To evaluate the efficacy and safety of Riluzole, Edaravone, Mosaitini, Tirasemtiv and Arimoclomol for amyotrophic lateral sclerosis (ALS) using network meta-analysis. Methods: Domestic and foreign literature databases were searched from their establishment to July 30, 2020 for randomized controlled trials that involve the above 5 medications for ALS. The literature was screened according to established criteria. Data were extracted, and network meta-analysis was performed with R software. Results: Fourteen studies involving 2767 patients were included in the analysis. Compared with the placebo, Riluzole reduced the incidence of death or disease progression in specific states (OR=0.75, 95% CI: 0.58-0.96), Tirasemtiv caused more general adverse events (OR= 3.1, 95%CI: 24.8), and Arimoclomol caused more serious adverse events (OR=8, 95%CI: 2.2-36). Relative treatment ranking and cluster analysis showed that Riluzole and Edaravone ranked first in efficacy and safety. Conclu? sion: Riluzole and Edaravone are effective and safe in the treatment of ALS. More clinical trials are needed to confirm the safety of Arimoclomol in ALS patients.