Cochrane reviews reaffirm vaping as most effective quit tool, spotlight emerging role of nicotine pouches

Electronic cigarettes containing nicotine remain the most effective aid to help smokers quit, outperforming traditional nicotine replacement therapies (NRTs) like patches and gum, according to the latest reviews published in the Cochrane Database of Systematic Reviews – one of the world’s most trusted sources of medical evidence.

The updated Cochrane review on electronic cigarettes for smoking cessation, which analysed data from 104 studies involving more than 30,000 adults, confirms what a growing body of research has shown since 2022: nicotine vapes are more effective than NRTs and likely more effective than non-nicotine e-cigarettes for helping smokers stay off cigarettes for at least six months.

Strongest evidence yet for nicotine vapes

The review found that for every 100 people using nicotine vapes to quit, 8 to 11 were successful, compared with around 6 using patches or gum and 4 using no support.

The evidence was rated “high certainty” when comparing nicotine e-cigarettes with NRT, and “moderate certainty” when compared with non-nicotine vapes.

Importantly, the review also found no clear increase in serious adverse events among those using nicotine vapes to quit smoking. Reported side effects such as throat irritation, cough, and nausea were mostly mild and tended to fade with continued use.

“Evidence suggesting that nicotine electronic cigarettes (EC) can aid in smoking cessation is consistent across several comparisons,” the authors concluded, while stressing the need for more long-term safety data – particularly on newer-generation devices with better nicotine delivery.

Cochrane has now reviewed e-cigarette evidence multiple times – including in November 2022, January 2024, and January 2025 – with each review strengthening the case for vaping as a front-line cessation option.

First review of nicotine pouches

Alongside the vaping review, Cochrane has released its first-ever systematic review on oral nicotine pouches – the small, tobacco-free sachets placed under the lip that have surged in popularity in the UK and Europe.

The review found no evidence of short-term serious health harms in people using nicotine pouches, based on four small studies involving 284 smokers. However, evidence on whether pouches help people quit smoking was inconclusive due to the limited number and size of existing trials.

Early signs suggest nicotine pouches may be less effective than nicotine vapes for helping people quit, though researchers stressed that this finding is based on a single small study and could change as more data become available.

Chemical exposure studies showed lower levels of harmful compounds such as NNAL, a chemical formed when cancer‐causing chemicals (from tobacco use) enter the body, and carbon monoxide in pouch users compared to smokers, suggesting potential harm reduction benefits.

“More research on the effects of oral nicotine pouches for cessation or reduction of use of other tobacco or non‐pharmaceutical nicotine products is urgently needed,” the authors wrote. “Future trials should prioritise comparing oral nicotine pouches to other active interventions (e.g. NRT and e‐cigarettes).”

Ten new studies on nicotine pouches are already underway, which Cochrane says could significantly expand the evidence base in the next few years.

The findings arrive amid ongoing debate in the UK about how to balance harm reduction with youth protection in nicotine regulation. The government has proposed tighter rules on vape packaging and flavours while considering how to classify nicotine pouches under existing tobacco control laws.

For retailers and the wider vape industry, the reviews underscore two trends: nicotine vapes remain the gold standard for smokers seeking to quit and nicotine pouches are emerging fast, with encouraging early safety data but insufficient proof of effectiveness.