The use of e-cigarettes as a smoking cessation method did not significantly prevent relapse or successful termination, according to survey findings published in Tobacco Control.

“This is the first survey in which e-cigarettes were less popular as a smoking cessation aid than FDA-approved pharmaceutical aids,” John P. Pierce, PhD, a distinguished professor at the Herbert Wertheim School of Public Health and Human Longevity Science at UC San Diego and UC San Diego Moores Cancer Center, said in a press release. “Not only were e-cigarettes not as popular, but they were associated with less successful quitting.”

Pierce and colleagues evaluated data from the nationally representative PATH cohort study to determine the effectiveness of e-cigarettes as a smoking cessation aid from 2017 — when sales for nicotine e-cigarettes increased in the U.S. — to 2019. The analysis included 3,578 participants who were established smokers in 2016 with a recent quit attempt and 1,323 recent former smokers.

E-cigarette use

Between 2016 and 2017, there was a more than 40% growth in sales for e-cigarette products in the U.S., according to the researchers.

In 2017, 12.6% (95% CI, 11.3-13.9) of smokers who recently attempted to quit reported using e-cigarettes as a cessation aid (8.7% e-cigarettes only, 3.2% e-cigarettes and nicotine replacement therapy/pharmaceutical aid, 0.5% e-cigarettes and other tobacco products, and 0.2% three or more products). This marked a decline from 17.4% in 2016, according to Pierce and colleagues.

Only 2.2% (95% CI, 0-4.4) of recent former smokers said they switched to a high nicotine e-cigarette. These products were most often used as a cessation aid by respondents aged 18 to 50 years compared with those aged older than 50 years. Also, non-Hispanic white individuals, those who attended college, those with higher incomes and daily smokers were more likely to report using e-cigarettes.

Other cessation aids

Meanwhile, 2.5% (95% CI, 1.9-3.1) of respondents reported using a non-e-cigarette tobacco product as a cessation aid and 20.6% (95% CI, 18.9-22.3) used a nicotine replacement therapy or pharmaceutical aid only. The researchers reported that most respondents (64.3%) attempted the “cold turkey” method, in which no products were used.

Smoking cessation

Among respondents who reported cigarette abstinence, 18.6% (95% CI, 16-21.2) said they did not use any aids. In contrast, a lower proportion (9.9%; 95% CI, 6.6-13.2) said they used e-cigarettes.

The results further showed that e-cigarettes were associated with lower abstinence rates at 12 or more months compared with pharmaceutical aids (adjusted risk difference [aRD] = 7.3%; 95% CI, 14.4 to –0.4) or any other method (aRD = 7.7%; 95% CI, 12.2 to –3.2), according to Pierce and colleagues.

Although the finding was insignificant, the researchers also noted that respondents who switched to e-cigarettes appeared to have a higher relapse rate than those who did not switch to e-cigarettes or other tobacco products. By 2019, nearly 60% of recent former smokers who used e-cigarettes daily had resumed cigarette smoking.

While randomized clinical trials show improved cessation with e-cigarettes, they are often not conducted under “optimal conditions” and do not reflect “the effectiveness of the product in community settings,” Pierce and colleagues wrote.

An epidemic

“There is good evidence that [e-cigarettes] have become the initiation product of choice for adolescents,” Pierce told Healio. “The Surgeon General has labeled this an epidemic. Some are concerned that this effect on teens may be wiping out all of the successes in tobacco control over the past 3 decades.”

When talking to patients about smoking cessation, “clinicians can correct patient misperceptions that e-cigarettes will make their quit attempt more successful,” he said.

According to Pierce, individuals who smoke are advised to mix and match approved cessation aids. As an over-the-counter option, nicotine replacement therapy is the most popular aid, he said. It is often used in combination with varenicline or Zyban (bupropion hydrochloride, GlaxoSmithKline), he added.

In September, Pfizer voluntarily recalled all lots of its varenicline product Chantix “due to the presence of unacceptable N-nitroso-varenicline levels,” according to the FDA. The agency approved a generic version of varenicline (Par Pharmaceutical) in August.

References:

Adoption of e-cigarettes for smoking cessation in 2017 low and ineffective. https://ucsdnews.ucsd.edu/pressrelease/adoption-of-e-cigarettes-for-smoking-cessation-in-2017-low-and-ineffective. Published Feb. 7, 2022. Accessed Feb. 11, 2022.

Chen R, et al. Tob Control. 2022;doi:10.1136/tobaccocontrol-2021-056901.

Endo launches first and only generic version of Chantix (varenicline) tablets in the United States. https://investor.endo.com/news-releases/news-release-details/endo-launches-first-and-only-generic-version-chantixr. Published Sept. 22, 2021. Accessed Feb. 16, 2022.

FDA updates and press announcements on nitrosamine in varenicline (Chantix). https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-and-press-announcements-nitrosamine-varenicline-chantix. Published Sept. 17, 2021. Accessed Feb. 16, 2022.

Laboratory analysis of varenicline products. https://www.fda.gov/drugs/drug-safety-and-availability/laboratory-analysis-varenicline-products. Published Aug. 23, 2021. Accessed Feb. 16, 2022.