Human Biomarker Exposure from Cigarettes versus Novel Heat-Not-Burn Devices: A Systematic Review and Meta-Analysis
A partir d'une revue systématique de la littérature publiée entre janvier 2010 et août 2019 (10 essais randomisés ; 1 766 participants), cette méta-analyse compare les niveaux de biomarqueurs d'exposition au tabac en fonction du produit utilisé (cigarettes classiques et produits de tabac chauffé "Heat-Not-Burn")
Novel tobacco products require independent research to assess their safety. This study assessed the current literature for trials comparing levels of biomarkers of exposure (BoE) between conventional cigarettes and heat-not-burn (HNB) devices.Ten databases were searched using terms including: ‘heat not burn’, ‘iqos’, ‘teeps’, ‘mrtp’, ‘tobacco heating’, and ‘glo’, between 1st January 2010 and 13th August 2019. Randomised controlled trials assessing comparative BoE levels in humans using either conventional cigarettes or novel HNB devices were eligible. BoE were tabulated, and differences between the intervention and control groups analysed and combined using a random effects meta-analysis.Ten non-blinded, randomised controlled trials were eligible, involving a total of 1,766 participants. Studies regularly reported on 12 BoE (including nicotine). HNB devices assessed included the ‘IQOS’ and ‘glo’ devices, and ‘precursor’ (being developed) HNB devices. In comparison to conventional cigarettes, all 12 BoEs assessed were significantly lower for participants assigned to a HNB device. In comparison to smoking abstinence, HNB devices were statistically equivalent for eight BoEs and significantly elevated for four BoEs.This review found that the potential for harm to humans is reduced when using HNB devices compared to conventional cigarettes, as indicated by significant reductions in BoE levels. Whilst these results support tobacco manufacturer claims of improved safety, the small number of studies included, limited range of BoE assessed, and involvement of the tobacco industry necessitate further independent research to confirm the HNB devices as being a safer alternative to conventional cigarettes.This study supports claims made by tobacco manufacturers on the improved safety of heat-not-burn tobacco devices in comparison to conventional cigarettes. These novel devices lead to reduced exposure to key biomarkers, which are linked to the health consequences attributed to tobacco use. This has strong implications for international public health as well as further research and policy development relating to the safety aspects and legalities of novel tobacco products.
Nicotine & Tobacco Research , résumé, 2018