Nicotine E-Cigarettes and Varenicline Equally Effective for Smoking Cessation, Study Finds

Smoking cessation is a significant public health goal, and various aids have been developed to support individuals in quitting smoking. Nicotine-containing electronic cigarettes (ECs) and varenicline are two such aids. However, little is known about their relative effectiveness. This study aimed to fill that knowledge gap by comparing the efficacy of ECs and varenicline in a controlled trial setting.

This randomized, placebo-controlled, single-center trial recruited 561 participants aged 25 to 75 years who smoked daily and wished to quit smoking. The study took place from August 1, 2018, to February 20, 2020, with 52 weeks of follow-up. Participants were randomized into three groups:

• EC group: 18 mg/mL nicotine-containing ECs and placebo tablets.

• Varenicline group: Standard dosing of varenicline and nicotine-free ECs.

• Placebo group: Placebo tablets and nicotine-free ECs.

All groups also received a motivational interview, and the intervention phase lasted for 12 weeks. The primary outcome was self-reported 7-day conventional cigarette smoking abstinence, confirmed by exhaled carbon monoxide levels at week 26. The analysis followed the intent-to-treat principle.

Of the 561 recruited participants, 458 were eligible and randomized (257 women [56%]; 201 men [44%]; mean age, 51 years). The primary outcome of smoking abstinence at week 26 was achieved by:

• 61 of 152 participants (40.4%) in the EC group.

• 67 of 153 participants (43.8%) in the varenicline group.

• 30 of 153 participants (19.7%) in the placebo group (P < .001).

Pairwise comparisons showed that both ECs and varenicline significantly outperformed the placebo:

• ECs vs. placebo: Risk difference (RD) of 20.7% (95% CI, 10.4-30.4; P < .001).

• Varenicline vs. placebo: RD of 24.1% (95% CI, 13.7-33.7; P < .001).

However, there was no significant difference between ECs and varenicline:

• RD of 3.4% (95% CI, −7.6 to 14.3; P = .56).

• No serious adverse events were reported.

The findings indicate that both nicotine-containing ECs and varenicline are effective smoking cessation aids. The significant differences between these methods and the placebo highlight their potential for helping individuals quit smoking. The study also underscores that no serious adverse events were associated with either method, supporting their safety profiles.

This study demonstrates that both varenicline and nicotine-containing ECs are effective in helping individuals quit smoking for up to six months. The lack of significant differences between the two methods suggests that both can be considered viable options for smoking cessation. Further research may continue to explore the long-term effects and efficacy of these smoking cessation aids.

Reference:

Tuisku, A., Rahkola, M., Nieminen, P., & Toljamo, T. (2024). Electronic cigarettes vs varenicline for smoking cessation in adults: A randomized clinical trial. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2024.1822