Table of Content

06 September 2026, Volume 35 Issue 8

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Review

Challenges and opportunities of hospital pharmaceutical care under DRG payment in China: A comprehensive review based on the current situation of hospital pharmaceutical care

Yuanlin Wu, Yanping Li, Tingting Jiang, Lanlan Gan, Ni Zhang, Yumeng Liu, Jianhong Chen, Xu Huang, Yao Liu

2026, 35(8):  695-722.  DOI: 10.5246/jcps.2026.08.050

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Hospital pharmaceutical care, a core component of professional medical services, is implemented in China to enhance the overall quality of hospital care and to ensure the safety, efficacy, and cost effectiveness of medication use. Several factors must be considered in clinical hospital pharmaceutical care, including patients' age, disease type, comorbidities, and duration of therapy. In 2019, China piloted the Diagnosis Related Groups (DRG) system, a novel disease classification and payment model based on medical and economic criteria, aimed at establishing rational pricing and reimbursement for diverse medical services. This payment reform provides an opportunity for hospital pharmaceutical care to prioritize service efficiency while safeguarding drug safety, effectiveness, and economic utilization. Consequently, the role of pharmacists in DRG based hospital pharmaceutical care is rapidly evolving. In this review, we comprehensively analyzed the scientific literature on the development of hospital pharmaceutical care in China. We systematically examined changes in hospital pharmacy management following DRG implementation, explored the challenges and opportunities for hospital pharmaceutical care, and highlighted the evolving roles and responsibilities of clinical pharmacists. Finally, we proposed recommendations for the development of hospital pharmacy teams with distinctively Chinese characteristics under the ongoing DRG payment reform.



Original articles

Milbemycin oxime functions as a novel dual inhibitor of NDM-1 and KPC-2

Qian Wang, Xiaohui Li, Yuehua Tao, Chenyu Wang, Xiao Wang, Yishuang Liu

2026, 35(8):  723-735.  DOI: 10.5246/jcps.2026.08.051

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The escalating global health burden imposed by antimicrobial resistance has reached a critical threshold, with extensively drug resistant Gram negative pathogens, particularly those producing β lactamases that inactivate β lactam antibiotics, constituting a formidable obstacle to effective anti infective therapy. Although the co administration of β lactam antibiotics with β lactamase inhibitors remains a cornerstone strategy for mitigating resistance, clinically approved inhibitors targeting metallo β lactamases (MBLs) are still conspicuously lacking. In this context, the present study identified milbemycin oxime as a previously unrecognized dual inhibitor with activity against both MBLs and serine β lactamases (SBLs). Mechanistic investigations further revealed that milbemycin oxime suppressed the enzymatic activities of NDM 1 and KPC 2 via a non competitive mode of inhibition, while its inhibitory effect on NDM 1 appeared not to be exclusively dependent on zinc ion coordination within the catalytic active site. And the binding site was preliminarily predicted using molecular docking. Collectively, these findings substantiated the promise of milbemycin oxime as a lead scaffold for the development of dual NDM 1/KPC 2 inhibitors, thereby offering both conceptual and practical advances toward overcoming β lactam antibiotic resistance.



Chemical composition analysis and establishment of fingerprints of the famous classical formula WenFei ZhiLiuDan based on UHPLC‑MS/HPLC‑PDA combined with chemical pattern recognition

Ruitong Tang, Qian Wang, Zhixuan Li, Chunyan Bai, Yefang Liang, Li Li, Rui Wang

2026, 35(8):  736-755.  DOI: 10.5246/jcps.2026.08.052

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This study aimed to develop a comprehensive quality evaluation approach for WenFei ZhiLiuDan by integrating LC-MS analysis, multi-component quantification, fingerprinting, and chemical pattern recognition techniques. LC-MS was employed to systematically characterize the major chemical constituents of WenFei ZhiLiuDan. The concentrations of gallic acid, glycyrrhizic acid, methyl eugenol, asarinin, and pulegone were determined using high-performance liquid chromatography (HPLC), and chromatographic fingerprints were established for 10 batches of WenFei ZhiLiuDan. These fingerprints were further analyzed and classified through cluster analysis, principal component analysis, and partial least squares-discriminant analysis. UHPLC-MS profiling identified a total of 74 chemical constituents. HPLC-PDA quantification demonstrated excellent linearity for all five components (R² > 0.999), with average recoveries ranging from 99.24% to 103.21% and relative standard deviations (RSDs) between 1.47% and 2.56%. Twenty common peaks were observed across all 10 batches, with similarity indices relative to the reference batch exceeding 0.91. Chemical pattern recognition classified the 10 batches into four distinct categories, and the results were consistent across the three analytical methods. The established evaluation protocol was accurate, reliable, straightforward, and reproducible, offering a robust strategy for the quality control and assessment of WenFei ZhiLiuDan.



Population pharmacokinetics of hydroxychloroquine sulfate in Chinese healthy subjects: first revelation of the impact of white blood cell count on its pharmacokinetic parameters

Yuqing Chen, Yaoqi Wen, Lijing Dai, Ya Luo, Xiuling He, Miaoling Tu, Zhanzhang Wang, Yuguan Wen

2026, 35(8):  756-772.  DOI: 10.5246/jcps.2026.08.053

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This study aimed to systematically characterize the population pharmacokinetic (PPK) profile of hydroxychloroquine (HCQ) sulfate in Chinese healthy subjects. HCQ concentrations in whole blood from 216 healthy volunteers were quantified using high-performance liquid chromatography–tandem mass spectrometry (HPLC-MS/MS). A PPK model was developed to estimate pharmacokinetic (PK) parameters, quantify the effects of clinical covariates (e.g., white blood cell (WBC) count) and baseline demographic characteristics, and describe concentration–time profiles using a nonlinear mixed-effects modeling approach. The PK data were best described by a two-compartment model. The model-estimated apparent central clearance (CL/F) was 22.6 L/h, the central volume of distribution (Vc/F) was 400 L, the peripheral clearance was 47.7 L/h, the peripheral volume of distribution was 1190 L, and the absorption rate constant (Ka) was 0.466/h. Covariate analysis indicated that WBC count had a significant effect on HCQ clearance. Specifically, each 1 × 10⁹/L increase in WBC was associated with an 8.28% reduction in CL/F (θ_CL–WBC = 0.0828). Incorporation of WBC as a covariate reduced the inter-individual variability of CL/F from 0.121 to 0.104, corresponding to a 14.1% reduction in variance (this reduction does not represent R² and should not be interpreted as the proportion of variance explained). Further analysis showed a negative relationship between WBC and CL/F, where a 3 × 10⁹/L increase in WBC was associated with an approximately 24.8% decrease in CL/F, and an increase from 4 × 10⁹/L to 10 × 10⁹/L (within the normal physiological range) resulted in an estimated 42.0% reduction in CL/F. No clinically significant safety concerns were observed. In conclusion, this study is the first to identify WBC count as an independent covariate influencing HCQ PKs in a healthy population. Future studies may benefit from physiologically based pharmacokinetic (PBPK) modeling to integrate multidimensional physiological variables and support more precise individualized dosing strategies.



Research hotspots and trends of Ginkgo biloba leaf based on bibliometrics

Yujie Wang, Linlin Du, Li Li, Shanshan Li, Minghua Wu, Haifen Lu, Zhaoyao Chen

2026, 35(8):  773-795.  DOI: 10.5246/jcps.2026.08.054

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This study employed bibliometric methods to visually analyze the research literature on Ginkgo biloba leaf. We systematically reviewed recent research trends, identified key thematic areas, and explored potential future directions, thereby providing a foundation for further investigation and practical applications of G. biloba leaf. The Web of Science (WOS) database was systematically searched using “Ginkgo biloba leaf” as the primary keyword. After removing duplicate records, the retrieved results were further screened and refined. A visual analysis of the relevant literature published between January 2005 and May 2025 was conducted using CiteSpace and VOSviewer. The analysis mapped annual publication outputs, country distribution, core research institutions, high-frequency co-cited journals, prolific author groups, keyword co-occurrence networks, clustering patterns, temporal evolution, and burst detection.



Network meta-analysis and pharmacoeconomic evaluation of endocrine drugs for the prevention of breast cancer in high-risk women

Li Lin, Huiting Lin, Jiaqin Cai, Yixiao Zhu, Lirong Zhang, Hong Sun, Xiaoxia Wei

2026, 35(8):  796-812.  DOI: 10.5246/jcps.2026.08.055

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Breast cancer remains the most commonly diagnosed malignancy and the leading cause of cancer-related death among women worldwide. While endocrine therapies, including selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs), have demonstrated efficacy in reducing breast cancer risk in high-risk populations, their comparative effectiveness, safety profiles, and cost-efficiency have not been fully elucidated, limiting informed clinical and policy decision-making. To address this gap, we conducted a network meta-analysis (NMA) encompassing six randomized controlled trials (n = 50 746) and developed an integrated Markov-decision tree model to systematically assess comparative efficacy, adverse events, and economic outcomes. The NMA revealed that exemestane (OR 0.45, 95% CI 0.25–0.80), anastrozole (OR 0.50, 95% CI 0.35–0.71), and tamoxifen (OR 0.68, 95% CI 0.57–0.81) significantly reduced overall breast cancer risk compared with placebo, with consistent protective effects observed in both invasive and estrogen receptor–positive subtypes. In contrast, none of the agents demonstrated significant efficacy in preventing estrogen receptor–negative breast cancer or ductal carcinoma in situ (DCIS). Notably, tamoxifen was associated with markedly elevated risks of deep vein thrombosis (OR 1.58, 95% CI 1.15–2.17) and endometrial cancer (OR 2.23, 95% CI 1.31–3.81). From the perspective of the Chinese healthcare system, exemestane provided the highest quality-adjusted life-years (14.87 QALYs) at the lowest total cost (CNY 14 079), thereby dominating anastrozole (14.59 QALYs; CNY 15 776) and tamoxifen (14.59 QALYs; CNY 18 916). Collectively, these results supported the preferential use of exemestane for breast cancer chemoprevention in high-risk women and offered robust evidence to guide clinical practice and health policy decisions.



Pegaspargase in pediatric acute lymphoblastic leukemia: A comprehensive analysis of adverse reaction signals

Yingqiu Tu, Zizhao Huang, Nan Zhong

2026, 35(8):  813-824.  DOI: 10.5246/jcps.2026.08.056

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This study sought to elucidate the adverse drug reaction (ADR) profile associated with pegaspargase in the treatment of pediatric acute lymphoblastic leukemia (ALL) by integrating real-world clinical data with the FDA Adverse Event Reporting System (FAERS) database. The overarching objective was to provide a robust evidence base to guide the safe administration of pegaspargase in children. A retrospective analysis was conducted on pediatric ALL patients treated with pegaspargase at our institution between September 2023 and August 2025. Concurrently, FAERS reports pertaining to pegaspargase-related adverse events in children, spanning the first quarter of 2004 through the third quarter of 2025, were systematically extracted. Signal detection was performed using both the reported odds ratio (ROR) and proportional reported ratio (PRR) methodologies. Adverse events were categorized according to the International Classification of Organs (ICO), aligned with the International Medical Terminology Dictionary. The study cohort comprised 28 pediatric patients who collectively received 133 doses of pegaspargase, with 82.0% of ADRs occurring within the first week following initial administration. Analysis of the FAERS database identified 1214 pediatric-specific adverse event reports, encompassing 19 System Organ Classes (SOCs) and 131 preferred terms. Signal detection highlighted several notable risks, including pancreatic necrosis, pancreatic pseudocyst, superior sagittal sinus thrombosis, hypercholesterolemia, hemorrhagic pancreatitis, hypofibrinogenemia, transformation to acute myeloid leukemia, reduced fibrinogen levels, cerebral thrombosis, and mediastinal emphysema. These findings underscore the necessity of vigilance not only for commonly reported adverse reactions but also for severe events that may not be fully delineated in the drug’s prescribing information, such as necrotizing and hemorrhagic pancreatitis. The establishment of predictive models based on dynamic clinical parameters may offer a promising strategy for the early identification of system-specific ADR risks, thereby enhancing patient safety in the pediatric population.