To systematically evaluate efficacy of regimens containing arsenic trioxide (ATO) for the patients with myelodysplastic syndrome and explore optimal combination. Randomized clinical trials about regimens containing ATO were retrieved from China National Knowledge Infrastructure, Embase, PubMed et al. With odds ratio as the effect size, network meta-analysis and component network meta-analysis was conducted by utilization of R and ‘netmeta’ package, after study selection, quality assessment and data extraction. As the result, thirty-eight RCTs were included with a total of 2089 patients, including 1257 treated by ATO containing regimen. With support therapy alone as reference, insignificant inconsistency and heterogeneity was observed. Although NMA did not demonstrate better efficacy of ATO alone, result of CNMA indicated that ATO was effective in improvement of ORR [OR=2.03(1.56, 2.64)] and CR [OR =1.66(1.24, 2.22)]. Five ATO-containing regimens reported could effectively improve ORR, some of them benefit in CR or HI as well. ATO+T+TCM was regarded as the optimal combination, which improved both ORR [OR=3.11(2.08, 4.66)], CR [OR=7.09(1.53, 32.82)] and HI [OR=2.02(1.24, 3.27)] in theory. ATO did not increase the risk of common adverse events compared to supportive therapy [(OR=0.90(0.67, 1.21)]. In conclusion, ATO is an effective and well tolerant option for patients with myelodysplastic syndrome.