The most appropriate treatment is to initiate an anti–tumor necrosis factor (anti-TNF) agent such as adalimumab. This patient has moderate to severe ulcerative colitis that is not responding to 60 mg/d of prednisone. Moderate to severe ulcerative colitis is often treated with oral glucocorticoids such as prednisone, 40 to 60 mg/d. Patients whose disease does not respond to oral glucocorticoids should be hospitalized and given intravenous glucocorticoids or should be treated with an anti- TNF agent. Randomized controlled clinical trials have shown three anti- TNF antibodies (infliximab, adalimumab, and golimumab) to be effective for inducing and maintaining remission in patients such as this with ulcerative colitis. Indications for hospital admission include dehydration, inability to tolerate oral intake, fever, significant abdominal tenderness, and abdominal distention
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