Man smoking e-cigarette

E-cigarettes more effective than nicotine replacement therapies, finds major UK clinical trial

Date: 31 January 2019

E-cigarettes are almost twice as effective as nicotine replacement treatments, such as patches and gum, at helping smokers to quit, according to a clinical trial funded by the NIHR.

The multi-centre trial, led by Queen Mary University of London, involved almost 900 smokers who also received additional behavioural support, found that 18.0 per cent of e-cigarette users were smoke-free after a year, compared to 9.9 per cent of participants who were using other nicotine replacement therapies. 

Lead researcher Professor Peter Hajek, said: “This is the first trial to test the efficacy of modern e-cigarettes in helping smokers quit. E-cigarettes were almost twice as effective as the ’gold standard’ combination of nicotine replacement products.

“Although a large number of smokers report that they have quit smoking successfully with the help of e-cigarettes, health professionals have been reluctant to recommend their use because of the lack of clear evidence from randomised controlled trials. This is now likely to change.”

The only previous trial comparing e-cigarettes to nicotine patches used early ‘cig-a-like’ e-cigarettes with very low nicotine delivery, had no face-to-face contact, and found low efficacies for both treatments.

The new study, today published in the New England Journal of Medicine, was funded by the NIHR’s Health Technology Assessment (HTA) Programme was set-up to test the long-term efficacy of newer refillable e-cigarettes compared with a range of nicotine replacement treatments

886 smokers attended UK National Health Service stop smoking services (in Tower Hamlets, City of London, Leicester and East Sussex) and were randomised to receive either a nicotine replacement treatment of their choice (including patches, gum, lozenges, sprays, inhalators, or a combination of products) provided for up to three months, or an e-cigarette starter pack with one or two bottles of e-liquid and encouragement to buy future supplies of their own choice of strengths and flavours.

All participants received weekly one-on-one behavioural support for at least four weeks, with expired air carbon monoxide monitoring.

In addition to e-cigarettes being almost twice as effective, the researchers found that:

  • The participants comprised largely of middle aged dependent smokers, with 40 per cent entitled to free prescriptions (a marker of social disadvantage or poor health)
  • Abstinence rates were higher in the e-cigarette arm at all time points
  • Among abstainers, e-cigarette participants were more likely to use their allocated product at 52 weeks than nicotine replacement participants (79.8 per cent vs 9.1 per cent)
  • Among participants who did not achieve full abstinence, more e-cigarette users achieved a carbon monoxide-validated reduction of smoking by at least 50 per cent
  • Adherence was similar in both arms, but e-cigarettes were used more frequently and for longer
  • E-cigarette participants reported more throat/mouth irritation (65.4 per cent vs 50.8 per cent) and nicotine replacement participants reported more nausea (37.8 per cent vs 31.4 per cent)
  • E-cigarette participants reported greater decline in incidence of cough and phlegm production after 52 weeks
  • Both products were perceived as less satisfying than cigarettes, but e-cigarettes provided higher satisfaction and were rated as more helpful than nicotine replacement treatment
  • E-cigarette arm abstainers experienced less severe urges to smoke at 1 and 4 weeks post-quit date. They also reported a lower increase in irritability, restlessness and inability to concentrate after the first week of abstinence, compared to those in the nicotine replacement arm 

Professor Hywel Williams, Director of the NIHR’s Health Technology Assessment Programme, which funded the study, said: “This groundbreaking NIHR-funded study provides clear evidence that e-cigarettes are almost twice as effective as nicotine replacement therapy for helping smokers to quit. Cigarette smoking is still a major cause of ill health and death in the UK, so this study will provide much needed evidence to help people and policy makers to make informed choices.”

More information on the study is available on the NIHR Journals Library


  • Summary:
    E-cigarettes are almost twice as effective as nicotine replacement treatments, such as patches and gum, at helping smokers to quit, according to a clinical trial funded by the NIHR.
  • Include on homepage (one at a time):
  • Areas of the site this news is applicable to:
  • LCRN:
  • Year of publication:
  • Specialty:
    • Tobacco-cessation
    • Public Health
  • News filter:

You may also be interested in