Human biomarker exposure from cigarettes versus novel heat-not-burn devices: a systematic review and meta-analysis

Drovandi, Aaron, Salem, Saad, Barker, Daniel, Booth, Debbie, and Kairuz, Therese (2020) Human biomarker exposure from cigarettes versus novel heat-not-burn devices: a systematic review and meta-analysis. Nicotine and Tobacco Research. ntz200. pp. 1077-1085.

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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.

Item ID: 60757
Item Type: Article (Research - C1)
ISSN: 1469-994X
Keywords: nicotine; biological markers; burns; heat (physical force); heating; safety; tobacco; tobacco industry; public health; medicine; tobacco use; devices, medical; cigarettes; smoking; abstinence; chief complaint
Copyright Information: © The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. The Accepted Manuscript of this publication will be available Open Access from ResearchOnline@JCU from 24 October 2020.
Date Deposited: 21 Nov 2019 05:32
FoR Codes: 42 HEALTH SCIENCES > 4206 Public health > 420604 Injury prevention @ 50%
32 BIOMEDICAL AND CLINICAL SCIENCES > 3205 Medical biochemistry and metabolomics > 320599 Medical biochemistry and metabolomics not elsewhere classified @ 50%
SEO Codes: 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920414 Substance Abuse @ 100%
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