E-Cigs Give Smokers an Edge in Quest to Quit

E-cigarettes plus counseling were better than counseling alone at helping active smokers quit, researchers reported.

At 12 weeks in the E3 trial, 21.9% of participants given nicotine-containing e-cigarettes quit smoking versus 17.3% of participants given non-nicotine e-cigarettes and 9.1% of participants given only counseling (risk difference 12.8%, 95% CI 4.0-21.60), according to Mark Eisenberg, MD, MPH, of Jewish General Hospital/McGill University in Montreal.

Overall, those using nicotine-containing e-cigarettes were 2.4 times more likely to quit than those who did not vape at all, Eisenberg and co-authors reported at the virtual American College of Cardiology (ACC) meeting.

"These findings show that nicotine e-cigarettes are effective for smoking cessation in the short term," Eisenberg said in a press release. "Vaping with counseling is more effective than counseling alone, although it's not a magic bullet for smoking cessation."

While the authors cautioned that the health effects of e-cigarettes are still not clear, and vaping should not be done for any purpose other than smoking cessation, there were few adverse events (AEs). Serious AEs were seen in seven patients: One patient in the nicotine e-cigs group with chronic obstructive pulmonary disease experienced an exacerbation and anxiety, while four in the non-nicotine e-cigs group had appendicitis, a heart attack, chest pain, and nosebleeds. In the counseling-only group, one patient was diagnosed with critical limb ischemia and another had a urinary tract infection.

"None of these events were considered to be treatment related," Eisenberg said, but added that "there remains a need for additional safety data."

The E3 trial is ongoing and will extend to 1 year as "longer-term data from the E3 trial will determine of benefits that persist over time," he noted.

The researchers enrolled 376 participants at 17 sites in Canada. Participants' mean age was 53 with an average smoking history of 35 years at just over one pack a day. Also, 91% had previously attempted to quit but failed, and the majority had previously tried smoking cessation medications or behavioral therapy without success.

One-third of the participants were assigned to receive e-cigarettes with nicotine, one-third got e-cigarettes without nicotine, and one-third received counseling only.

All participants received about 100 minutes of counseling over the course of the 12 weeks that included guidance on quitting smoking. Those receiving e-cigarettes were instructed to vape as much as they felt they needed.

Follow-up was done in the clinic and over the telephone. Abstinence from smoking was biochemically validated. At 12 weeks, those who reported not smoking a cigarette (even one puff) in the past week, and passed the breath test, were deemed as having quit. For those who did not quit, Eisenberg's group considered whether or not participants had reduced the total number of cigarettes smoked per day versus the number they were smoking at the start of the study.

Compared with baseline smoking rates of 21 cigarettes per day, participants who received nicotine e-cigarettes reduced their daily cigarette consumption by 13 cigarettes per day versus 11 among participants receiving non-nicotine e-cigarettes and seven among those receiving counseling alone.

Eisenberg said that the quit rates among e-cigarette users were relatively high, especially because the participants were heavy smokers who had used tobacco for years.

"While these are not clinical outcomes like death or lung cancer rates, the results are still quite impressive," he said.

ACC discussant Eugene Yang, MD, of the University of Washington in Bellevue, noted, "We have a desperate need for more well-designed studies and data [on e-cigarettes for smoking cessation]. As physicians, we are struggling as to what to recommend with e-cigarettes to promote cessation. There is a lack of data to suggest if there is a clear benefit to e-cigarettes in improving those outcomes."

"This study clearly shows a small benefit with short-term follow-up at 12 weeks. We know that the relapse rates are high at both 6 months and 12 months, so getting that additional information will certainly be beneficial. I think we do need further studies to assess adverse events which can be accomplished with longer follow-up," he added.

Yang noted studies that indicate there could be cardiac and/or pulmonary consequences with the use of e-cigarettes so the research needs to done very carefully.

He stressed that until definitive studies can show that e-cigarettes can help people quit safely, he would refer patients to nicotine replacement therapy and counseling as suggested in treatment guidelines.