Review of: Fucito LM et al, Am J Prev Med 2024;67(2):296–298.

Study Type: Randomized Controlled Trial

The prevalence of vaping is growing, especially among young people. Nearly 15% of 18–24-year-old adults use e-cigarettes regularly and vaping is now more common in this age group than smoking cigarettes (Sanford BT et al, JAMA Intern Med 2024;184(1):106–108). Though vaping is less harmful than combustible tobacco, it is not benign—e-cigarette use is associated with wheezing, dyspnea, and bronchitis, and research shows that most e-cigarette users want to quit (Tackett AP et al, Thorax 2024;79(2):163–168; Palmer AM et al, JAMA Netw Open 2021;4(4):e214146).

We know that varenicline is effective in helping people quit tobacco, including regular cigarettes. A recent meta-analysis found a 6-month quit rate with varenicline of nearly 23% while placebo was less than 10% (Livingstone-Banks J et al, Cochrane Database Syst Rev 2023;5(5):CD006103). However, varenicline hasn’t yet been tested for e-cigarettes, so it was an open question as to whether it would help people stop vaping as well. 

To answer this, investigators conducted the first trial of varenicline for people who exclusively use e-cigarettes. Researchers recruited 40 participants, who were randomized to receive either varenicline titrated up to 2 mg daily (n=20) or a placebo (n=20). All participants received one smoking cessation counseling session, completed self-reports of nicotine use, and were followed for 12 weeks. 

Researchers found that the varenicline group had higher rates of abstinence than the placebo group. At week eight, the 7-day quit rate in the varenicline group was 45% vs 30% in the placebo group. This difference persisted at the other time point measured, 12 weeks, with a quit rate of 40% in the varenicline group vs 30% in the placebo group. Importantly, those who quit vaping did not do so by switching to combustible cigarettes. In fact, only two participants (one in each group) reported cigarette smoking at all. Varenicline was mostly well tolerated, though there were more adverse events in the varenicline group than the placebo group, none of them serious (12 vs 5).

This small trial was not powered to demonstrate statistical significance, and relied on self-report rather than biochemical verification. But the results are encouraging and suggest that varenicline is worth considering for your patients trying to quit vaping.

Carlat Take

This study, though preliminary, provides the first evidence that varenicline can be an effective treatment for those trying to stop vaping. Given that varenicline is already FDA-approved and low-risk, we recommend considering it for your patients who are looking to quit either e-cigarettes or other tobacco products.