Electronic Cigarettes Versus Varenicline for Smoking Cessation: A Systematic Review and Meta-analysis of in-person Support Augmentation Strategies

Tobacco smoking is a global health crisis, causing over 8 million deaths annually, including 1.3 million in India. The rise of electronic cigarettes (e-cigarettes) has raised questions about their effectiveness compared to traditional aids like varenicline. This systematic review evaluates the comparative effectiveness of e-cigarettes and varenicline in facilitating smoking cessation, especially with in-person support strategies. The review followed the PRISMA guidelines and utilized the PICOS framework to include randomized controlled trials and clinical trials published up to April 9, 2024. A comprehensive search across PubMed, EBSCO, and the Cochrane Library identified relevant studies comparing e-cigarettes and varenicline against placebo or other cessation methods. Data extraction focused on continuous abstinence rates, point prevalence abstinence, and reductions in cigarette consumption. Five studies were included in the analysis. Tattan Birch <i>et al</i>. (2023) reported a 47.9% abstinence rate in the e-cigarette-varenicline group compared to 31.8% for varenicline alone (RR = 1.51). The ECSMOKE trial found noninferiority between e-cigarettes with nicotine and varenicline, with continuous abstinence rates of 30% versus 28%, respectively. Other studies highlighted the significant impact of varenicline on reducing smoking behavior and urges. The findings suggest that both e-cigarettes and varenicline are effective smoking cessation aids, particularly when combined with behavioral support. However, the high risk of bias in the included studies necessitates cautious interpretation. Future research should focus on long-term outcomes and the psychological factors influencing cessation success to enhance public health strategies aimed at reducing smoking prevalence.