E-Cigarettes versus Nicotine-Replacement Therapy for Smoking Cessation.

Abstract

To the Editor: The trial by Hajek et al. (Feb. 14 issue)1 shows the potential effectiveness of e-cigarettes for smoking cessation. The conclusions, however, might be misleading. Nicotine-replacement therapy had previously failed in 75% of the participants in the trial. It is not surprising that it failed again in most participants, and, as noted in the editorial by Borrelli and O’Connor in the same issue of the Journal,2 the success rate of 9.9% was half that reported in other studies. The trial might support the effectiveness of e-cigarettes in participants in whom nicotine-replacement therapy had previously failed, but its findings cannot be generalized to those in whom bupropion (8% of participants) or varenicline (34%) had failed, or to those who had not received treatment previously (20%). The success of e-cigarettes may have been greater than that of nicotine replacement because of the longer duration of treatment. Among the participants with 1-year abstinence, 80% were still vaping at 1 year, as compared with 9% who were still using nicotine replacement, possibly because of the experience of vaping (i.e., the handto-mouth ritual, act of inhaling, flavor, immediate effects of nicotine, and social aspects), encouragement to use e-cigarettes, or the lower costs of e-liquid. Research is needed to compare longer durations with standard durations of Food and Drug Administration (FDA)–approved therapies.3 Normalizing vaping and modeling addictive behavior might escalate the extent of the epidemic among youth.2 Nicotine adversely affects brain development, and as noted in the editorial by Drazen et al.4 in the same issue of the Journal, teens who vape are more likely to start smoking than those who do not.5 Caution is advised when choosing e-cigarettes, with consideration of their comparable effectiveness to FDA-approved medications but uncertain long-term harms.