E-cig/NRT combo has better quit rates

Skin cancers

11 Sep 2019

New evidence from a New Zealand vaping study suggests that more smokers could successfully quit if they use e-cigarettes in combination with nicotine patches.

The randomised trial, published in Lancet Respiratory Medicine, is said to be the first to test the efficacy  and safety of using nicotine e-cigarettes with nicotine patches as combination NRT.

In the study, conducted by Auckland University researchers, 1124 vaping-naïve adult smokers were assigned to nicotine patches only (125), patches plus placebo (nicotine-free) e-cigarettes (500), and patches plus an e-cigarette with 18mg of nicotine (499).

Participants were advised to start using their quit products two weeks before their quit date, and continue for a further 12 weeks. They were also offered six weeks of phone-based behavioural support.

People who used patches plus nicotine e-cigarettes were the more likely to have abstained from smoking for six months following the treatment, than those who used patches plus nicotine-free e-cigarettes

At six months 35 (7%) of participants in the nicotine patches plus nicotine e-cigarette group had verified continuous abstinence compared with 20 (4%) in the patches plus nicotine-free e-cigarette group (risk difference 2·99), and three (2%) people in the patches only group (RD 4·60).

Half (62) of the participants in the patches only group withdrew or were lost to follow-up by 6 months compared with 32% in the patches plus nicotine e-cigarette group and 33% in the patches plus nicotine-free e-cigarette group.

No significant between-group differences were noted for serious adverse events, and none were treatment-related.

The study investigators said their findings added to those of other vaping trials that suggested e-cigarettes could have a role in smoking cessation

“All five published trials on e-cigarettes for smoking cessation are pragmatic in design, suggesting that under real-world conditions, e-cigarettes (with and without nicotine) could help some people quit smoking,” they wrote.

“E-cigarettes should be offered as one of the many smoking cessation aids available to people wanting to quit, but do not appear to be a solution for all.

Lead investigator Associate Professor Natalie Walker of the National Institute of Health Innovation (NIHI) said the difference in quitting rates between the combined vaping-NRT group versus patches only did not look great but would add up to a significant public health benefit.

“If we promoted using patches with a nicotine e-cigarette in New Zealand, where about 512,000 people smoke regularly, we would support … potentially 24,000 to 50,000 more people [to quit] than if patches only were used.

“That’s a lot of people whose lives could be changed for the better – along with the health of their families and communities – simply by promoting the combination treatment.”

Study co-investigator Professor Chris Bullen, a tobacco control researcher, said using e-cigarettes combined with patches would not work for everyone but the new findings showed they should be offered as one of the many smoking cessation aids available.

“People using e-cigarettes should be encouraged to fully switch away from tobacco to e-cigarettes, with the aim of eventually also stopping vaping (if possible), given the lack of any long-term safety data for these devices,” he said.

An accompanying commentary by tobacco control researcher Professor Neal Benowitz of the Department of Medicine, University of California San Francisco (UCSF), said a notable secondary outcome of the study was the reported reduction in number of cigarettes smoked per day.

At three months, the proportion of people reducing the number of cigarettes per day by more than 50% was significantly higher in the patch plus nicotine e-cigarette group than in the patch plus nicotine-free e-cigarette group (54% vs 46%).

“This observation is informative because smoking reduction is a measure of drug effect and can be a predictor of future abstinence,” he wrote.

“The study supports national policies that would make nicotine e-cigarettes available to promote smoking cessation,” concluded Professor Benowitz, whose declared conflicts of interest included personal fees from Achieve Life Sciences and Pfizer.

The study authors received grants from the Health Research Council of New Zealand and purchased e-cigarettes and nicotine from companies NZVAPOR and Nicopharm, which have no links with the tobacco industry. NZVAPOR also provided, at no cost to participants, on-line and phone support regarding use of the e-cigarettes.

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