (confirmed by exhaled carbon monoxide levels) was similar with nicotine-­containing e-­cigarettes or varenicline (40% and 44% respectively, compared with 20% abstinence with double placebo). At 12 months, abstinence was more com­mon with varenicline than e-cigarettes (38% vs 28%), but the difference was not statistically significant (and the study was not powered to investigate this secondary outcome). Varenicline users were more likely to discontinue treatment due to adverse events than were e-­cigarette users (18% vs 10%); no serious adverse events were reported in any group.

Comment: Varenicline and nicotine­ containing e­-cigarettes were similarly effective for smoking cessation at six months, and e-­cigarette users were less likely to discontinue treatment due to side effects. E-­cigarette use for smoking cessation remains controversial for some clinicians, in part because long­term health effects of e­-cigarettes are still unknown. Nevertheless, experts generally agree that e-­cigarettes are safer than continued use of conventional cigarettes, and I’ll continue to discuss the option of e-­cigarettes with my patients who have been unsuccessful with other smoking­ cessation methods.

Molly S. Brett, MD, Assistant Professor of Medicine, University of Colorado, Boulder, USA.

Tuisku A, et al. Electronic cigarettes vs varenicline for smoking cessation in adults: a randomized clinical trial. JAMA Intern Med 2024 Jun 17; e-pub (https://doi.org/10.1001/jamainternmed.2024.1822).

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine.