e-Cigarettes: a double-edged sword?

The use of e-cigarettes has rapidly increased. A UK based randomised trial by Hajek et al (NEJM 2019;380:629) evaluated the effectiveness of e-cigarettes versus nicotine replacement therapy (NRT) as a tool for smoking cessation. Adults attending National Health Service smoking cessation services not currently using NRT or e-cigarettes were eligible. Participants had to agree to not use the non-assigned treatment for at least 4 weeks post quit date. 886 adults already attending stop smoking services were randomised to receive either refillable e-cigarettes (439/886) or a range of NRT (447/886) of their choice. Behavioural support was offered to both groups. NRT was offered for 12 months (~£120 for 3-month supply) or a starter e-cigarette pack with one liquid refill (~£30.25) and encouragement to purchase additional refills themselves. Sustained abstinence was defined as no more than five cigarettes 2 weeks following the quit date and exhaled CO <8 ppm at 52 weeks. Those in the e-cigarette group were statistically more likely to achieve abstinence at each timepoint analysed (4 weeks, 26 weeks and 26–52 weeks) including the primary outcome at 1 year (18.0% vs 9.9%, relative risk (RR) 1.83; 95% CI 1.30 to 2.58). The side effect profile was also investigated. Participants in the NRT arm were more likely to suffer from nausea (37.9% vs 31.3%) and ongoing cough with …