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Cigarettes vs. Varenicline for Smoking Cessation in Adults
Quick Takes
- In this randomized clinical trial, varenicline therapy and nicotine-containing e-cigarettes (ECs) were found to be effective as ways to help adult smokers to stop smoking conventional cigarettes for 6 months.
- Greater smoking cessation was observed among both those randomized to nicotine-containing ECs and those randomized to varenicline, compared to placebo.
- ECs and varenicline were not significantly different in regard to smoking cessation rates.
Study Questions:
Are nicotine-containing electronic cigarettes (ECs) effective compared to varenicline for smoking cessation?
Methods:
The investigators used a randomized, placebo-controlled, single-center trial design to compare 1) 18 mg/mL of nicotine-containing ECs together with placebo tablets to 2) varenicline with standard dosing together with nicotine-free ECs or 3) placebo tablets together with nicotine-free ECs for 12 weeks. The follow-up lasted 52 weeks. All participants received motivational interviews. Participants were residents of northern Finland, aged 25-75 years, who smoked daily and volunteered to quit smoking. Recruitment was conducted between August 2018 and February 2020. The primary outcome was self-reported 7-day cigarette smoking abstinence, confirmed by exhaled carbon monoxide levels on week 26.
Results:
A total of 561 participants were recruited, of which 458 were eligible (257 women [56%]; 201 men [44%]; mean [standard deviation] age, 51 [11.6] years) were randomized. The primary outcome occurred in 61 of 152 participants (40.4%) in the EC group, 67 of 153 (43.8%) in the varenicline group, and 30 of 153 (19.7%) in the placebo group (p < 0.001). In the pairwise comparison, placebo differed statistically significantly from ECs (risk difference [RD], 20.7%; 95% confidence interval [CI], 10.4-30.4; p < 0.001) and varenicline (RD, 24.1%; 95% CI, 13.7-33.7; p < 0.001), but the difference was statistically insignificant between ECs and varenicline (RD, 3.4%; 95% CI, −7.6 to 14.3; p = 0.56). No serious adverse events were reported.
Conclusions:
This randomized clinical trial found that varenicline and nicotine-containing ECs were both effective in helping individuals to quit smoking conventional cigarettes for up to 6 months.
Perspective:
This randomized controlled trial suggests that nicotine-containing ECs may assist daily smokers in smoking cessation. Cessation rates were similar to varenicline. However, as the authors suggest, this was a single-site trial and should be replicated in other populations to understand the generalizability of these findings.
Clinical Topics: Prevention, Smoking
Keywords: Electronic Nicotine Delivery Systems, Smoking Cessation, Varenicline
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