Electronic cigarettes for smoking cessation.

Summary

In this living Cochrane review (90 completed studies; 49 RCTs; 29,044 participants), nicotine e-cigarettes increase long-term quit rates versus NRT (RR 1.59, 95% CI 1.30–1.93) and versus non-nicotine ECs. Serious adverse events were rare with no clear excess versus comparators; however, longer, larger trials are needed to fully assess safety.

Key Findings

• Nicotine e-cigarettes increase quit rates versus NRT (high-certainty) and versus non-nicotine e-cigarettes (moderate-certainty).
• Serious adverse events were rare across study arms; no clear difference versus NRT or non-nicotine ECs.
• Evidence for AEs is imprecise and long-term safety needs longer, larger RCTs; illicit/THC products may have different harm profiles.

Clinical Implications

Offer nicotine e-cigarettes as a cessation option alongside NRT and behavioral support, while counseling on regulated products and the need for follow-up given limited long-term safety data.

Limitations

• Imprecision remains due to limited number of high-quality RCTs with low event rates
• Long-term safety beyond 6–12 months is not fully established

Future Directions

Conduct long-duration, adequately powered RCTs to evaluate long-term safety, sustained abstinence, and head-to-head comparisons with combined pharmacotherapies.