By Timothy S. Donahue

Top Takeaways:

• Quit advantage: Nicotine vapes produced higher smoking-cessation rates than nicotine replacement therapy.
• Strong evidence: The updated Cochrane review analyzed 80 randomized trials involving nearly 30,000 participants.
• Safety picture: Researchers found no evidence of serious short-term harm but said longer, larger trials are still needed.

Vaping has strengthened its case as a smoking cessation tool.

An updated Cochrane review found high-certainty evidence that nicotine-containing e-cigarettes help more people quit smoking than traditional nicotine replacement therapies, such as nicotine patches and gum.

The living systematic review, published in the Cochrane Database of Systematic Reviews, included 80 completed randomized controlled trials with 29,861 participants. Nine trials were added in the latest update, but the review’s overall conclusions did not change.

Researchers found that people assigned to nicotine e-cigarettes were 61% more likely to quit smoking for at least six months than those assigned to NRT. In absolute terms, the researchers estimated that nicotine e-cigarettes could produce about four additional quitters for every 100 people compared with NRT. The analysis was based on 11 studies with 4,114 participants.

The review’s summary translates this into roughly 8 to 10 people quitting for every 100 using nicotine e-cigarettes, compared with about six using nicotine replacement therapy.

“We have very strong evidence that regulated nicotine e-cigarettes are substantially less harmful than smoking,” said Jamie Hartmann-Boyce, a senior author of the review and researcher at the University of Massachusetts Amherst. “Based on the consistency of the findings here, it’s clear that they are a proven and viable option for people wishing to quit traditional cigarettes. This update includes nine new trials, and our main conclusions haven’t changed.”

Nicotine e-cigarettes also probably outperform non-nicotine e-cigarettes. Seven trials involving 1,918 participants found that nicotine vaping increased quit rates by an estimated two per 100 compared with non-nicotine vaping. Cochrane rated that evidence as moderate certainty.

The advantage over behavioral support alone or no support was also significant, though the evidence was less certain. Eleven studies with 7,214 participants reported a relative risk of 1.75 in favor of nicotine e-cigarettes. Cochrane rated that evidence as low certainty because of the risk of bias inherent in the study designs.

“Quitting smoking is hard and a lot of people who smoke will have tried many times to quit smoking and been unsuccessful,” said lead author Nicola Lindson of the University of Oxford. “For that reason, it is important that there are a number of different options available to help somebody quit, which could encourage them to keep trying.

“Although nicotine vapes are unlikely to be completely risk free, they are less harmful than smoking and that is the most important comparison to make for people who are still smoking tobacco.”

Regarding safety, the researchers found that serious adverse events were uncommon across the trials. There was moderate-certainty evidence that serious adverse-event rates were similar between nicotine e-cigarettes and NRT. The researchers reported no evidence of serious short-term harm from nicotine e-cigarettes but cautioned that longer and larger trials are needed to fully assess safety.

The findings apply specifically to regulated nicotine-containing e-cigarettes. The authors cautioned that illicit products and those containing other active substances, including THC, may have different risk profiles.

“For somebody who is already addicted to nicotine through cigarettes, having a safer alternative like an e-cigarette is something worth considering, especially when other quit aids have proven unsuccessful,” Hartmann-Boyce said.

The 2026 review updates Cochrane’s 2025 analysis and is part of an ongoing living systematic review. Researchers continually search for new evidence and update the analysis as relevant studies become available. The evidence in the latest review is current through Jan. 1, 2026.