New data on EC
and smoking cessation

Effects of e-cigarettes (EC) whenpurchased by smokers

1Two types of uninformative
studies: 1. Failed vapers
 Following Kalkhoran and Glanz 2016,

surveys continue to find lower quit rates invapers unable to quit
 Wang et al. Pediatr Res 2017
 Weaver et al. PLoS One 2018

 Cohorts of smokers unable to quit with EC

include heavier smokers with poor
prognosis (successful quitters removed) See also Villanti et al. Addiction 2018
review of methodological problems

How does the illusion
come about?
 Studies recruit smokers, ask them if theytried EC, and check quitting in those that
did/did not Successful EC quitters left the sample; thoseleft in the EC group, especially dual users,
are not good at quitting Football talent scouts pick kids from schools.
Less talent left than in schools not scouted.
Scout visits, like EC use, did not destroy
talent, just removed it2

Two types of uninformative
studies: 2. Treatment failures Patients receiving counselling and NRT
 Some tried EC after treatment and wereless likely abstinent at 6M than those
who did not ‘EC may hamper quitting’ BUT failures were more likely to try EC
 Analysing only non-quitters, the link
disappeared
Zawertailo et al. 2017

Treatment failures try EC morethan succeses: More studies
 Successful quitters in NRT trials were lesslikely to use EC post-treatment than failures;‘EC use was associated with lower quitting
Curry et al. NTR 2017
than non-use’ Quitline clients, infrequent (but not daily)
post-treatment EC use=lower abstinence.

Subialka et al. Addict Behav 2018

 EC use post-treatment ‘associated with lesstobacco abstinence’

Rigotti et al. Ann Intern Med 20183

Eurobarometer 2017
 7% of ex-smokers in EU quit with all

licensed meds together
 6% quit with EC
Note Some meds promoted in all EU countries
for >35 years; EC much newer (butduration of abstinence/risk of relapse notclear)
Special Eurobarometer 458, 2017

BMJ 2017;358:j3262

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Balance of evidence after the
new crop of data EC are by far the most popular quit aid

 Even if their efficacy is the same as thatof other aids, they are helping morepeople, and do so at no cost to healthcare systems

Effects of e-cigarettes (EC) in clinicalcontext, studies 2017-2018

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RCT that included EC 1st gen EC, meds+EC, same+incentives (2x)
 Smoking employees, did not ask for treatment
 Repeated blood sampling to be ‘abstainer’ 6-M ‘quit rates’ 1% in EC and 0.5% in

meds+EC arms (NS) (0.1% info+texts)
 Up to $600 to attend blood sampling: 2.9%
 12M: 0%, 0.3%, 0.3%, 1.2% (0%-5% in ‘engaged’) Difficult to interpret
Halpern et al. NEJM 2018

Short-term RCT
 Cartridge EC (Blu) N=25:16mg/ml; N=21:24mg/ml; N=22 noEC
 4M quit rates: 5% control, 4% EC16,10% EC22 (NS) More self-reported reduction with EC,
biomarkers difference large but NS
Carpenter et al. Cancer Epidemiol Biomarkers&Prevention 20176

Pre-post cohort N=50 smokers with psychosis
 1st generation disposable EC provided

free for 6 weeks, then buying their own
 Asked to replace cigs with EC as muchas possible
 Significant reductions in CPD and CO at
4 and at 24 weeks
Hickling et al. Psychological Medicine 2018

Laboratory studies
 N=28, within-subjects design
 Overnight abstinence, EC 36mg/ml; EC0mg/ml; no EC
 Nicotine EC relieved craving vs placeboand no EC
 N=12 abstinent for 24h, nicotine EC
relieved craving vs placebo EC
Perkins et al. Exp Clin Psychopharmacol 20177

UK stop-smoking services 2017
4-week self-reported quit rate

Balance of evidence after thenew crop of data No contributions to Cochrane, so theconclusions that EC with nicotine are
better than placebo and EC effects are
similar to effects of NRT still stand8