Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, QC, Canada; Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, QC, Canada; Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada; Department of Medicine, McGill University, Montreal, QC, Canada.
Am J Med. 2023 Aug;136(8):804-813.e4. doi: 10.1016/j.amjmed.2023.04.014. Epub 2023 May 5.
People who smoke conventional cigarettes are increasingly turning to electronic cigarettes (e-cigarettes) as a pathway to quitting. However, the efficacy and safety of e-cigarettes for smoking cessation remains controversial.
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), identified through a systematic search of the MEDLINE, EMBASE, and Cochrane CENTRAL databases. Inclusion was restricted to RCTs with a follow-up duration ≥6 months. The primary endpoint was the most rigorous criterion of biochemically validated abstinence at maximum follow-up, and the primary comparison was nicotine e-cigarettes versus any conventional (ie, non-e-cigarette) smoking cessation therapy. The Cochrane Risk of Bias Tool was used to assess bias. Count data were pooled across trials using random-effects models with inverse variance weighting to estimate relative risks (RRs) and corresponding 95% confidence intervals (CIs). We registered the study protocol with the Open Science Framework Registries (osf.io/26fkq).
A total of 5 RCTs (n = 3253) were included. Compared with conventional smoking cessation therapies, the use of nicotine e-cigarettes was associated with an increase in abstinence, defined by the most rigorous criterion of abstinence reported (RR 1.77; 95% CI, 1.29-2.44). Nicotine e-cigarettes also increased abstinence (defined by the most rigorous criterion) compared with non-nicotine e-cigarettes (RR 1.56; 95% CI, 1.13-2.15). The incidence of death or serious adverse events was low across all trials at maximum follow-up.
Among individuals attempting to quit smoking, nicotine e-cigarettes are more efficacious than conventional nicotine replacement or behavioral smoking cessation therapies, and may prove beneficial in reducing smoking-related health risks.
越来越多吸传统香烟的人正在转向电子烟作为戒烟的途径。然而，电子烟戒烟的效果和安全性仍然存在争议。
我们对 MEDLINE、EMBASE 和 Cochrane CENTRAL 数据库进行了系统检索，以确定随机对照试验（RCT）的系统评价和荟萃分析。纳入标准为随访时间≥6 个月的 RCT。主要终点是在最大随访时通过最严格的生物化学验证的戒烟标准，主要比较是尼古丁电子烟与任何常规（即非电子烟）戒烟治疗。使用 Cochrane 偏倚风险工具评估偏倚。使用随机效应模型和倒数方差加权对试验进行汇总，以估计相对风险（RR）和相应的 95%置信区间（CI）。我们在开放科学框架登记处（osf.io/26fkq）注册了研究方案。
共有 5 项 RCT（n=3253）纳入研究。与常规戒烟治疗相比，使用尼古丁电子烟与报告的最严格的戒烟标准（RR 1.77；95%CI，1.29-2.44）的戒烟率增加相关。尼古丁电子烟与非尼古丁电子烟相比（RR 1.56；95%CI，1.13-2.15），也增加了戒烟率（定义为最严格的标准）。在最大随访时，所有试验的死亡或严重不良事件发生率均较低。
在试图戒烟的个体中，尼古丁电子烟比常规尼古丁替代或行为戒烟治疗更有效，并且可能有助于降低与吸烟相关的健康风险。
