E-cigarettes to Augment Stop Smoking In-person Support and Treatment with Varenicline (E-ASSIST): a
Friday, July 15, 2022
Posted by: Natalia Gromov
Tattan-Birch
H, Kock L, Brown J, et al.
E-cigarettes to Augment
Stop Smoking In-person Support and Treatment with Varenicline (E-ASSIST): a
Pragmatic Randomised Controlled Trial.
[published online ahead of print, 2022 Jun 23]. Nicotine Tob Res.
2022;ntac149. doi:10.1093/ntr/ntac149
Background. We
examined whether, in adults receiving behavioural support, offering
e-cigarettes together with varenicline helps more people stop smoking
cigarettes than varenicline alone.
Methods. A
two-group, parallel-arm, pragmatic randomised controlled trial was conducted in
six English stop smoking services from 2019-2020. Adults enrolled onto a
12-week programme of in-person one-to-one behavioural smoking cessation support
(N=92) were randomised to receive either (i) a nicotine e-cigarette starter-kit
alongside varenicline or (ii) varenicline alone. The primary outcome was
biochemically-verified abstinence from cigarette smoking between weeks
nine-to-12 post quit-date, with those lost to follow-up considered not
abstinent. The trial was stopped early due to COVID-19 restrictions and a
varenicline recall (92/1266 participants recruited).
Results. Nine-to-12-week
smoking abstinence rates were 47.9% (23/48) in the e-cigarette-varenicline
group compared with 31.8% (14/44) in the varenicline-only group, a 51% increase
in abstinence among those offered e-cigarettes; however, the confidence
interval (CI) was wide, including the possibility of no difference (risk ratio
[RR]=1.51, 95%CI=0.91-2.64). The e-cigarette-varenicline group had 43% lower
hazards of relapse from continuous abstinence than the varenicline-only group
(hazards ratio [HR]=0.57, 95%CI=0.34-0.96). Attendance for 12 weeks was higher
in the e-cigarette-varenicline than varenicline-only group (54.2% versus 36.4%;
RR=1.49, 95%CI=0.95-2.47), but similar proportions of participants in both
groups used varenicline daily for ≥8 weeks after quitting (22.9% versus 22.7%;
RR=1.01, 95%CI=0.47-2.20). Estimates were too imprecise to determine how
adverse events differed by group.
Conclusion. Tentative
evidence suggests offering e-cigarettes alongside varenicline to people
receiving behavioural support may be more effective for smoking cessation than
varenicline alone.
Implications. Offering
e-cigarettes to people quitting smoking with varenicline may help them remain
abstinent from cigarettes, but the evidence is tentative because our sample
size was smaller than planned - caused by COVID-19 restrictions and a
manufacturing recall. This meant our effect estimates were imprecise, and
additional evidence is needed to confirm that providing e-cigarettes and
varenicline together helps more people remain abstinent than varenicline alone.
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