REVIEW OF: Wagener TL et al, Lancet Reg Health Am 2026;54:101351

STUDY TYPE: RCT

Most cigarette smokers relapse after their first quit attempt, and it’s not clear what works best the second time around. Though effective, quitlines (free phone counseling available in all 50 states) remain underused (Matkin W et al, Cochrane Database Syst Rev 2019;5(5):CD002850). This trial asked whether re-engaging failed quitline callers with e-cigarettes or combination NRT plus counseling could improve their odds on a second attempt.

Researchers recruited 350 adults from a pair of state quitlines who were still smoking after a recent enrollment. Participants were randomized to eight weeks of either e-cigarettes (Juul) or combination NRT (patch plus lozenge), along with three counseling calls, in an unblinded trial. The primary outcome was biochemically verified seven-day abstinence at eight weeks.

Abstinence rates were low and similar: 14% with e-cigarettes compared to 10% with NRT (OR 1.56, 95% CI 0.81–3.04). Both groups cut cigarette consumption by about 13 cigarettes per day from baseline. A prolonged abstinence advantage for e-cigarettes (12.0% vs 5.7%; p = 0.044) disappeared by week 12. Side effect profiles differed: Patients experienced cough and breathing difficulties with e-cigarettes, compared to dizziness, sleeplessness, and allergies with NRT.

Two caveats favor NRT: Its long-term safety is far better established, and unlike e-cigarettes, its nicotine content is standardized; in other words, these results may not generalize for other e-cigarette brands or devices.

CARLAT TAKE
E-cigarettes neither outperformed nor underperformed combination NRT in this relapse-prone group. The key takeaway: Re-engaging patients who have failed is worthwhile regardless of product, and patient preference can guide the choice. State quitline services can be accessed by calling 1-800-QUIT-NOW.