BARCELONA, Spain — Electronic cigarettes are as effective as the patch when it comes to helping smokers overcome the cravings of nicotine addiction, suggests the first randomized study of its kind.

The work, presented here at the European Respiratory Society (ERS) 2013 Annual Congress, and simultaneously published online in the Lancet, demonstrates that smokers using e-cigarettes and those using the patch are able to abstain from smoking in equal proportions after 6 months.

Chris Bullen, MD, director of the National Institute for Health Innovation at the University of Auckland in New Zealand, and his team compared 3 approaches to smoking cessation in 657 smokers. Participants actively trying to quit were randomly assigned to active e-cigarettes that contained 16 mg of nicotine, placebo e-cigarettes with no nicotine, or patches that contained 21 mg of nicotine.

After randomization, study participants were instructed to use the assigned method for 1 week prior to their quit date, and for 12 weeks thereafter. During the study period, all participants were offered behavioural support. The researchers assessed sustained abstinence from cigarettes 6 months after the quit date.

Overall, 5.7% of participants remained cigarette-free at 6 months. Treatment success was highest with the active e-cigarettes, followed by the patches, and lowest with the placebo e-cigarettes; however, these differences were not statistically significant.

Table. Percentage of Smokers Who Successfully Quit

Treatment Group Successful Cessation, %
E-cigarettes (n = 292) 7.3
Nicotine patches (n = 292) 5.8
Placebo e-cigarettes (n = 73) 4.1

 

When the researchers analysed cigarette consumption and evaluated the benefit of cutting down instead of quitting, the results were statistically significant. More participants in the active e-cigarette group than in the patch group had reduced consumption by at least half at 6 months (57% vs 41%). Differences in addiction and withdrawal scores were also significant between the 2 active-treatment groups (= .018)

There were no differences in adverse events in the 3 groups.

However, the success seen with the active e-cigarette did come with some interesting caveats. "At 6 months, more than a third of the people in that group who had quit smoking were still using the e-cigarettes," Dr. Bullen reported.

This suggests that they substituted e-cigarettes for their nicotine supply. I suppose you could argue that this is a bad thing, that you're maintaining nicotine dependence, but at least it is better than having the person continue to smoke," he said. "However, for those in the e-cigarette cohort who didn't manage to quit, about 30% now use both. This is certainly a concern, and more research is needed in the area of dual use."

If a person uses e-cigarettes to successfully quit smoking but is still using them a year later, is that a problem? Gareth Jones, MD, from the Liverpool Heart and Chest Hospital in the United Kingdom, told Medscape Medical News that a smoker who successfully quits should certainly be congratulated. "But I would be obligated to mention that I don't know what these devices will do to the lungs in the long term. As yet, there is no clear evidence on which to base an opinion. Ideally, I'd want you to quit using the e-cigarette as well, as long as it didn't mean you would go back to using real cigarettes."

The dearth of solid data is partially explained by the nature of the product. "The problem in the United Kingdom is that there is no standard e-cigarette," Dr. Jones explained. "A recent study by the World Health Organization showed that even e-cigarettes manufactured by the same company have widely variable components. There are regulations coming in the United Kingdom in 2016 that will require safety and efficacy data, but until then, we really don't know what you're inhaling."

Outgoing ERS president Francesco Blasi, MD, emphasized that more data are needed to gauge the effects of the long-term use of e-cigarettes.

"This study is an important first step in looking at the safety and efficacy of these devices," he told Medscape Medical News. "This is exactly what we want — the ERS wants more science in this regard. They've shown that in the short term, e-cigarettes are as effective as the nicotine patch, and that the safety seems good.

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The whole article is over at http://www.medscape.com/viewarticle/810645 and written Neil Canavan 

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