The use of electronic cigarettes as a means of smoking cessation is still the subject of debate for smoking cessation. A recent Cochrane review looked at the next step: how to help patients quit e-cigarettes after transitioning from traditional cigarettes.
There is little data on how to quit nicotine-containing e-cigarettes and achieve abstinence. Several learned societies have positioned themselves in favor of the use of electronic cigarettes to help quit smoking, based on favorable studies, but at the risk of causing other forms of nicotine dependence.
For this work, the researchers brought together all the literature published on the subject over the past 20 years, targeting in particular randomized trials recruiting adult smokers and former smokers. Only nine studies, totaling 5,209 participants, met their selection criteria. In six of them, the participants no longer smoked tobacco at all when they entered the study. Eight studies included only young adults, and one also included young people aged 13 to 17.
The studies collected by the authors aimed to evaluate the benefit of nicotine replacement treatments: cytisine (not marketed in France) and varenicline compared to a placebo or behavioral treatment.
Inconclusive results
For the authors of the review, the results are inconclusive regarding the use of a combination of substitution treatments, given the low level of cumulative evidence in the studies. There are no data on stopping vaping with a 6-month follow-up with cytisine. With varenicline, the authors considered that there was a « augmentation possible » vaping cessation rates at 6 months. No serious adverse events were reported in combined substitution treatments and with cytisine. For varenicline, only one serious event was reported in the intervention group.
Regarding behavioral methods, results were also mixed, although there was a possible increase in discontinuation rates for SMS interventions among 13-24 year olds (low certainty evidence).
However, researchers suggest that text messaging interventions may help more youth and young adults quit vaping than no or minimal support. Likewise, varenicline could help people stop vaping.
Some 20 randomized clinical trials are underway, according to the authors, who hope for indications to guide practice and policies on vaping cessation. They warn that their review will be updated every month.
