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Electronic nicotine delivery systems and/or electronic non-nicotine delivery systems for tobacco smoking cessation or reduction: a systematic review and meta-analysis
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  • Menfil A. Orellana-Barrios, Drew Payne and Kenneth Nugent
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    Letter to the Editor
    • Menfil A. Orellana-Barrios, Physician: Internal Medicine - Cardiology University of Florida, Jacksonville
    • Other Contributors:
      • Drew Payne, Physician: Internal Medicine
      • Kenneth Nugent, Physician: Critical Care - Pulmonary

    Dear Editor:

    We commend El Dib and colleagues(1) on their extensive review effort and offer the following critiques:

    a. In their analysis regarding ENDS vs. ENNDS for smoking cessation (Figure 5)(1), the authors have chosen to compare the 6-month cessation rate for the ASCEND(2) study with the 12-month cessation rate in the ECLAT(3) study. Using equal time frames seem like it would allow a more homogenous comparison, particularly because this is available from the ECLAT publication. This does raise the bigger issue that an important conclusion in review related to e-cigarette and smoking cessation should be advocating for uniformity in outcome reporting, as has been proposed in prior publications (e.g. the Russel Standard)(4).

    b. We disagree with the author's main analysis where subjects lost to follow-up (LFU) excluded. It is incorrect to assume that the cessation rate in the LFU group is the same as the subject who actually completed the study. Regardless of this, the authors have indeed performed a "worse case" analysis but here we find discrepancy between the published cessation data from the studies and the numbers used in the analysis. Using an intention-to-treat (ITT) analysis, for instance, the ASCEND trial reported a cessation rate for ENDS of 21/289 (30/289 including non-verified) while in ECLAT this was 22/200. This is in contrast to 25/289 and 34/200, respectively, as used in the author's analysis. In the ENNDS subg...

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    Conflict of Interest:
    None declared.