Efficacy and safety of electronic cigarettes as a smoking cessation intervention: a systematic review and network meta-analysis

Quigley, J. M. , Walsh, C., Lee, C., Long, J., Kennelly, H., McCarthy, A. and Kavanagh, P. (2021) Efficacy and safety of electronic cigarettes as a smoking cessation intervention: a systematic review and network meta-analysis. Tobacco Prevention and Cessation, 7, 69. (doi: 10.18332/tpc/143077) (PMID:34877438) (PMCID:PMC8607936)

Abstract

Introduction: This systematic review of randomized controlled trials (RCTs) evaluated the efficacy and safety of electronic cigarettes (e-cigarettes, ENDS) in helping people who smoke to achieve abstinence compared with electronic non-nicotine delivery systems (ENNDS, no nicotine) or any smoking cessation comparator treatment or combination of treatments at 24–26 weeks and at 52 weeks. Methods: Systematic review techniques involved searches of three databases in February 2020 with update searches run on 14 May 2021, two-person independent screening, two-person independent assessment of bias, formal extraction of data with verification by a second person, a feasibility assessment to decide if meta-analysis was appropriate, and network meta-analysis (NMA) of data at 24–26 weeks. Data at 52 weeks were narratively summarized. Results: Ten RCTs met the inclusion criteria, eight for efficacy and ten for safety. Eight of the nine RCTs were assessed as at high risk of bias. The sample sizes of the RCTs were 30–2012. Using nicotine replacement therapy (NRT) as the reference treatment, the incidences of smoking cessation at 24–26 weeks were comparable between ENDS and NRT groups (RR=1.17; 95% CrI: 0.66–1.86). Three sensitivity analyses were carried out indicating the main findings for 24–26 weeks were robust to assumptions. The findings at 52 weeks were inconclusive. Conclusions: This systematic review and NMA indicates that there is no clear evidence of a difference in effect between nicotine containing e-cigarettes and NRT on incidences of smoking cessation at 24–26 weeks, and substantial uncertainty remains.

• Item Type: Articles
• Additional Information: This article was funded as part of the routine public service work of the Health Research Board, Ireland.
• Keywords: Smoking cessation, network meta-analysis, systematic review, e-cigarettes.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Quigley, Joan
• Authors: Quigley, J. M., Walsh, C., Lee, C., Long, J., Kennelly, H., McCarthy, A., and Kavanagh, P.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
• Journal Name: Tobacco Prevention and Cessation
• Publisher: EU European Publishing
• ISSN: 2459-3087
• ISSN (Online): 2459-3087
• Published Online: 22 November 2021
• Copyright Holders: Copyright © 2021 Quigley J. M. et al.
• First Published: First published in Tobacco Prevention and Cessation 7: 69
• Publisher Policy: Reproduced under a Creative Commons License