Electronic Cigarettes for Smoking Cessation —A Clinician’s Dilemma

The randomized clinical trial by Lin et al in this issue of JAMA Internal Medicine demonstrated that participants randomized to nicotine electronic cigarettes (ECs) experienced greater sustained smoking abstinence at 6 months than participants randomized to medicinal nicotine gum and similar (noninferior) sustained abstinence to participants randomized to varenicline (Chantix; Pfizer), a partial nicotinic receptor agonist. Notably, the study, conducted in China with 1068 participants, compared only a single form of nicotine replacement therapy (NRT) rather than 2 NRT forms in combination (eg, patch plus gum or lozenge), which have been observed to be more effective than single NRT and comparable to varenicline. Additionally, the study tested nicotine gum at a dose that may have been suboptimal (ie, 2-mg dose for those smoking up to 20 cigarettes, based on Chinese guidelines). Lin et al also noted events reported in the Chinese media during the trial, including a government report concluding that ECs are unsafe and a recall of varenicline, which may have dampened the efficacy of ECs and varenicline. Nevertheless, the study was well powered, retention was high in all 3 conditions (>80%), and medication adherence was comparable among groups.
Source: JAMA Internal Medicine - Category: Internal Medicine Source Type: research