Effectiveness and Safety Profile of Alternative Tobacco and Nicotine Products for Smoking Reduction and Cessation: A Systematic Review

Abstract

Neily Zakiyah,1,2 Febby V Purwadi,1,2 Widya N Insani,1– 3 Rizky Abdulah,1,2 Irma M Puspitasari,1,2 Melisa I Barliana,1,2,4 Ronny Lesmana,2,5,6 Amaliya Amaliya,7 Auliya A Suwantika1,2,8 1Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia; 2Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia; 3Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; 4Department of Biological Pharmacy, Biotechnology Pharmacy Laboratory, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia; 5Division of Physiology, Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia; 6Division of Biological Activity, Central Laboratory, Universitas Padjadjaran, Bandung, West Java, Indonesia; 7Department of Periodontics, Faculty of Dentistry, Universitas Padjadjaran, Bandung, West Java, Indonesia; 8Center for Health Technology Assessment, Universitas Padjadjaran, Bandung, West Java, IndonesiaCorrespondence: Neily ZakiyahDepartment of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, IndonesiaTel [phone]Email [email protected]: Alternative tobacco and nicotine products such as electronic cigarettes (EC), smokeless tobacco, and nicotine replacement therapy (NRT) are currently being assessed as options in tobacco harm reduction due to their potential role in smoking reduction and smoking cessation.Objective: To provide the current evidence on the effectiveness and safety of various alternative tobacco and nicotine products for smoking reduction and cessation.Methods: A systematic review using databases from MEDLINE (PubMed), EMBASE, and The Cochrane Library was conducted up to December 2020 to identify eligible experimental and observational studies assessing the use of alternative tobacco and nicotine products on smoking reduction and smoking cessation and the safety of these products. The Cochrane Risk of Bias 2 (RoB 2) and ROBINS-I tools were used to assess the risk of bias of the included studies. Results were described through a narrative synthesis of the evidence.Results: From 1955 retrieved references, 44 studies (31 randomized controlled trials/RCTs and 13 prospective cohort studies) met the inclusion criteria and were included in the review. Twenty-nine studies were assessing EC, one study evaluated heat-not-burn (HNB) product, five studies were focused on snus, and nine studies assessed NRT in the form of nicotine patch, gum, etc. The overall results suggested that alternative tobacco and nicotine products in the form of EC, snus, and NRT can moderately reduce daily cigarette consumption and has potential to assist smoking cessation attempts, with fewer adverse events.Conclusion: The findings suggested that alternative tobacco and nicotine products have a potential role in assisting smoking reduction and cessation, highlighting their role in the tobacco harm reduction approach. Further studies should focus on investigating long-term outcomes, safety, and effectiveness of alternative tobacco and nicotine products to better inform smoking reduction/cessation policy.PROSPERO Registration Number: CRD42020205830.Keywords: cigarette smoking, smoking cessation, smoking reduction, nicotine, e-cigarettes, snus, nicotine replacement therapy, harm reduction

Keywords

• cigarette smoking
• smoking cessation
• smoking reduction
• nicotine
• e-cigarettes
• snus
• nicotine replacement therapy
• harm reduction