Vaping Better for Quitting Cigarettes Than Nicotine Replacement in Tough Population

Vaping improved smoking cessation rates better than nicotine replacement therapies (NRT) among socioeconomically disadvantaged adults, a randomized trial from Australia showed.

Breath test-verified continuous smoking abstinence after 6 months nearly tripled with use of vaporized nicotine products (VNPs) compared with NRT during a quit attempt, with rates of 28.4% compared with 9.6%, a significant difference that Bayesian analysis suggested was 99% certain for superiority.

Vaping was also better across subanalyses by age, sex, nicotine dependence, and mental illness and resulted in fewer patient-reported adverse events (incidence rate ratio 0.75, 95% CI 0.65-0.88), Ryan J. Courtney, PhD, of the University of New South Wales in Australia, and colleagues reported.

“Given the challenges for cessation among these socially disadvantaged populations, VNPs present a promising treatment option for this priority group,” they wrote in the Annals of Internal Medicine.

Getting people hooked on a different form of nicotine isn’t ideal, but “there’s no question that smoking compared to vaping is so much worse,” commented Peter Shields, MD, of the Ohio State University Cancer Control Program in Columbus, who was not involved in the trial. For adults, “if you get someone to quit smoking and then move them from vaping, that’s the best plan.”

The findings fit with a number of prior studies in the general population, he noted.

“We don’t need any more studies in this world to know that vaping is an adequate smoking cessation tool, and in many cases, in many studies, better than nicotine replacement therapy,” he told MedPage Today. “What’s different about this study is that they’re looking at a population that’s particularly difficult to help quit because it’s low socioeconomic status [SES]. So it’s showing what’s true for the general population also holds true for a low-SES population.”

The trial included 1,045 adults ages 18 and older living in and around Sydney who smoked daily, were willing to quit, and were receiving a government pension or allowance as a proxy for social disadvantage. Participants were randomized 1:1 to open-label treatment with an 8-week supply of nicotine gum or lozenges or the same duration of supply of nicotine e-liquid to use in either a tank device or a pod device, with an option of tobacco, menthol, and fruit flavors. Both groups received 5 weeks of behavioral support via automated text messages.

The study population was predominately middle-age, with a median age of 50, and female (67%). Mental health disorders were common, with 42% reporting either a recent diagnosis or treatment for it.

At baseline, trial participants smoked a median of 20 cigarettes per day. About 40% had tried NRT before, but less than 14% had vaped previously.

Everyone was classified as smoking unless self-reporting 6-month continuous abstinence verified by a carbon monoxide breath test, including participants lost to follow-up and those who self-reported abstinence without bioconfirmation.

As expected from previous trials, participants stuck with vaping more often than continuing use of NRT at final 7-month follow-up, with at least weekly use among 56.3% versus 30.9% (OR 2.88, 95% CI 2.18-3.81, P<0.001).

Among those who did continue to smoke at the 7-month follow-up, the vaping group didn’t smoke fewer cigarettes or reduce their smoking from baseline compared with the NRT group. Respiratory symptoms were similar between groups throughout the trial.

While vapers reported fewer adverse events overall, serious events came out similar between groups. The most common adverse events were COVID-19, cough, headache, and nausea. “Cough and headache occurred more frequently in the VNP group, and nausea occurred more frequently in the NRT group,” the researchers reported.

One limitation was potential for false negative results from use of the carbon monoxide test for biochemical cessation verification, which only can detect exposure to smoking within the previous 24-hour period. Participants were told the test would catch tobacco smoking but not for how long prior to the test it could detect exposure.