E-cigarettes are more effective than nicotine replacement therapy when combined with behavioural support, according to a new study in the New England Journal of Medicine.

Adults (n=886) attending NHS stop-smoking services randomly received one or more NRTs of their choice for up to three months or an e-cigarette starter pack and a recommendation to buy further e-liquids of their preferred flavour and strength. All patients received weekly behavioural support for at least four weeks. Among the NRT group, 88.1 per cent used combinations of NRT.

“This is the first trial to test the efficacy of modern e-cigarettes in helping smokers to quit,” said lead researcher Professor Peter Hajek from Queen Mary University of London. “Although a large number of smokers report that they have quit smoking successfully with the help of e-cigarettes, health professionals have been reluctant to recommend their use because of the lack of clear evidence from randomised controlled trials. This is now likely to change.”

The one-year abstinence rate was 83 per cent higher with e-cigarettes compared with NRT: 18.0 and 9.9 per cent respectively. Among participants who did not achieve full abstinence, 12.8 per cent of the e-cigarette group and 7.4 per cent of the NRT group showed at least a halving in smoking, validated using carbon monoxide (a 75 per cent difference between the groups).

Time to relapse and relapse rates at 52 weeks among participants in the study with sustained abstinence at four weeks did not differ significantly.

Throat or mouth irritation was commoner with e-cigarettes than NRT (65.3 and 51.2 per cent respectively). Nausea was commoner with NRT than e-cigarettes (37.9 and 31.3 per cent respectively). E-cigarette users reported a 20 per cent greater decline in cough and a 30 per cent larger reduction in phlegm from baseline to 52 weeks than in the NRT group.

In this trial, e-cigarettes produced a greater effect than that seen in previous studies. Several factors might account for this including enrolling smokers who sought help, providing face-to-face support, using refillable e-cigarettes and allowing patients to choose their preferred e-liquid.

“Community pharmacists can now tell smokers that there is evidence that refillable e-cigarettes can help them quit,” Professor Hajek told Pharmacy Magazine.

“Community pharmacists should also continue to refer smokers who seek help to local stop smoking services. All smoking aids, whether medications or e-cigarettes, are likely to be more effective when accompanied by support, guidance and monitoring that these services provide.”