The international evidence-based medicine organization Cochrane has updated its systematic review on vapes for smoking cessation. The review includes a total of 80 randomized controlled trials (RCTs) and 29,861 adult smokers, with 9 trials added in this update. Results indicate that nicotine vapes increase smoking cessation rates (at a minimum of 6 months) compared to nicotine replacement therapy (NRT), with the evidence rated as high certainty; in terms of absolute effect, this translates to an increase of approximately 4 successful quitters per 100 people. No clear difference was found regarding the incidence of serious adverse events between the two methods, though further research is needed on long-term safety and the efficacy of newer vape devices.
Key Summary
The 2026 update incorporates 80 RCTs and 29,861 adult smokers (including 9 newly added trials); the overall conclusion remains unchanged from the previous version.
In 11 trials involving 4,114 participants that directly compared nicotine vapes with NRT, nicotine vapes demonstrated higher long-term cessation rates (relative risk ratio: 1.61), supported by high-certainty evidence.
Absolute effect estimates show that for every 100 people using NRT, approximately 6 successfully quit smoking, compared to approximately 10 in the nicotine vape group—an increase of about 4 quitters per 100 people.
No clear evidence suggests that nicotine vapes increase the risk of serious adverse events compared to NRT; however, evidence gaps remain regarding long-term safety and the cessation efficacy of newer-generation devices, such as pod systems and disposable vapes.
Cochrane’s Latest Evidence on Vapes for Smoking Cessation
September 7, 2026. According to the latest systematic review on vapes for smoking cessation published by Cochrane on August 26, 2026, researchers analyzed 80 RCTs involving 29,861 adult smokers and found that nicotine-containing vapes increase smoking cessation rates (at a minimum of 6 months) compared to nicotine replacement therapy (NRT). The evidence for this finding is rated as high certainty.
Although 9 RCTs were added in this update, the research team stated that the primary conclusions remain unchanged. The review, titled “Electronic cigarettes for smoking cessation,” was published in the Cochrane Database of Systematic Reviews (Issue 8, 2026). The research team comprised members from institutions including the University of Oxford, Queen Mary University of London, the University of Auckland, the University of Michigan, the University of East Anglia, Harvard Medical School and Massachusetts General Hospital, Monash University, and the University of Massachusetts Amherst. The literature search for this update covered studies up to January 1, 2026.
Latest Evidence Base Comprises 80 Randomized Controlled Trials
The 80 studies included in this update were all randomized controlled trials (RCTs), involving a total of 29,861 participants. After updating the study protocol in 2025, the team adjusted the inclusion criteria to limit studies to eligible RCTs; consequently. The number of studies in the 2026 version cannot be directly compared with earlier versions that included non-randomized studies.
Of the 80 studies, 40 were conducted in the United States and 16 in the United Kingdom, with the remainder distributed across countries such as Australia, Greece, Italy, New Zealand, and Canada. All study participants were adult smokers.
Among these, 34 studies reported smoking cessation outcomes at a minimum of six months, 35 provided data suitable for adverse event analysis, and 48 reported data on serious adverse events.
Comparisons examined in the studies included nicotine vapes versus nicotine replacement therapy (NRT), non-nicotine vapes, behavioral support or no support, and other smoking cessation medications and nicotine products. Some trials also compared different vape devices, nicotine concentrations, and flavor options.
Nicotine Vapes Increase Smoking Cessation Rates Compared With NRT
In the primary comparison supported by the most robust evidence, 11 RCTs involving a total of 4,114 participants compared the smoking cessation efficacy of nicotine vapes versus NRT.
Pooled results showed that the likelihood of achieving smoking cessation for at least six months was higher in the nicotine vape group than in the NRT group, with a relative risk of 1.61 (95% confidence interval: 1.23 to 2.12). Cochrane rated this finding as high-certainty evidence. Based on the absolute effect estimates provided in the review, approximately 6 out of every 100 participants receiving NRT successfully quit smoking, compared to about 10 in the nicotine vape group—an increase of roughly 4 quitters per 100 people.
The research team also conducted analyses based on the form of NRT used, including single-form NRT and combination NRT. Sensitivity analyses showed that the direction of the overall results remained unchanged after excluding studies at high risk of bias or those with funding ties to the tobacco or vape industries.
Nicotine Vapes Show Higher Quit Rates Than Non-Nicotine Vapes
Seven randomized controlled trials involving a total of 1,918 participants compared nicotine vapes with non-nicotine vapes.
The results showed higher long-term quit rates in the nicotine vape group, with a relative risk of 1.34 (95% CI 1.05–1.69); the evidence was rated as having moderate certainty.
Based on absolute effect estimates, approximately 6 out of every 100 people using non-nicotine vapes successfully quit smoking, compared to about 8 among those using nicotine vapes.
Comparisons between nicotine vapes and behavioral support alone—or no smoking cessation support—also showed increased quit rates. Pooled results from 11 studies involving 7,214 participants showed a relative risk of 1.75 (95% CI 1.39–2.20).
However, the evidence in this category was rated as having low certainty. The research team noted that implementing blinding in such trials is difficult and that there were differences in the level of intervention and support received by different groups, resulting in a high risk of performance bias.
Serious Adverse Events Show No Clear Difference Compared With NRT
Regarding safety, 10 studies involving 4,045 participants provided data comparing serious adverse events between nicotine vapes and NRT.
Pooled results showed no clear difference in the incidence of serious adverse events between the two groups, with a risk difference of 0.01 (95% CI -0.01 to 0.02); the evidence was rated as having moderate certainty. Regarding general adverse events, results from eight studies involving 3,107 participants also showed no clear difference between the two groups; however, due to result heterogeneity and limited estimation precision, the certainty of this evidence was rated as low.
The study authors stated that while no evidence of serious short-term harm associated with using nicotine vapes for smoking cessation was detected, larger trials with longer follow-up periods are still needed to fully assess long-term safety.
The review evaluated regulated nicotine-containing vape products. The authors noted that illicit products and those containing tetrahydrocannabinol (THC) or other active substances may carry different risk profiles.
Evidence Gaps Remain for Newer-Generation Vape Devices
The review covered a variety of vape devices. Studies where device types could be clearly identified included refillable devices, cartridge-based systems, pod systems, disposable vapes, and other types used in research.
The research team pointed out that nicotine delivery capabilities can vary significantly across different types of vapes, potentially influencing smoking cessation outcomes. In recent years, some pod systems utilizing nicotine salts have achieved higher levels of nicotine delivery, more closely mimicking the pharmacokinetic profile of combustible cigarettes.
However, there is currently an insufficient number of randomized trials across different device categories to conduct a robust subgroup analysis by device type. Consequently, existing results cannot be used to determine whether different categories or generations of vapes yield the same smoking cessation outcomes.
In this update, Cochrane also highlighted the need for further research into newer vapes with higher nicotine delivery efficiency, as more effective nicotine delivery could influence the likelihood of smokers successfully quitting.
Cochrane Review Identifies 61 Ongoing Studies
This study is part of a “living systematic review” that Cochrane continuously updates. The research team regularly searches for new evidence and updates the review as relevant new findings emerge.
As of this update, in addition to the 80 completed studies. The review has identified 61 ongoing studies. Following the addition of nine new randomized controlled trials, the research team’s primary conclusion remains unchanged: there is still high-certainty evidence that nicotine vapes increase long-term smoking cessation rates compared to nicotine replacement therapy (NRT), while further research is needed regarding long-term safety, comparisons between different device types, and comparisons with certain other cessation methods.
Cochrane is a prominent international research network in evidence-based medicine; its systematic reviews evaluate and synthesize existing medical evidence using standardized methods and are widely used to inform clinical practice, public health, and policy decisions.
