Aliment Pharmacol Ther 2010; 32: 1059–1068 Summary Background  The long‐term benefit of interferon‐alfa (IFN‐α) treatment in preventing various hepatic complications is not certain. Aim  To study the effects of IFN‐α on reducing the risk of developing overall hepatic events (hepatocellular carcinoma, cirrhotic complications and liver‐related mortality) in chronic hepatitis B patients. Methods  Randomized controlled trials, case–control studies and cohort studies were retrieved from electronic databases and conference s. Relative risks (RRs) of different hepatic complications among patients treated by IFN‐α vs. no treatment or placebo were studied. Results  Eleven studies were identified totalling 975 patients treated by IFN‐α vs. 1147 untreated controls for analysis. Patients were treated by IFN‐α for 1–24 months with a post‐treatment follow‐up of 1–13 years. Treatment by IFN‐α reduced the risk of overall hepatic events (RR 0.55, 95% confident interval or CI 0.43–0.70, P < 0.001) and cirrhotic complications (RR 0.46, 95% CI 0.32–0.67, P < 0.001) by 45% and 54% respectively. Patients who responded to IFN‐α had more profound reduction in overall hepatic events (RR 0.20, 95% CI 0.05–0.87, P = 0.03) and cirrhotic complications (RR 0.19, 95% CI 0.09–0.38, P < 0.001) vs. the untreated controls. Conclusion  Interferon‐alfa treatment reduces the risk of hepatic events particularly among responders to treatment.