Vapes top nicotine patches, gum for smoking cessation

Clinical takeaway: Nicotine e-cigarettes are a proven option for patients who haven't quit with standard aids. 

Most people who smoke want to stop, and most who try will fail. Nearly half of unassisted quit attempts collapse within a week, and fewer than five percent of people remain abstinent a year out. For clinicians, the gap between patients' intent to quit and their success with available aids is the durable frustration of tobacco treatment, and it has kept attention on any tool that might move long-term quit rates. 

E-cigarettes entered that landscape as a consumer product rather than a licensed therapy, and they have become a popular quit aid wherever regulation allows. Part of the appeal is mechanistic: unlike patches or gum, vaping replaces the sensory and behavioral rituals of smoking alongside the nicotine, the elements traditional replacement therapy never addressed. What remained unresolved was whether that translated into more people actually quitting, and whether the devices were safe enough to recommend for the purpose. A continuously updated Cochrane review of randomized trials, now in its latest iteration, speaks to both questions. 

The verdict on effectiveness is now as strong as the review's framework allows. In absolute terms, roughly 10 of every 100 people using nicotine e-cigarettes quit, compared with six of 100 using NRT, about four additional quitters per 100. The advantage held whether the comparator was single-form or combination NRT. 

Nicotine e-cigarettes also outperformed their non-nicotine counterparts, with moderate-certainty evidence, adding about two quitters per 100. Against behavioral support alone or no support, quit rates were higher still in relative terms, about four more quitters per 100, but the evidence is low-certainty because those trials could not be blinded. Serious adverse events were no more frequent with nicotine e-cigarettes than with NRT, and that finding is now moderate-certainty, upgraded this cycle as events accumulated. 

The living systematic review pooled 80 randomized controlled trials representing 29,861 adults who smoked, with searches current to January 2026. The NRT comparison drew on 11 trials and 4,114 participants, spanning single-form and combination therapy. Removing industry-funded trials in sensitivity analyses left the conclusions unchanged. 

The trials most useful to decision-makers next are head-to-head comparisons against frontline pharmacotherapies beyond NRT, and tests of e-cigarettes as an adjunct to existing quit medications, particularly patch-plus-vape combinations. The team is also working on a separate review of interventions to help people quit vaping itself, framing the switch from cigarettes as a transition toward quitting nicotine altogether rather than an endpoint. 

"It's worth highlighting that our review looks at regulated e-cigarettes containing nicotine, but many of those available on the market do not meet these standards," cautioned Jamie Hartmann-Boyce, senior author of the review, University of Massachusetts Amherst. "Unlicensed e-cigarettes are potentially dangerous, with issues including unstable batteries and harmful chemicals. Anyone looking to use e-cigarettes to quit smoking should only purchase devices that have been tested and approved by their country's regulatory body." 

Source: Lindson N, et al. (2026 Aug 25) Cochrane Database Syst Rev. Electronic cigarettes for smoking cessation