Study Finds that E-Cigarettes are at Least as Effective as Patches for Smoking Cessation
By Lindsay Fox Posted October 9, 2013
A new study published in Lancet from researchers in New Zealand has pitted e-cigarettes against patches to see which approach is more effective. For the countless e-cig users who've successfully quit smoking the finding won’t come as much of a surprise, but the results – that e-cigs were slightly more effective than patches – should serve as a wake-up call to the anti-vaping crowd and regulators: e-cigs do actually work. It’s yet another piece of evidence which attests to both the safety and effectiveness of e-cigs, and the randomized and placebo-controlled nature of the study gives the finding even more weight.
What They Did
The researchers hypothesized that e-cigs are more effective than nicotine patches for helping people quit smoking, and set out to test the hypothesis between 2011 and 2013. The tests were conducted in New Zealand, with participants all aged 18 or over and having smoked 10 or more cigarettes per day over the previous year.
They randomly assigned the smokers to either receive a nicotine-containing e-cig, a nicotine patch or a “placebo” (nicotine-free) e-cig in a 4:4:1 ratio – meaning that a total of 292 participants received a nicotine e-cig, 292 received patches and 73 were given nicotine-free e-cigs. They received the products for free (with the nicotine content label removed from the e-cig cartridges) and the main outcome the researchers looked for was complete abstinence after 6 months. This was measured using the quantity of carbon monoxide in the participants’ exhaled breath – an objective measure of whether or not the individual had been smoking.
In addition, they also caught up with the participants one month and three months after their assigned quit date, looking at secondary outcome measures such as abstinence over the last seven days, the number of cigarettes consumed and the amount of time before they relapsed to tobacco use. They also kept track of the amount of participants who stopped taking the assigned treatments.
What They Found
Overall, e-cigs and patches performed roughly equally well. There wasn't a statistically significant difference between the interventions after six months, but the figures reveal that a larger proportion of e-cig users were abstinent from smoking at every meeting. After one month, 23.2 percent of nicotine e-cig users were abstinent, compared to 15.9 percent of patch users and 16.4 percent of placebo e-cig users. At three months, 13.1 percent of nicotine e-cig users had been continually abstinent, compared to 9.2 percent of patch users and 6.8 percent of placebo e-cig users.
The main outcome measure – the six-month abstinence rate – showed that 7.3 percent of e-cig users, 5.8 percent of patch users and 4.1 percent of placebo e-cig users were abstinent. This means that nicotine e-cig users were around 26 percent more likely to be abstinent at the end of the study than patch users.
This is the main finding of the research, but it definitely isn't the only one relevant to the question of whether e-cigs are more or less effective than nicotine patches. They also found that those in the nicotine e-cig group consumed an average of two fewer cigarettes per day than patch-users, and significant differences in the amount of participants who managed to reduce their cigarette intake by more than half. After six months, 57 percent of the nicotine e-cig group had at least halved their daily cigarette consumption, compared to just 41 percent of the patches group and 45 percent of the nicotine-free e-cig group.
In addition, the median length of time (the middle value, not a traditional mean-based average) before relapsing was over twice as long in the nicotine e-cig group than in the patch or placebo e-cig group – with the median values being 35 days for nicotine e-cig users, 14 days for patch users and 12 for placebo e-cig users. Also, nicotine e-cig users were more likely to have been abstinent for the past seven days at the one month (nicotine e-cig users: 23.9 percent vs. patch users: 17.3 percent), three month (21.5 vs. 17 percent) and six-month (21.1 vs. 15.6 percent) follow-ups in comparison to the patch group (with similar results for nicotine e-cig vs. placebo e-cig groups).
Finally, it’s clear from the research that e-cigs were generally more acceptable to users than patches. Although there was no significant difference in the rates of adverse effects reported, 137 e-cig users reported adverse effects in comparison to 119 in the patch group. It’s worth noting that for both of these groups most events were non-serious and assumed to be unrelated to the study product. A good indication of how well-tolerated the interventions are is the amount of people who dropped out of the study before the follow-up: the majority of those who didn’t return at follow-up were assigned to patches. At six months, 29 percent of those assigned to nicotine e-cigs were still using them compared to just 8 percent in the patch group.
This seems ripe for use as an “e-cigs prolong nicotine addiction” spin from the anti-vaping crowd, until you remember that a larger proportion of the e-cig users weren't smoking at six months. In fact, more were probably still using them because they enjoyed them. After six months, 85 percent of those in the nicotine e-cig group said they would recommend the intervention to a friend trying to quit smoking compared to just 50 percent of the patches group.
The results of this research are wholly in favor of the use of e-cigs for smoking cessation, effectively addressing one of the key critiques of e-cigs often heard from the anti-vaping crowd. In the discussion section, the researchers even point out that their study probably underestimates the potential effectiveness of e-cigs:
Our findings point to potential for e-cigarettes in regard to cessation effectiveness beyond that noted in the present study. Furthermore, because they have far greater reach and higher acceptability (as shown by the present study) among smokers than NRT [patches and gums], and seem to have no greater risk of adverse effects, e-cigarettes also have potential for improving population health.
The tired old line that “e-cigs haven’t been proven to help you quit,” and the assertion that approved patches are somehow better is on shakier ground than ever. If anti-vaping advocates intend to continue on in their claims, it’s about time they presented some evidence in support of them, because the evidence in favor of e-cigs is growing by the month.