E-cigarettes are as effective in smoking cessation as the drugs varenicline and cytisine. This is according to a comprehensive review published in the Cochrane Journal.
"We found evidence with high certainty that these are the three most effective smoking cessation tools we have today." the researchers write in their analysis.
How do medicines such as Champix (varenicline) and similar preparations compare with e-cigarettes and other nicotine medicines in different quit attempts? Researchers at the Universities of Oxford and Leshister wanted to find out.
In total, more than 150 000 people were included in the 300 studies analyzed. The studies were of the 'randomized controlled trial' type and followed those who tried to quit smoking for at least six, but up to 12, months.
"E-cigarettes were found to help about 14 out of 100 who quit smoking. This compared to 6 out of 100 who did not use any of the studied aids" write the researchers in University of Oxford News.
Medicines effective - but not available
The drugs varenicline (champix in Sweden) and cytisine were equally effective. At the same time, the researchers note that varenicline, a drug on the WHO list of essential medicines, is currently (2023) not available in Europe, South America, Japan or parts of North America due to a manufacturing problem.
"Cytisine is also not currently licensed or marketed in countries outside of central and eastern Europe, meaning that it is effectively unavailable in much of the world, including the UK and the US," the researchers write.
Weaker evidence for comination therapy
The researchers also found evidence that combinations of various other medicines were effective in smoking cessation. This mainly concerned different treatments with nicotine patches. But here the evidence was somewhat shaky.
"We base our conclusion on studies that evaluated one drug at a time and not simultaneously in the same intervention. However, there is strong evidence that, for example, nicotine sprays and tablets in combination with strong nicotine patches provide benefits compared to using only one of these tools at a time," the researchers write.
Studied e-cigarettes since 2014
The study was published Cochrane Database of Systematic Reviews and adds to the series of smoking cessation studies that Cochrane regularly publishes on the subject. The aim is to provide evidence for health care providers making decisions about treatment options. Since 2014, e-cigarettes have been included in the comparisons with medications and nicotine products designed to help smokers quit. By 2022, Cochrane found that e-cigarettes with nicotine are twice as effective in smoking cessation as traditional nicotine medicines.
In addition to vejp products, varenicline and cytisine and classical NRT, bupropion was included in the current analysis.
Cochrane reviews also analyze the potential side effects of different products and have not noted any serious, lasting side effects of either e-cigarettes or other nicotine replacement products in the short and medium term, when they used in smoking cessation.
Lack of evidence in Sweden
According to the Swedish Public Health Agency and the National Board of Health and Welfare, there is currently no evidence on the effectiveness of e-cigarettes for smoking cessation. Although Cochrane's data-based analyses are often used in evaluations in Sweden, e-cigarettes are not recommended for smoking cessation in Sweden. At the same time, neither varenicline nor cytisine is available in Sweden, something that been highlighted in various media.
