Are e-cigarettes safer and more effective than other treatments for quitting smoking?

(Boston)-- While not an FDA-approved treatment, e-cigarettes are used as, or more often by smokers to help them quit smoking, versus FDA-approved treatments for smoking cessation. An editorial in response to a newly published paper on the effectiveness of e-cigarettes for smoking cessation in the New England Journal of Medicine says that caution should be used in recommending e-cigarettes for smoking cessation.

"While e-cigarettes are 'safer' than traditional cigarettes, they are not without risks," said Belinda Borrelli, PhD, professor of Health Policy & Health Services Research at Boston University Henry M. Goldman School of Dental Medicine, and George O'Connor, MD, professor of medicine at Boston University School of Medicine.

Their editorial accompanied a new study (Hajek et al.) comparing the effectiveness of e-cigarettes against the nicotine-replacement therapy (NRT) for smoking-cessation. That study found the one-year abstinence rate was higher in the e-cigarette group (18 percent) than the NRT group (9.9 percent). The authors of the editorial argue that since the cessation rates of traditional cigarettes are similar between e-cigarettes and FDA-approved products, FDA approved products for smoking cessation should be recommended first. For example, treatment with NRT and bupropion achieves abstinence rates of approximately 25 to 26 percent at six months and 20 percent at one year, with slightly higher abstinence rates for combination therapy. Quit rates with Varenicline (Chantix) have shown even higher cessation rates.

Given the known and unknown health effects of e-cigarette use in the general population and in high-risk groups, health care providers should only recommend e-cigarettes when an FDA approved treatment fails, and then manage cessation with e-cigarettes like they would with any other FDA approved treatment. "Start with the lowest effective dose, monitor side effects and work towards a treatment end date," said Borrelli. However, the editorialists state that there is not enough data at present for formal guidelines to have emerged regarding specific recommendations about dosing and safety.

According to the authors of the editorial, a key finding of the study is that among participants with sustained abstinence at one year, 80 percent in the e-cigarette group were still using e-cigarettes, whereas only nine percent in the nicotine-replacement group were still using nicotine replacement. "This pattern of long-term use raises concerns about the health consequences of long-term e-cigarette use. We know that e-cigarette vapor contains many toxins and exerts potentially adverse biologic effects on human cells," explained O'Connor. Both Borrelli and O'Connor believe that indefinite e-cigarette use in place of traditional cigarettes should not be viewed as a completely successful smoking-cessation outcome, given the uncertain health risks to the smoker and to those in the environment.

Boston University School of Medicine