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E3: Nicotine e-cigarettes plus counselling aid smoking cessation

Natalia Reoutova
07 Apr 2020
Dr Mark Eisenberg

The use of nicotine e-cigarettes (ECs) along with counselling is more efficacious in aiding smoking cessation than counselling alone, according to 12-week results of a multicentre, randomized study presented at the American College of Cardiology 2020/World Congress of Cardiology (ACC.20/WCC) virtual meeting.

“Even with the use of pharmacological or behavioural therapy, well over two-thirds of those attempting to quit resume smoking within 1 year. For this reason, many smokers have adopted the use of ECs in an attempt to quit smoking. Nevertheless, the efficacy and safety of ECs for smoking cessation remain poorly delineated,” stated the study’s first author, Dr Mark Eisenberg of the Department of Epidemiology, Biostatistics, and Occupational Health at McGill University, Montreal, Quebec, Canada.

The Evaluating the Efficacy of E-Cigarette Use for Smoking Cessation (E3) trial randomized 376 smokers (mean age, 52 years; 53 percent male; mean years smoking, 35; mean cigarettes per day, 21) from 17 centres in Canada to one of three arms: nicotine ECs with counselling, non-nicotine ECs with counselling, and counselling alone. [Eisenberg M, et al, ACC.20/WCC, abstract 412-08]

“At each of the evaluated time points [weeks 1, 2, 4, 8 and 12], a higher rate of smoking abstinence was observed among participants who received nicotine ECs with counselling than in the other two arms. At 12 weeks, smoking abstinence rate was 22 percent among those who received nicotine ECs and counselling vs 9 percent among those who received counselling only. The risk difference [RD] was 12.8 percent [95 percent confidence interval (CI), 4.0 to 21.6], and the relative risk [RR] was 2.4 [95 percent CI, 1.3 to 4.6],” reported Eisenberg.

“To be considered abstinent, the participants were required to not smoke even one puff of a normal cigarette in the past week, and their reading on a carbon monoxide monitor had to be at 10 ppm,” explained Eisenberg.

In addition, participants receiving ECs smoked fewer conventional cigarettes per day than those who received counselling only. “At 12 weeks, those randomized to receive nicotine ECs and counselling smoked 8 conventional cigarettes per day vs 10 cigarettes per day smoked by participants receiving non-nicotine ECs and counselling vs 14 cigarettes per day smoked by participants receiving counselling alone,” reported Eisenberg.

The mean difference in the daily number of cigarettes smoked was -5.7 for nicotine ECs and counselling vs counselling alone and -3.6 for non-nicotine ECs plus counselling vs counselling alone. “Both values were statistically significant [p<0.05],” noted Eisenberg.

One serious adverse event (AE) occurred in the nicotine ECs and counselling arm, compared with five in the non-nicotine ECs and counselling arm, and two in the counselling alone arm. “All of these AEs were adjudicated by the endpoints evaluation committee as not being related to treatment received,” noted Eisenberg.    

“In conclusion, receiving nicotine ECs with individual counselling for 12 weeks is more efficacious for smoking cessation compared with counselling alone. The use of non-nicotine ECs combined with individual counselling appears to have benefits that are intermediate between nicotine ECs plus counselling and counselling alone. Very few AEs occurred during the 12 weeks, but there remains a need for further safety data,” summarized Eisenberg.

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