Study Finds E-Cigarettes More Effective than Nicotine Replacement Therapy In Helping Smokers Quit


Lindsey Stroud


Researchers analyzed 886 randomized study participants to examine the effectiveness of e-cigarettes and nicotine replacement therapy products on smoking cessation. Participants were more mostly middle-aged smokers and were separated into two groups including an NRT group and an e-cigarette group. More than 78 percent of participants completed the 52-week follow up conducted by the researchers.

Of the 100+ participants that reported abstinence during the 52-week follow up, researchers found that 80 percent of those participants were using e-cigarettes and 9 percent were using NRT products. Overall, researchers found that e-cigarette users reported a higher abstinence rate at 18.0 percent, compared to the NRT group, which reported a 9.9 percent one-year abstinence rate. The researchers concluded that e-cigarettes are twice as effective as NRT in helping smokers quit.

Implications: Researchers outside the United States continue to provide data that indicate e-cigarettes are successful tools in smoking cessation. It is imperative policymakers consider this data when regulating e-cigarette and vapor products to ensure they are promoting tobacco harm reduction products that can reduce the costs attributed to combustible tobacco.


Background: E-cigarettes are commonly used in attempts to stop smoking, but evidence is limited regarding their effectiveness as compared with that of nicotine products approved as smoking-cessation treatments.

Methods: We randomly assigned adults attending U.K. National Health Service stop-smoking services to either nicotine-replacement products of their choice, including product combinations, provided for up to 3 months, or an e-cigarette starter pack (a second-generation refillable e-cigarette with one bottle of nicotine e-liquid [18 mg per milliliter]), with a recommendation to purchase further e-liquids of the flavor and strength of their choice. Treatment included weekly behavioral support for at least 4 weeks. The primary outcome was sustained abstinence for 1 year, which was validated biochemically at the final visit. Participants who were lost to follow-up or did not provide biochemical validation were considered to not be abstinent. Secondary outcomes included participant-reported treatment usage and respiratory symptoms.

Results: A total of 886 participants underwent randomization. The 1-year abstinence rate was 18.0% in the e-cigarette group, as compared with 9.9% in the nicotine-replacement group (relative risk, 1.83; 95% confidence interval [CI], 1.30 to 2.58; P<0.001). Among participants with 1-year abstinence, those in the e-cigarette group were more likely than those in the nicotine-replacement group to use their assigned product at 52 weeks (80% [63 of 79 participants] vs. 9% [4 of 44 participants]). Overall, throat or mouth irritation was reported more frequently in the e-cigarette group (65.3%, vs. 51.2% in the nicotine-replacement group) and nausea more frequently in the nicotine-replacement group (37.9%, vs. 31.3% in the e-cigarette group). The e-cigarette group reported greater declines in the incidence of cough and phlegm production from baseline to 52 weeks than did the nicotine-replacement group (relative risk for cough, 0.8; 95% CI, 0.6 to 0.9; relative risk for phlegm, 0.7; 95% CI, 0.6 to 0.9). There were no significant between-group differences in the incidence of wheezing or shortness of breath.

Conclusions: E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy, when both products were accompanied by behavioral support. (Funded by the National Institute for Health Research and Cancer Research UK; Current Controlled Trials number, ISRCTN60477608. opens in new tab.)


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