Cochrane · systematic review · CD010216
Electronic cigarettes for smoking cessation
Lindson, N, Butler, AR, McRobbie, H, et al. · Cochrane Database of Systematic Reviews · 2024 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
9
current version
GRADE rated
9
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 1 · 11.1%Low 4 · 44.4%Moderate 3 · 33.3%High 1 · 11.1%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyNicotine EC compared to NRT for smoking cessation
Population: People who smoke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Smoking cessation at 6 months to 1 year Nicotine EC vs NRT | RR 1.59 [1.29, 1.93] | 7 studies · 2544 participants | High |
Adverse events at 4 weeks to 6‐9 months Assessed by self‐report Nicotine EC vs NRT | RR 1.03 [0.91, 1.17] | 5 studies · 2052 participants | Moderate Downgraded: imprecision |
Serious adverse events at 4 weeks to 1 year Assessed via self‐report and medical records Nicotine EC vs NRT | RR 1.2 [0.9, 1.6] | 6 studies · 2411 participants | Low Downgraded: imprecision |
Nicotine EC compared to non‐nicotine EC for smoking cessation
Population: People who smoke cigarettes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Smoking cessation at 6‐12 months Nicotine EC vs non‐nicotine EC | RR 1.46 [1.09, 1.96] | 6 studies · 1613 participants | Moderate Downgraded: risk of bias, imprecision |
Adverse events at 1 week to 6 months Assessed via self‐report Nicotine EC vs non‐nicotine EC | RR 1.01 [0.91, 1.11] | 5 studies · 840 participants | Moderate Downgraded: imprecision |
Serious adverse events at 1 week to 1 year Assessed via self‐report and medical records Nicotine EC vs non‐nicotine EC | RR 1 [0.56, 1.79] | 9 studies · 1412 participants | Low Downgraded: imprecision |
Nicotine EC compared to behavioural support only/no support for smoking cessation
Population: People who smoke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Smoking cessation at 6 to 12 months Assessed using biochemical validation Nicotine EC vs behavioural support only/no support | RR 1.88 [1.56, 2.25] | 9 studies · 5024 participants | Low Downgraded: risk of bias |
Adverse events at 12 weeks to 6 months Assessed via self‐report Nicotine EC vs behavioural support only/no support | RR 1.22 [1.12, 1.32] | 4 studies · 765 participants | Low Downgraded: risk of bias |
Serious adverse events at 4 weeks to 8 months Assessed via self‐report and medical records Nicotine EC vs behavioural support only/no support | RR 0.89 [0.59, 1.34] | 10 studies · 3263 participants | Very low Downgraded: risk of bias, imprecision |
Nicotine EC compared to NRT for smoking cessation
Population: People who smoke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Smoking cessation at 6 months to 1 year Nicotine EC vs NRT | RR 1.63 [1.3, 2.04] | 6 studies · 2378 participants | High |
Adverse events at 4 weeks to 6‐9 months Assessed by self‐report Nicotine EC vs NRT | RR 1.02 [0.88, 1.19] | 4 studies · 1702 participants | Moderate Downgraded: imprecision |
Serious adverse events at 4 weeks to 1 year Assessed via self‐report and medical records Nicotine EC vs NRT | RR 1.12 [0.82, 1.52] | 5 studies · 2411 participants | Low Downgraded: imprecision |
Nicotine EC compared to non‐nicotine EC for smoking cessation
Population: People who smoke cigarettes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Smoking cessation at 6‐12 months Nicotine EC vs non‐nicotine EC | RR 1.94 [1.21, 3.13] | 5 studies · 1447 participants | Moderate Downgraded: risk of bias, imprecision |
Adverse events at 1 week to 6 months Assessed via self‐report Nicotine EC vs non‐nicotine EC | RR 1.01 [0.91, 1.11] | 5 studies · 840 participants | Moderate Downgraded: imprecision |
Serious adverse events at 1 week to 1 year Assessed via self‐report and medical records Nicotine EC vs non‐nicotine EC | RR 1 [0.56, 1.79] | 8 studies · 1272 participants | Low Downgraded: imprecision |
Nicotine EC compared to behavioural support only/no support for smoking cessation
Population: People who smoke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Smoking cessation at 6 to 12 months Assessed using biochemical validation Nicotine EC vs behavioural support only/no support | RR 2.66 [1.52, 4.65] | 7 studies · 3126 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events at 12 weeks to 6 months Assessed via self‐report Nicotine EC vs behavioural support only/no support | RR 1.22 [1.12, 1.32] | 4 studies · 765 participants | Low Downgraded: risk of bias |
Serious adverse events at 4 weeks to 8 months Assessed via self‐report and medical records Nicotine EC vs behavioural support only/no support | RR 1.03 [0.54, 1.97] | 9 studies · 1993 participants | Very low Downgraded: risk of bias, imprecision |
Nicotine EC compared to NRT for smoking cessation
Population: People who smoke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Smoking cessation at 6 months to 1 year Nicotine EC vs NRT | RR 1.53 [1.21, 1.93] | 4 studies · 1924 participants | Moderate Downgraded: imprecision |
Adverse events at 4 weeks to 6 months Assessed by self‐report Nicotine EC vs NRT | RR 0.98 [0.8, 1.19] | 2 studies · 485 participants | Low Downgraded: imprecision |
Serious adverse events at 4 weeks to 1 year Assessed via self‐report and medical records Nicotine EC vs NRT | RR 1.44 [0.94, 2.19] | 3 studies · 1183 participants | Low Downgraded: imprecision |
Nicotine EC compared to non‐nicotine EC for smoking cessation
Population: People who smoke cigarettes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Smoking cessation at 6 ‐ 12 months Nicotine EC vs non‐nicotine EC | RR 1.94 [1.21, 3.13] | 5 studies · 1447 participants | Moderate Downgraded: risk of bias, imprecision |
Adverse events at 1 week to 6 months Assessed via self‐report Nicotine EC vs non‐nicotine EC | RR 1.01 [0.91, 1.11] | 3 studies · 601 participants | Moderate Downgraded: imprecision |
Serious adverse events at 1 week to 1 year Assessed via self‐report and medical records Nicotine EC vs non‐nicotine EC | RR 0.95 [0.52, 1.72] | 6 studies · 1033 participants | Low Downgraded: imprecision |
Nicotine EC compared to behavioural support only/no support for smoking cessation
Population: People who smoke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Smoking cessation at 6 to 12 months Assessed using biochemical validation Nicotine EC vs behavioural support only/no support | RR 2.61 [1.44, 4.74] | 6 studies · 2886 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events at 12 weeks to 6 months Assessed via self‐report Nicotine EC vs behavioural support only/no support | RR 1.22 [1.12, 1.32] | 4 studies · 765 participants | Low Downgraded: risk of bias |
Serious adverse events at 4 weeks to 6 months Assessed via self‐report and medical records Nicotine EC vs behavioural support only/no support | RR 1.51 [0.7, 3.24] | 7 studies · 1303 participants | Very low Downgraded: risk of bias, imprecision |
Nicotine EC compared to NRT for smoking cessation
Population: People who smoke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Smoking cessation at 6 months to 1 year Nicotine EC vs NRT | RR 1.69 [1.25, 2.27] | 3 studies · 1498 participants | Moderate Downgraded: imprecision |
Adverse events at 4 weeks to 6 months Assessed by self‐report Nicotine EC vs NRT | RR 0.98 [0.8, 1.19] | 2 studies · 485 participants | Low Downgraded: imprecision |
Serious adverse events at 4 weeks to 1 year Assessed via self‐report and medical records Nicotine EC vs NRT | RR 1.37 [0.77, 2.41] | 2 studies · 727 participants | Low Downgraded: imprecision |
Nicotine EC compared to non‐nicotine EC for smoking cessation
Population: People who smoke cigarettes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Smoking cessation at 6‐12 months Nicotine EC vs non‐nicotine EC | RR 1.7 [1.03, 2.81] | 4 studies · 1057 participants | Moderate Downgraded: risk of bias, imprecision |
Adverse events at 1 week to 6 months Assessed via self‐report Nicotine EC vs non‐nicotine EC | RR 1.01 [0.91, 1.11] | 3 studies · 601 participants | Moderate Downgraded: imprecision |
Serious adverse events at 1 week to 1 year Assessed via self‐report and medical records Nicotine EC vs non‐nicotine EC | RR 0.6 [0.15, 2.44] | 4 studies · 494 participants | Low Downgraded: imprecision |
Nicotine EC compared to behavioral support only/no support for smoking cessation
Population: People who smoke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Smoking cessation at 6 to 12 months Assessed using biochemical validation Nicotine EC vs behavioral support only/no support | RR 2.7 [1.39, 5.26] | 5 studies · 2561 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events at 12 weeks to 6 months Assessed via self‐report Nicotine EC vs behavioral support only/no support | RR 1.22 [1.12, 1.32] | 4 studies · 765 participants | Low Downgraded: risk of bias |
Serious adverse events at 4 weeks to 6 months Assessed via self‐report and medical records Nicotine EC vs behavioral support only/no support | RR 1.17 [0.33, 4.09] | 6 studies · 1011 participants | Very low Downgraded: risk of bias, imprecision |
Nicotine EC compared to NRT for smoking cessation
Population: People who smoke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Smoking cessation at 6 months to 1 year Nicotine EC vs NRT | RR 1.69 [1.25, 2.27] | 3 studies · 1498 participants | Moderate Downgraded: imprecision |
Adverse events at 4 weeks to 6 months Assessed by self‐report Nicotine EC vs NRT | RR 0.98 [0.8, 1.19] | 2 studies · 485 participants | Low Downgraded: imprecision |
Serious adverse events at 4 weeks to 1 year Assessed via self‐report and medical records Nicotine EC vs NRT | RR 1.37 [0.77, 2.41] | 2 studies · 727 participants | Low Downgraded: imprecision |
Nicotine EC compared to non‐nicotine EC for smoking cessation
Population: People who smoke cigarettes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Smoking cessation at 6‐12 months Nicotine EC vs non‐nicotine EC | RR 1.71 [1, 2.92] | 3 studies · 802 participants | Moderate Downgraded: risk of bias, imprecision |
Adverse events at 1 week to 6 months Assessed via self‐report Nicotine EC vs non‐nicotine EC | RR 1 [0.73, 1.36] | 2 studies · 346 participants | Low Downgraded: imprecision |
Serious adverse events at 1 week to 1 year Assessed via self‐report and medical records Nicotine EC vs non‐nicotine EC | RR 0.25 [0.03, 2.19] | 4 studies · 494 participants | Low Downgraded: imprecision |
Nicotine EC compared to behavioural support only/no support for smoking cessation
Population: People who smoke
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Smoking cessation at 6 to 12 months Assessed using biochemical validation Nicotine EC vs behavioural support only/no support | RR 2.5 [1.24, 5.04] | 4 studies · 2312 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events at 12 weeks to 6 months Assessed via self‐report Nicotine EC vs behavioural support only/no support | RR 1.17 [1.04, 1.31] | 3 studies · 516 participants | Very low Downgraded: risk of bias, imprecision |
Serious adverse events at 4 weeks to 6 months Assessed via self‐report and medical records Nicotine EC vs behavioural support only/no support | RR 1.33 [0.25, 6.96] | 5 studies · 842 participants | Very low Downgraded: risk of bias, imprecision |
Electronic cigarettes for smoking cessation
Population: people defined as current smokers at enrolment into trials, motivated or unmotivated to quit
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cessation: Nicotine EC versus placebo EC2 | RR 2.29 [1.05, 4.96] | 2 studies · 662 participants | Low Downgraded: imprecision, indirectness |
Cessation: Nicotine EC versus nicotine replacement therapy | RR 1.26 [0.68, 2.34] | 1 study · 584 participants | Very low Downgraded: indirectness |
Adverse events (AEs) | RR 0.97 | 11 studies · 1201 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Electronic cigarettes for smoking cessation and reduction
Population: people defined as current smokers at enrolment into trials, motivated or unmotivated to quit
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cessation: Nicotine EC versus placebo EC2 | RR 2.29 [1.05, 4.96] | 2 studies · 662 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Cessation: Nicotine EC versus nicotine replacement therapy | RR 1.26 [0.68, 2.34] | 1 study · 584 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Reduction: Nicotine EC versus placebo EC proportion of participants who achieved ≥ 50% reduction in baseline cigarette consumption | RR 1.31 [1.02, 1.68] | 2 studies · 612 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Reduction: Nicotine EC versus nicotine replacement therapy proportion of participants who achieved ≥ 50% reduction in baseline cigarette consumption | RR 1.41 [1.2, 1.67] | 1 study · 546 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Adverse events (AEs) | no estimate extracted | 8 studies · 1090 participants | Low Downgraded: risk of bias, imprecision, indirectness |