Addictive Behaviors 119 (2021) 106912

Available online 15 March 2021
0306-4603/© 2021 Elsevier Ltd. All rights reserved.

A systematic review of randomized controlled trials and network
meta-analysis of e-cigarettes for smoking cessation

Gary C.K. Chan a, *, Daniel Stjepanović a, Carmen Lim a, Tianze Sun a,
Aathavan Shanmuga Anandan a, Jason P. Connor a, b, Coral Gartner c, Wayne D. Hall a,
Janni Leung a

a Centre for Youth Substance Abuse Research, The University of Queensland, Australia
b Discipline of Psychiatry, The University of Queensland, Australia
c School of Public Health, The University of Queensland, Australia

A R T I C L E I N F O

Keywords:
E-cigarette
Vaping
Smoking
Quitting
Smoking cessation
Tobacco

A B S T R A C T

Aim: E-cigarettes, or nicotine vaping products, are potential smoking cessation aids that provide both nicotine
and behavioural substitution for combustible cigarette smoking. This review aims to compare the effectiveness of
nicotine e-cigarettes for smoking cessation with licensed nicotine replacement therapies (NRT) and nicotine-free
based control conditions by using network meta-analysis (NMA).
Methods: We searched PubMed, Web of Science and PsycINFO for randomised controlled trials (RCTs) that
allocated individuals to use nicotine e-cigarettes, compared to those that used licensed NRT (e.g., nicotine
patches, nicotine gums, etc), or a nicotine-free control condition such as receiving placebo (nicotine-free) e-
cigarettes or usual care. We only included studies of healthy individuals who smoked. Furthermore, we identified
the latest Cochrane review on NRT and searched NRT trials that were published in similar periods as the e-
cigarette trials we identified. NMA was conducted to compare the effect of e-cigarettes on cessation relative to
NRT and control condition. Cochrane risk-of-bias tool for randomized trials Version 2 was used to access study
bias.
Results: For the e-cigarette trials, our initial search identified 4,717 studies and we included 7 trials for NMA after
removal of duplicates, record screening and assessment of eligibility (Total N = 5,674). For NRT trials, our initial
search identified 1,014 studies and we included 9 trials that satisfied our inclusion criteria (Total N = 6,080).
Results from NMA indicated that participants assigned to use nicotine e-cigarettes were more likely to remain
abstinent from smoking than those in the control condition (pooled Risk Ratio (RR) = 2.08, 97.5% CI = [1.39,
3.15]) and those who were assigned to use NRT (pooled RR = 1.49, 97.5% CI = [1.04, 2.14]. There was a
moderate heterogeneity between studies (I2 = 42%). Most of the e-cigarette trials has moderate or high risk of
bias.
Conclusion: Smokers assigned to use nicotine e-cigarettes were more likely to remain abstinent from smoking than
those assigned to use licensed NRT

Addictive Behaviors 119 (2021) 106912

Available online 15 March 2021
0306-4603/© 2021 Elsevier Ltd. All rights reserved.

A systematic review of randomized controlled trials and network
meta-analysis of e-cigarettes for smoking cessation

Gary C.K. Chan a, *, Daniel Stjepanović a, Carmen Lim a, Tianze Sun a,
Aathavan Shanmuga Anandan a, Jason P. Connor a, b, Coral Gartner c, Wayne D. Hall a,
Janni Leung a

a Centre for Youth Substance Abuse Research, The University of Queensland, Australia
b Discipline of Psychiatry, The University of Queensland, Australia
c School of Public Health, The University of Queensland, Australia

A R T I C L E I N F O

Keywords:
E-cigarette
Vaping
Smoking
Quitting
Smoking cessation
Tobacco

A B S T R A C T

Aim: E-cigarettes, or nicotine vaping products, are potential smoking cessation aids that provide both nicotine
and behavioural substitution for combustible cigarette smoking. This review aims to compare the effectiveness of
nicotine e-cigarettes for smoking cessation with licensed nicotine replacement therapies (NRT) and nicotine-free
based control conditions by using network meta-analysis (NMA).
Methods: We searched PubMed, Web of Science and PsycINFO for randomised controlled trials (RCTs) that
allocated individuals to use nicotine e-cigarettes, compared to those that used licensed NRT (e.g., nicotine
patches, nicotine gums, etc), or a nicotine-free control condition such as receiving placebo (nicotine-free) e-
cigarettes or usual care. We only included studies of healthy individuals who smoked. Furthermore, we identified
the latest Cochrane review on NRT and searched NRT trials that were published in similar periods as the e-
cigarette trials we identified. NMA was conducted to compare the effect of e-cigarettes on cessation relative to
NRT and control condition. Cochrane risk-of-bias tool for randomized trials Version 2 was used to access study
bias.
Results: For the e-cigarette trials, our initial search identified 4,717 studies and we included 7 trials for NMA after
removal of duplicates, record screening and assessment of eligibility (Total N = 5,674). For NRT trials, our initial
search identified 1,014 studies and we included 9 trials that satisfied our inclusion criteria (Total N = 6,080).
Results from NMA indicated that participants assigned to use nicotine e-cigarettes were more likely to remain
abstinent from smoking than those in the control condition (pooled Risk Ratio (RR) = 2.08, 97.5% CI = [1.39,
3.15]) and those who were assigned to use NRT (pooled RR = 1.49, 97.5% CI = [1.04, 2.14]. There was a
moderate heterogeneity between studies (I2 = 42%). Most of the e-cigarette trials has moderate or high risk of
bias.
Conclusion: Smokers assigned to use nicotine e-cigarettes were more likely to remain abstinent from smoking than
those assigned to use licensed NRT

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