Switch Meds for UC

I have been posting here lately, trying to get through a terrible flare. Since I was diagnosed with UC in 1998, I have taken Asacol, then switched to Delzicol. These are both mesalamine meds. I have also taken Canasa suppositories, and oral prednisone. All of these work less and less to maintain remission and also overcome a flare. Are there meds to try in terms of 'next line of defense' or does it differ depending on flare severity, number of years with UC, someone's age, etc? In other words, would my next options be to try sulfasalazine meds before trying immunosuppressant drugs, or do some people need to go right to the stronger drugs for a bad flare? Just trying to get my thoughts in order before my GI visit next week. I am concerned that she is not being aggressive enough in my treatment, but at the same time I don't want to jump into anything too quickly. She has me taking Delzicol and then Canasa suppositories. Neither works. Aren't they pretty much one and the same? I want to question her on taking either pred suppositories or enemas instead of Canasa. These were effective for me a long time ago. This stuff can really drive you crazy.

No two cases of uc are the same. Some stay on the mild, anti-inflammatory medications for decades without problems. Others quickly progress up the medication ladder at a fireman's hastened pace. Uc has a tendency to spread in extent and severity over time in some, and our treatments must keep pace with it, to maintain a good quality of life.

Generally there are three tiers of uc medications:

1.) Patients start with anti-inflammatory medications (active ingredient mesalamine) in both oral and rectal route. Your Asacol and now Delzicol are the oral route. Your canasa is the rectal route. If your ulcerative colitis extends beyond your rectum, then enemas (e.g., rowasa) are better than canasa suppositories as they cover a much greater area. You can try different variations (brands) but most are very similar. Max out the anti-inflammatory medications at 4,800 milligrams per day (oral route) and 4,000 milligrams rectal route (one rowasa enema) and if that isn't enough, then it's time to climb the ladder.
2.) Immunomodulators (Imuran/azathiopurine, or 6mp/mercacaptopurine) are the next step. These medications reduce the amount of white blood cells (aka lymphocytes) within your bloodstream. White blood cells are used by the immune system to attack and inflame tissue. The less white blood cells you have, the less inflammation they can cause (uc causes inflammation in the large intestine). These medications take 2-3 months to reach optimum healing/therapeutic levels within your body. They require routine blood monitoring (WBC cannot get too low). If that isn't enough than time to climb the ladder.
3.) Biologics (remicade, humira, simponi, entvyio) are biologically engineered proteins that interfere with the immune systems ability to signal and send an attack. The anti-tnf medications mute or reduce the ability of the immune system to say "send an attack over here". Once the attack signal gets weaker, you can heal. These medications are considerably faster working (6 weeks or less) and stronger medications.

rmbr all the meds are much safer than UC that is not controlled
the only exception is prednisone as that is not meant as long term therapy