A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy

Datos Bibliográficos

ID23345668
AutoresPeter Hajek (0000-0001-9160-4296, From Queen Mary University of London (P.H., A.P.-W., D.P., K.M.S., N.B., H.J.M.), King’s College London (F.P., P.S.), and London South Bank University (L.D.), London, the University of York, York (J.L., S.P., Q.W.), and Leicester City Council, Leicester (L.R.) — all in the United Kingdom; and Roswell Park Comprehensive Cancer Center, Buffalo, NY (M.G.).), Anna Phillips-Waller (From Queen Mary University of London (P.H., A.P.-W., D.P., K.M.S., N.B., H.J.M.), King’s College London (F.P., P.S.), and London South Bank University (L.D.), London, the University of York, York (J.L., S.P., Q.W.), and Leicester City Council, Leicester (L.R.) — all in the United Kingdom; and Roswell Park Comprehensive Cancer Center, Buffalo, NY (M.G.).), Anna Phillips‐Waller (0000-0001-6856-6439, Queen Mary University of London), Dunja Przulj (0000-0003-1133-8835, From Queen Mary University of London (P.H., A.P.-W., D.P., K.M.S., N.B., H.J.M.), King’s College London (F.P., P.S.), and London South Bank University (L.D.), London, the University of York, York (J.L., S.P., Q.W.), and Leicester City Council, Leicester (L.R.) — all in the United Kingdom; and Roswell Park Comprehensive Cancer Center, Buffalo, NY (M.G.).), Francesca Pesola (0000-0002-2054-7930, From Queen Mary University of London (P.H., A.P.-W., D.P., K.M.S., N.B., H.J.M.), King’s College London (F.P., P.S.), and London South Bank University (L.D.), London, the University of York, York (J.L., S.P., Q.W.), and Leicester City Council, Leicester (L.R.) — all in the United Kingdom; and Roswell Park Comprehensive Cancer Center, Buffalo, NY (M.G.).), Katie Myers Smith (0000-0003-1837-3924, From Queen Mary University of London (P.H., A.P.-W., D.P., K.M.S., N.B., H.J.M.), King’s College London (F.P., P.S.), and London South Bank University (L.D.), London, the University of York, York (J.L., S.P., Q.W.), and Leicester City Council, Leicester (L.R.) — all in the United Kingdom; and Roswell Park Comprehensive Cancer Center, Buffalo, NY (M.G.).), Natalie Bisal (0000-0002-5938-0349, From Queen Mary University of London (P.H., A.P.-W., D.P., K.M.S., N.B., H.J.M.), King’s College London (F.P., P.S.), and London South Bank University (L.D.), London, the University of York, York (J.L., S.P., Q.W.), and Leicester City Council, Leicester (L.R.) — all in the United Kingdom; and Roswell Park Comprehensive Cancer Center, Buffalo, NY (M.G.).), Jinshuo Li (0000-0003-1496-7450, From Queen Mary University of London (P.H., A.P.-W., D.P., K.M.S., N.B., H.J.M.), King’s College London (F.P., P.S.), and London South Bank University (L.D.), London, the University of York, York (J.L., S.P., Q.W.), and Leicester City Council, Leicester (L.R.) — all in the United Kingdom; and Roswell Park Comprehensive Cancer Center, Buffalo, NY (M.G.).), Steve Parrott (0000-0002-0165-1150, From Queen Mary University of London (P.H., A.P.-W., D.P., K.M.S., N.B., H.J.M.), King’s College London (F.P., P.S.), and London South Bank University (L.D.), London, the University of York, York (J.L., S.P., Q.W.), and Leicester City Council, Leicester (L.R.) — all in the United Kingdom; and Roswell Park Comprehensive Cancer Center, Buffalo, NY (M.G.).), Peter Sasieni (0000-0003-1509-8744, From Queen Mary University of London (P.H., A.P.-W., D.P., K.M.S., N.B., H.J.M.), King’s College London (F.P., P.S.), and London South Bank University (L.D.), London, the University of York, York (J.L., S.P., Q.W.), and Leicester City Council, Leicester (L.R.) — all in the United Kingdom; and Roswell Park Comprehensive Cancer Center, Buffalo, NY (M.G.).), Lynne Dawkins (0000-0003-1236-009X, From Queen Mary University of London (P.H., A.P.-W., D.P., K.M.S., N.B., H.J.M.), King’s College London (F.P., P.S.), and London South Bank University (L.D.), London, the University of York, York (J.L., S.P., Q.W.), and Leicester City Council, Leicester (L.R.) — all in the United Kingdom; and Roswell Park Comprehensive Cancer Center, Buffalo, NY (M.G.).), Louise Ross (0000-0002-8402-3482, From Queen Mary University of London (P.H., A.P.-W., D.P., K.M.S., N.B., H.J.M.), King’s College London (F.P., P.S.), and London South Bank University (L.D.), London, the University of York, York (J.L., S.P., Q.W.), and Leicester City Council, Leicester (L.R.) — all in the United Kingdom; and Roswell Park Comprehensive Cancer Center, Buffalo, NY (M.G.).), Maciej Ł Goniewicz (0000-0001-6748-3068, Roswell Park Comprehensive Cancer Center), Qi Wu (0000-0001-5487-3278, From Queen Mary University of London (P.H., A.P.-W., D.P., K.M.S., N.B., H.J.M.), King’s College London (F.P., P.S.), and London South Bank University (L.D.), London, the University of York, York (J.L., S.P., Q.W.), and Leicester City Council, Leicester (L.R.) — all in the United Kingdom; and Roswell Park Comprehensive Cancer Center, Buffalo, NY (M.G.).), Hayden Mcrobbie (0000-0002-7777-1845, Queen Mary University of London), Hayden J McRobbie (From Queen Mary University of London (P.H., A.P.-W., D.P., K.M.S., N.B., H.J.M.), King’s College London (F.P., P.S.), and London South Bank University (L.D.), London, the University of York, York (J.L., S.P., Q.W.), and Leicester City Council, Leicester (L.R.) — all in the United Kingdom; and Roswell Park Comprehensive Cancer Center, Buffalo, NY (M.G.).)
Año2019
Volumen380
Número7
Páginas629-637
Fecha de publicación2019-02-14
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaNew England Journal of Medicine (JOURNAL)
Identificadores de la revistaISSN: 0028-4793 • E-ISSN: 1533-4406
EditorialMassachusetts Medical Society (PUBLISHER • US)
DOI10.1056/nejmoa1808779
PMID30699054
OpenAlexW2913337886
IdiomaEN
Citas recibidas119
Referencias citadas20

BACKGROUND: E-cigarettes are commonly used in attempts to stop smoking, but evidence is limited regarding their effectiveness as compared with that of nicotine products approved as smoking-cessation treatments. METHODS: We randomly assigned adults attending U.K. National Health Service stop-smoking services to either nicotine-replacement products of their choice, including product combinations, provided for up to 3 months, or an e-cigarette starter pack (a second-generation refillable e-cigarette with one bottle of nicotine e-liquid [18 mg per milliliter]), with a recommendation to purchase further e-liquids of the flavor and strength of their choice. Treatment included weekly behavioral support for at least 4 weeks. The primary outcome was sustained abstinence for 1 year, which was validated biochemically at the final visit. Participants who were lost to follow-up or did not provide biochemical validation were considered to not be abstinent. Secondary outcomes included participant-reported treatment usage and respiratory symptoms. RESULTS: A total of 886 participants underwent randomization. The 1-year abstinence rate was 18.0% in the e-cigarette group, as compared with 9.9% in the nicotine-replacement group (relative risk, 1.83; 95% confidence interval [CI], 1.30 to 2.58; P<0.001). Among participants with 1-year abstinence, those in the e-cigarette group were more likely than those in the nicotine-replacement group to use their assigned product at 52 weeks (80% [63 of 79 participants] vs. 9% [4 of 44 participants]). Overall, throat or mouth irritation was reported more frequently in the e-cigarette group (65.3%, vs. 51.2% in the nicotine-replacement group) and nausea more frequently in the nicotine-replacement group (37.9%, vs. 31.3% in the e-cigarette group). The e-cigarette group reported greater declines in the incidence of cough and phlegm production from baseline to 52 weeks than did the nicotine-replacement group (relative risk for cough, 0.8; 95% CI, 0.6 to 0.9; relative risk for phlegm, 0.7; 95% CI, 0.6 to 0.9). There were no significant between-group differences in the incidence of wheezing or shortness of breath. CONCLUSIONS: E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy, when both products were accompanied by behavioral support. (Funded by the National Institute for Health Research and Cancer Research UK; Current Controlled Trials number, ISRCTN60477608 .).

Nicotine · Nicotine dependence · Nicotine replacement therapy · Psychiatry · Randomized controlled trial · Smoking cessation · Internal Medicine · Medicine · Nicotinic Acetylcholine Receptors Study · Pediatric health and respiratory diseases · Smoking Behavior and Cessation