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Several international guidelines (from the National Institute for Health and Care Excellence, the New Zealand Ministry of Health, the Royal Australian College of General Practitioners, and the Haute Authorit de Sant de France) advise that e-cigarettes may be used for cessation in certain cases but that information should be provided on the risks and uncertainties, including that e-cigarettes are not licensed medicines in most jurisdictions, and that there is a lack of evidence on long-term harms.95 , 97 99 The Australian and French guidelines suggest that other therapies should be considered first.97 , 99 The United States Preventive Services Task Force judged that the evidence on e-cigarettes was insufficient and recommends directing patients to interventions with proven effectiveness and safety.94 Gaps in knowledge Large comparative trials101 will likely refine future recommendations

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One RCT ( n = 120) provided very low-certainty evidence for the effect of S-adenosyl-L-methionine on smoking cessation (38 fewer per 1000, 95% CI 95 fewer to 134 more).26 Two RCTs ( n = 261) reporting on St