Exploring Electronic Cigarettes’ Success Among Other Tobacco Cessation Methods


Researchers assessed the benefits of electronic cigarettes for tobacco cessation compared with varenicline and nicotine chewing gum.

Electronic cigarettes (ECs) are as effective as varenicline, used as a smoking cessation aid, and more effective than nicotine replacement therapy (NRT) among a group of patients who had little previous experience with smoking cessation treatments, according to a study published in JAMA Network Open.1

However, additional research is still needed to assess the safety of ECs over a longer follow-up, the authors noted.

A recent study explored the use of electronic cigarettes compared with other tobacco cessation methods. | image credit: brillianata - stock.adobe.com

A recent study explored the use of electronic cigarettes compared with other tobacco cessation methods. | image credit: brillianata - stock.adobe.com

In a recent study conducted in China, researchers explored the efficacy of ECs compared with 2 other tobacco cessation methods: varenicline and NRT. Varenicline, also known as Chantix or Champix, is the “most extensively tested and most widely used pharmacological aid to stopping smoking,” wrote the authors of the study.1 While NRT comes in many forms, the study focused on nicotine chewing gum—one of the most popular NRT methods.1

Key Takeaways

  • The study aimed to address which tobacco cessation method was most effective among ECs, varenicline, and nicotine chewing gum.
  • Results yielded almost equal efficacy in tobacco cessation for the EC and varenicline study groups. However, EC use was significantly more effective than the observed NRT method, nicotine chewing gum.
  • Researchers called into question long-term EC use compared with nicotine replacement therapy and varenicline's short-term purposes.

About the Study

Study participants were recruited and randomly placed into 3 testing arms: EC, varenicline, and NRT, with 409 participants in both the EC and varenicline groups and 250 participants in the NRT group. All individuals screened had been smoking at least 10 cigarettes (16 on average) a day for the past 5 years but were motivated to quit.

Individuals in each group were required to complete initial screenings for carbon monoxide (CO) readings and given their allocated treatment materials. Depending on the testing arm they were placed in, individuals were either given a cartridge-based EC product, a 12-week supply for daily varenicline use, or a 12-week supply of nicotine chewing gum.

READ MORE: Family and Peers Play Robust Roles in Influencing E-Tobacco Use, Study Finds

Participating in monthly screenings during a 6-month period, 1068 individuals (66.5% men, mean age, 33.9; 94% Han Chinese) were included in the study’s primary analysis. After choosing a targeted quit date (TQD)—typically 2 weeks after patients’ baseline screening—each participant was encouraged to use their respective methods as instructed and to quit smoking tobacco completely by the TQD.1

Just over 80% of the sample size completed all 6 of the monthly follow-ups, with drop-out rates relatively even across all 3 testing arms.

ECs Vs. Varenicline and NRT

With the goal of identifying sustained abstinence rates among individuals in each testing arm, researchers found ECs to retain the highest rate (15.7%), with varenicline (14.2%) and NRT (8.8%) following behind.

According to the authors of the study, “validated sustained abstinence was defined as a self-report of smoking no more than 5 cigarettes from 2 weeks after the TQD and no smoking at all during the previous week.”1

Furthermore, 63% of people in the EC arm continued using their allocated treatments by the final follow-up at 6 months. All varenicline and NRT group members ceased the use of their allocated treatments prior to the final follow-up.1

The study results were successful in that ECs are the most efficient tobacco-cessation method compared to varenicline and NRT. However, these findings pose new questions regarding the safety of long-term EC use.

READ MORE: E-Cigarette Use Among Patients with CVD Rebounds After Initial Decline

Long-Term EC Use

It is important to understand the nature of ECs and how they differ from products like varenicline and nicotine chewing gum.

“Extended EC use may be beneficial for some previous smokers by helping them to maintain some of the subjective rewards of smoking, avoid post-cessation weight gain, or prevent relapse,” authors noted.1 “However, although EC use is expected to pose few health risks of smoking, some adverse health outcomes of long-term EC use are likely.”

Products like varenicline and nicotine chewing gum differ from ECs in that they serve as a method for quitting rather than a tobacco substitute, and they are usually not used long-term.1

As more smokers move from tobacco to ECs, the need for further research in tobacco cessation increasingly grows. And with recent findings making waves in the industry1—such as Pfizer’s 2021 recall of varenicline and China’s Report on the Health Hazards of Smoking 2020—further evidence for the best tobacco cessation methods is more necessary than ever.1

“The key question about long-term switching from smoking to EC use is whether this is a positive or a negative outcome,” concluded the authors.1

1. Lin H, Liu Z, Hajek P, et al. Efficacy of electronic cigarettes vs varenicline and nicotine chewing gum as an aid to stop smoking: a randomized clinical trial. JAMA Intern Med. Published online January 29, 2024. doi:10.1001/jamainternmed.2023.7846
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