Drug synergy occurs when two or more drugs are used in a combination therapy, and the total effect of the drugs is more than would be expected based on their individual effects. Although numerous methods exist for evaluating synergy between two drugs, few have been developed for three or more drugs, and most of them have some significant drawbacks. This dissertation extends a number of two-drug synergy methods to accommodate three or more drugs. First, the method of Plummer and Short [27] is extended to three or more drugs, which is an appropriate method for cases where only global synergy may be present. Next, the parametric method of Kong and Lee [19] is extended, which is appropriate for cases where local synergy may be present. Finally, the semiparametric method of Kong and Lee [20] is extended to three or more drugs, which is an appropriate method for cases where either local synergy may be present or where the model assumptions of the extended Plummer and Short method and the extended Kong and Lee methods are not met. For each method, synergy models are presented for the case of n drugs; the models are then implemented and evaluated using simulated data for the case of three drugs, and their goodness of fit is evaluated using simulations. When more than two drugs are used in a combination, there is an additional complexity not present in 2-drug synergy: determining whether any detected synergy is between all n drugs or only a subset of the drugs. All of the new methods presented in this dissertation are able to make that distinction.
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Public Health
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Rutgers University Electronic Theses and Dissertations
Rutgers University. Graduate School - New Brunswick
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