Nicotine patches used in combination with e-cigarettes for smoking cessation
Walker 2020 trial design and results
Design
Pragmatic randomised trial
Treatment
Nicotine patches plus a nicotine e-cigarette
Control
Nicotine patches alone, or patches plus a nicotine-free e-cigarette
Population
1124 people wanting to stop smoking, in New Zealand
Follow-up
6 months
Primary endpoint
Biochemically verified continuous abstinence at 6 months
Result
Of 1124 randomised — 125 to patches alone, 500 to patches plus a nicotine e-cigarette and 499 to patches plus a nicotine-free e-cigarette — loss to follow-up at 6 months was 50%, 32% and 33% respectively. Verified continuous abstinence at 6 months was modestly higher with the nicotine e-cigarette than with either comparator, with no treatment-related serious adverse events.
Secondary endpoints
Adverse events, product use, withdrawal symptoms
Combining reduced-harm nicotine products, such as nicotine patches with a nicotine e-cigarette, can lead to a modest improvement in smoking cessation over and above that obtained from using patches plus a nicotine-free e-cigarette (or patches alone), with no indication of any serious harm in the short-term.
The trial authors, in the published abstract
How it has aged
Isolates the nicotine from the ritual by using a nicotine-free e-cigarette as one comparator — a genuinely informative control that most e-cigarette trials lack. The effect is modest, and smaller than the head-to-head advantage over nicotine replacement seen in TEC.
Publications
Nicotine patches used in combination with e-cigarettes (with and without nicotine) for smoking cessation: a pragmatic, randomised trial
Walker N, Parag V, Verbiest M, et al. Nicotine patches used in combination with e-cigarettes (with and without nicotine) for smoking cessation: a pragmatic, randomised trial. Lancet Respir Med 2020 Jan;8(1):54-64.
Modest improvement over patches plus a nicotine-free e-cigarette or patches alone
Nicotine-free e-cigarette comparator isolates the pharmacological effect