Background: New Canadian treatment optimization recommendations (TOR) were released in 2020 to guide clinicians on the optimal use of disease modifying treatments (DMTs). The alignment of current practices to TOR was investigated to identify potential areas for improvement in patient care. Methods: From January–July 2021, a chart audit of 160 patients was conducted by a sample of Canadian neurologists. Patient selection criteria included adult patients with relapsing-remitting MS, who had been switched from an initial DMT. Results: In alignment with TOR, most patients received a platform therapy initially (89%; n=143) and suboptimal efficacy response (MRI changes, relapses, disability progression) was the most common trigger for switching treatment. Furthermore, the expanded disability status scale was used in 94% (n=151) of cases during clinical assessment. In some instances, neurologists did not adhere to TOR. Only 10% (n=16) of patients were tested for cognitive function and over half (58%; n=93) did not receive gadolinium contrast at re-baseline MRI. Major criteria for switching therapies based on relapse rate, severity/recovery, or MRI were not followed in (n=4; n=27; n=7) patients respectively. Conclusions: Canadian neurologists are generally aligned with recent TOR for MS. However, they are not switching nearly as often or as early as per TOR criteria.