Vapes superior to NRT for smoking cessation in populations with social disadvantage, trial finds
Nearly 30% of patients randomized to vaporized nicotine products were abstinent at six months compared with 9.6% of those randomized to nicotine replacement therapy (NRT), a trial of disadvantaged patients in Australia found.
Vaporized nicotine products (VNPs) were more effective than nicotine replacement therapy (NRT) for smoking cessation in an Australian trial among people experiencing social disadvantage.
Researchers conducted a two-group, open-label trial that randomized 1,045 adults (median age, 50 years; 67% female) who smoked daily to a free eight-week supply of NRT or VNPs between March 2021 and December 2022. All participants received text-message support, were willing to quit smoking, and were receiving a government pension/allowance, which served as a proxy for social disadvantage. Participants received two VNP devices (tank and pod) and three e-liquid flavors in the VNP group and choice of gum or lozenge in the NRT group. Six-month continuous smoking abstinence, verified using a carbon monoxide breath test at seven-month follow-up, was the primary outcome. Findings were published by Annals of Internal Medicine on July 15.
A total of 866 participants (82.9%) completed the final follow-up. The verified six-month continuous abstinence rate was 9.6% (50 of 523) in the NRT group compared with 28.4% (148 of 522) in the VNP group (posterior risk difference estimate, 18.7% [95% credible interval, 14.1% to 23.3%]; >99% posterior probability that VNP is superior). Quit rates within treatment groups were comparable for those with and without a recent mental illness diagnosis or treatment (9% vs. 10% for NRT and 26% vs. 30% for VNP, respectively). Self-reported adverse events were less frequent among patients randomized to VNP (355 events among 237 participants) compared with NRT (442 events among 278 participants; incident rate ratio, 0.75 [95% CI, 0.65 to 0.88]; P<0.001). Common adverse events included COVID-19 infection, cough, headache, and nausea.
Increased quit rates in the VNP group may have been due to the fact patients received the latest generation of pod device with a liquid containing nicotine at 40 mg/mL, the authors explained, adding this “is likely to have provided improved nicotine delivery compared with older-generation VNP devices, resulting in improved alleviation of withdrawal symptoms.”
Limitations include that a biochemical verification method was used to test short-term (past 24 hours) exposure to cigarette smoke. Long-term health effects of vaping are also unknown, and more research is needed, the researchers wrote.
“Given the challenges for cessation among these socially disadvantaged populations, VNPs present a promising treatment option for this priority group,” they concluded.