E-cigarettes containing nicotine help more smokers to quit than traditional nicotine replacement therapies. This is the conclusion reached by the international research organisation Cochrane in yet another update to its ongoing systematic review.

At the same time, the findings are beginning to have a greater impact outside the research community. In the US, doctors are now advised to discuss e-cigarettes with patients who smoke, whilst the British authorities have been distributing starter packs containing e-cigarettes to smokers for several years.

The international research organisation Cochrane has once again updated its review of the research on e-cigarettes as an aid to smoking cessation. The latest analysis includes 80 randomised controlled trials involving a total of 29,861 participants. Nine studies have been added since the last update.

However, the results do not alter the researchers’ previous conclusion.

– We have very strong evidence that regulated e-cigarettes containing nicotine are significantly less harmful than smoking. Given how consistent the findings are, it is clear that they are a well-documented and viable alternative for people who wish to stop smoking traditional cigarettes, says Jamie Hartmann-Boyce, a professor at the University of Massachusetts Amherst and one of the lead authors of the review.

More people are giving up smoking

According to Cochrane, there is high-certainty evidence that e-cigarettes containing nicotine lead to more successful smoking cessation than nicotine replacement therapies such as patches and chewing gum.

In absolute terms, the difference equates to around four additional people giving up smoking for every 100 people who use e-cigarettes instead of nicotine replacement therapy.

The results are also better when compared with nicotine-free e-cigarettes. In this case, the difference corresponds to around two additional people giving up smoking per 100 people.

When e-cigarettes are compared with behavioural support alone or no support, the results also favour e-cigarettes. However, Cochrane rates the certainty of the evidence in this part of the analysis as lower.

The conclusion has remained unchanged

The Cochrane review is what is known as a “living systematic review” – an ongoing systematic review in which researchers regularly search for new studies and update the analysis as the scientific evidence base expands.

Vejpkollen has been tracking this review since 2020. Even back then, researchers assessed that e-cigarettes containing nicotine were likely to help more people stop smoking than traditional nicotine replacement therapies. In subsequent updates, both the number of studies and the number of participants have increased, whilst the reliability of parts of the evidence has been strengthened.

The latest update does not alter the main finding.

– “This update includes nine new studies, and our main conclusions remain unchanged,” states Jamie Hartmann-Boyce.

At the same time, the researchers found no evidence that the use of e-cigarettes to help people give up smoking increased the risk of serious side effects. However, they emphasise that there is still a need for larger studies with longer follow-up periods in order to assess rare and long-term effects.

Is beginning to influence the recommendations

Whilst Cochrane continues to update the evidence, research into e-cigarettes as a smoking cessation aid is also beginning to take on greater significance within the healthcare sector and in public health.

In July, the medical journal JAMA published new recommendations from an international group of researchers affiliated with the Society for Research on Nicotine and Tobacco. The group believes that US doctors should include e-cigarettes when discussing various options for quitting smoking with adult patients.

Among other things, the researchers point out that e-cigarettes containing nicotine have been shown to be more effective in helping people give up smoking than nicotine replacement therapies approved by the US Food and Drug Administration (FDA).

The recommendation does not mean that e-cigarettes should be the first choice for all smokers. Instead, the researchers suggest that doctors should be able to discuss the risks and benefits alongside other established methods and support patients who choose e-cigarettes in using them in a way that increases their chances of giving up cigarettes altogether.

The UK is distributing e-cigarettes

In the UK, e-cigarettes have already been given a more direct role in the national strategy to reduce smoking.

Through the “Swap to Stop” initiative, smokers in England have been offered free starter packs containing e-cigarettes, along with support to help them quit smoking.

A study by King’s College London and University College London, published earlier this year, estimated that around 125,000 more people used e-cigarettes in an attempt to give up smoking in the year following the programme’s introduction.

The researchers used data from the UK Smoking Toolkit Study and found a clear increase in the use of e-cigarettes as a means of quitting smoking following the launch of the initiative.

“The most important comparison”

Cochrane also emphasises that the findings apply to regulated e-cigarettes containing nicotine – not to illegal products or products containing other substances, such as THC.

Nor do the researchers describe e-cigarettes as risk-free.

– Although e-cigarettes containing nicotine are probably not entirely risk-free, they are less harmful than smoking. That is the most important comparison for people who still smoke tobacco, says Nicola Lindson, lead author of the review and a researcher at the University of Oxford.

At the same time, Cochrane continues to monitor the research. New studies are regularly added to the review, with a particular focus on longer-term follow-ups and newer types of e-cigarettes.

“Further randomised controlled trials are currently underway. To ensure that the review continues to provide up-to-date information, this is an ongoing systematic review. We carry out and review searches every month and update the review as new relevant evidence becomes available,” write the researchers behind the review.

Source:
Electronic cigarettes for smoking cessation – Lindson, N – 2026 | Cochrane Library

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