Statistical determination of synergy based on Bliss definition of drugs independence

PLoS One. 2019 Nov 25;14(11):e0224137. doi: 10.1371/journal.pone.0224137. eCollection 2019.

Abstract

Although synergy is a pillar of modern pharmacology, toxicology, and medicine, there is no consensus on its definition despite its nearly one hundred-year history. Moreover, methods for statistical determination of synergy that account for variation of response to treatment are underdeveloped and if exist are reduced to the traditional t-test, but do not comply with the normal distribution assumption. We offer statistical models for estimation of synergy using an established definition of Bliss drugs' independence. Although Bliss definition is well-known, it remains a theoretical concept and has never been applied for statistical determination of synergy with various forms of treatment outcome. We rigorously and consistently extend the Bliss definition to detect statistically significant synergy under various designs: (1) in vitro, when the outcome of a cell culture experiment with replicates is the proportion of surviving cells for a single dose or multiple doses, (2) dose-response methodology, (3) in vivo studies in organisms, when the outcome is a longitudinal measurement such as tumor volume, and (4) clinical studies, when the outcome of treatment is measured by survival. For each design, we developed a specific statistical model and demonstrated how to test for independence, synergy, and antagonism, and compute the associated p-value.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Animals
  • Antineoplastic Agents / pharmacology*
  • Antineoplastic Agents / therapeutic use
  • Cell Culture Techniques
  • Cell Line, Tumor
  • Cell Survival / drug effects
  • Clinical Trials as Topic
  • Disease Models, Animal
  • Dose-Response Relationship, Drug
  • Drug Antagonism
  • Drug Evaluation, Preclinical
  • Drug Synergism
  • Humans
  • Intention to Treat Analysis
  • Kaplan-Meier Estimate
  • Mice
  • Models, Biological*
  • Neoplasms / drug therapy*
  • Neoplasms / mortality
  • Treatment Outcome

Substances

  • Antineoplastic Agents