BACKGROUND AND AIM: Pegylated interferon-alpha (PEG-IFN) provides potential advantages over nucleos(t)ide analogues in the treatment of chronic hepatitis B (CHB) given its finite course, durability and lack of drug resistance. Much of the evidence is derived from controlled studies and it is unclear whether these results can be replicated in an everyday, non-controlled setting. The aim of this study was to examine the efficacy and tolerability of PEG-IFN-alpha2A in CHB patients in a clinical setting. METHODS: Chronic hepatitis B patients treated with PEG-IFN-alpha2A (180microg/week, 48 weeks) at five tertiary hospitals were retrospectively identified. Baseline demographic and clinical data, on-treatment virological and serological responses and adverse events (AE) were recorded. Treatment outcomes were defined as alanine aminotransferase (ALT) normalization, hepatitis B virus DNA 6log IU/mL, 9.5 advanced fibrosis). Six months after therapy 46 achieved normalization of ALT, 16 had viral loads <351 IU/mL and 32 achieved HBeAg seroconversion. 29 HBeAg negative patients were treated (75 male, 86 born in Asia, 48 had viral loads > 6log IU/mL, 24 advanced fibrosis). Six months post-treatment, 55 and 36 maintained a normalized ALT and HBV DNA <351 IU/mL, respectively. Optimal viral suppression was maintained in 50-75 of patients over 2 years of follow up. 6.5 of all patients discontinued therapy due to AEs. CONCLUSION: In everyday clinical practice PEG-IFN therapy in CHB is well tolerated and can achieve a similar efficacy to that seen in large controlled trials.