A newly published review in the Cochrane Library Database of Systematic Reviews provides further evidence that e-cigarettes and vapor products are more effective than nicotine replacement therapy (NRT) in helping smokers quit.

The authors employed 50 completed studies that had been published up to January 2020, which represented over 12,400 participants. Of the 50 studies, 26 were randomized control trials, “in which people who smoke were randomized to an [e-cigarette] or control condition.” In order to be included in the Cochrane review, “studies had to report abstinence from cigarettes at six months or longer and/or data on adverse events or other markers of safety at one week or longer.”

This is the latest Cochrane review update and includes 35 new studies. The authors found that there was “moderate-certainty evidence, limited by imprecision, that quit rates were higher in people randomized to nicotine [e-cigarettes] than in those randomized to nicotine replacement therapy.” The authors found that e-cigarette use translated “to an additional four successful quitters per 100.” The authors also found higher quit rates in participants that had used e-cigarettes containing nicotine, compared to the participants that had not used nicotine.

The authors noted the most reported adverse events were “throat/mouth irritation, headache, cough, and nausea, which tended to dissipate over time with continued use.”

The authors conclude that more “people probably stop smoking for at least six months using e-cigarettes than using nicotine replacement therapy,” and e-cigarettes may be useful to smokers without behavior support. Further, the authors found that for “every 100 people using nicotine e-cigarettes to stop smoking, 10 might successfully stop, compared with only six of 100 people using nicotine replacement therapy or nicotine-free e-cigarettes.”

The results are similar to a 2016 Cochrane review of e-cigarettes for smoking cessation, which found that there was “evidence from two trials that [e-cigarettes] help smokers to stop smoking in the long term compared to placebo [e-cigarettes].” Cochrane reviews are recognized worldwide as representing a gold standard for systematic reviews.

Regarding the new review, Prof Lion Shahab, Professor of Health Psychology and Co-Director of the UCL Tobacco and Alcohol Research Group, University College London, said “the authors also did not detect evidence of serious harms from electronic cigarettes, which should reassure policymakers and health bodies that electronic cigarettes have an important role to play in reducing the burden from combustible tobacco use.”

Peter Hajek, contributing senior author to the Cochrane review and Director of the Tobacco Dependence Research Unit at Queen Mary University of London remarked “e-cigarettes are a form of nicotine replacement that is more attractive to smokers and that seems more effective than the earlier products. The results of this new review of randomised trials of vaping tally with other evidence from cohort and epidemiological studies, suggesting that for many smokers, e-cigarettes represent an effective tool for quitting smoking.”

E-cigarettes and vaping tools have emerged as an effective tool in helping smokers quit. Despite this, many elected officials have moved to ban their sale in localities and states, with these officials often claiming that e-cigarettes are not needed because FDA-approved quitting tools exist. This study provides further evidence that e-cigarettes have helped many American adults quit smoking and are, indeed, more effective than FDA-approved nicotine replacement therapy in helping smokers quit.