Evidence that electronic cigarettes are effective for smoking cessation long-term is lacking

May 17, 2015

ATS 2015, DENVER - There is little reliable evidence that electronic cigarettes are effective for long-term smoking cessation, according to a new analysis of the currently available research which was presented at the 2015 American Thoracic Society International Conference.

"While e-cigarettes have been shown to significantly improve abstinence at 1 month compared with placebo, no such evidence is available supporting their effectiveness for longer periods," said lead author Riyad al-Lehebi, MBBS, of the University of Toronto. "Until such data are available, there are a number of other smoking cessation aids available that have a more robust evidence base supporting their efficacy and safety."

The meta-analysis included four studies of the efficacy and safety of e-cigarettes for promoting smoking cessation in 1011 patients and an additional 18 studies of the safety of e-cigarettes reporting adverse effects that occurred in 1212 patients.

At 1 month, e-cigarettes significantly improved the prevalence of abstinence among study subjects, but this effect was no longer observed at 3- or 6-month follow-ups. In one study, no significant difference in 6-month abstinence rates were observed between e-cigarettes and placebo or between e-cigarettes and the nicotine patch.

Adverse effects of e-cigarette use noted in the studies included dry cough, throat irritation, and shortness of breath. The incidence of serious adverse events did not differ between e-cigarettes and placebo e-cigarettes, but e-cigarette use was associated with a higher rate of adverse effects than the nicotine patch.

"Although e-cigarettes are widely promoted and used as a smoking cessation tool, we found no data supporting their long-term efficacy and safety," said al-Lehebi. "Given the potential health risks of using these unproven and unregulated devices, individuals seeking help with smoking cessation should consider other more well-established options until more research is performed."
* Please note that numbers in this release may differ slightly from those in the abstract. Many of these investigations are ongoing; the release represents the most up-to-date data available at press time.

Abstract 65842

Efficacy and Safety of Electronic Cigarettes for Smoking Cessation: A Systematic Review
Scientific Abstract
06.14 - Smoking: Prevention/Education/Cessation (NUR/BSHSR)
R.O. Allehebi, M.H. Khan, M.B. Stanbrook; Division of Respiraology, Department of Medicine, University of Toronto - Toronto, ON/CA

Abstract Body

Rationale: Electronic-cigarettes (e-cigarettes) are battery-powered electronic nicotine delivery devices designed to deliver nicotine in a similar manner to tobacco without tobacco's other harmful constituents. We systematically reviewed the evidence to date regarding the efficacy and safety of e-cigarettes.

Methods: We searched MEDLINE and EMBASE from 1946 to May 2014. Studies of efficacy were included if they enrolled current smokers and compared e-cigarettes to placebo, active control or no therapy. Studies of safety were included regardless of design if they reported any adverse events associated with e-cigarette use.

Results: Of 4569 abstracts identified, 297 articles underwent full-text review. For efficacy, 4 studies (2 randomized trials, 2 uncontrolled before-and-after studies) met inclusion criteria. For safety, 22 articles met inclusion criteria. Meta-analysis showed that point prevalence abstinence was significantly better for e-cigarettes vs. placebo at 1 month (RR 1.71, 95% CI 1.08-2.72, I2 = 0%). However, differences for point prevalence abstinence did not reach statistical significance at 3 months (RR 1.95, 95% CI 0.74-5.13, I2 = 65%) or 6 months (RR 1.32, 95% CI 0.59-2.93, I2 = 59%), with large heterogeneity between studies rendering the validity of these pooled estimates uncertain. The only study to evaluate continuous abstinence found low rates at 6 months, with no significant differences seen between e-cigarettes compared with placebo (7.3% vs. 4.1%, RR 1.77, 95% CI 0.54-5.77) or open-label nicotine patch (7.3% vs. 5.8%, RR 1.26, 95% CI 0.68-2.34). Respiratory adverse effects among e-cigarette users included dry cough (incidence range 26-32%), throat irritation (7-32%), and shortness of breath (2- 20%), although incidence of these events tended to decrease over time. Case reports have documented serious adverse events in e-cigarette users including death, lipoid pneumonia, and recurrent atrial fibrillation. In comparative studies, incidence of serious adverse events did not differ between e-cigarettes and placebo e-cigarettes (19.7% vs. 13.9%, RR 1.36, 95% CI 0.54-3.42), but were more frequent with e-cigarettes than open-label nicotine patch (19.7% vs. 11.8%, RR 1.97, 95% CI 1.05-3.68).

Conclusions: Electronic cigarettes achieve higher rates of smoking cessation at 1 month than placebo, but limited available data suggest that this effect may not be sustained over longer time periods. E-cigarettes are associated with frequent short-term respiratory adverse events and may pose a higher risk of serious adverse events than nicotine patch. Given the paucity of existing data, long-term studies of the efficacy and safety of e-cigarettes are needed to determine their possible role in smoking cessation.

American Thoracic Society

Related Smoking Cessation Articles from Brightsurf:

A call for more comprehensive smoking cessation programs for cancer patients who smoke
In an editorial published in JAMA, UNC Lineberger's Adam Goldstein, MD, MPH, director of the UNC Tobacco Treatment Programs and professor in the UNC School of Medicine Department of Family Medicine, and his co-authors called for more funding and better reimbursement for smoking cessation counseling for cancer patients who smoke.

Group-based smoking cessation help US inmates quit tobacco
Behavioral and nicotine replacement therapies offered together can help people who are incarcerated quit smoking, according to Rutgers researchers.

Cost-benefit analysis of funding a smoking cessation program before surgery
For patients undergoing surgery, smoking is linked with a higher risk of experiencing complications following their procedure, and quitting smoking before surgery may help reduce this risk.

E-Cigarettes more effective than counseling alone for smoking cessation
Smokers who received smoking cessation counseling and used electronic cigarettes (e-cigarettes) containing nicotine were more than twice as likely to successfully quit smoking compared to those who received counseling but did not use e-cigarettes, in a clinical trial presented at the American College of Cardiology's Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC).

Adding smoking cessation to lung cancer screening can reduce mortality by 14%
Including smoking cessation with existing lung cancer screening efforts would reduce lung cancer mortality by 14% and increase life-years gained by 81% compared with screening alone, according to a study from Rafael Meza from the University of Michigan and colleagues and published in the Journal of Thoracic Oncology, a publication of the International Association for the Study of Lung Cancer.

Certain factors predict smoking cessation in patients with rheumatoid arthritis
Smoking doubles the risk of developing rheumatoid arthritis and continuing to smoke after being diagnosed has negative effects on patients.

Smoking cessation treatment targets adolescents
The primary focus of smoking cessation research has been adults in the past, but a new study in JAMA Pediatrics zeroed in on adolescents.

Smoking cessation program for patients with, without cancer
A tobacco treatment program delivered at a cancer center had average seven-day smoking abstinence rates of about 45% at three- and six-month follow-ups and nearly 44% at the nine-month follow-up, and those rates didn't differ between patients with and without cancer.

Study underscores role of menthol cigarettes in smoking cessation
Researchers cite Big Tobacco's marketing stronghold on African-American smokers among reasons why this group is 12% less likely to quit.

Mindfulness smoking-cessation app can change the brain
Brown University researchers have found that a mindfulness-based smartphone app designed to help people stop smoking was effective at reducing study participants' self-reported daily cigarette consumption.

Read More: Smoking Cessation News and Smoking Cessation Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.