PURPOSE: The efficacy of on-treatment hepatitis B surface antigen (HBsAg) levels in guiding pegylated interferon (PEG-IFN) therapy for chronic hepatitis B (CHB) infections is still controversial. The aim of this study is to quantitatively evaluate the efficacy of on-treatment HBsAg levels as a response-guided therapy strategy to guide PEG-IFN-based therapies for CHB. METHODS: We searched PUBMED, EMBASE, and the Cochrane Library (1997-2013) for clinical research involving HBsAg quantification, and the response to PEG-IFN-based therapy. Pooled effect of HBsAg levels on guiding PEG-IFN-based therapies for CHB was evaluated using fixed-effects or random-effects model. RESULTS: From 13 studies (n = 1493 patients), patients with optimal on-treatment HBsAg levels were found to have a greater chance of attaining a response (RR 5.17, 95 % CI 3.75-7.11, p < 0.00001), and the pooled total response rate was 54 % (95 % CI 44-63 %). At week 12, patients without optimal on-treatment HBsAg levels had hardly achieved a response (the early non-response rate: 99 %, 95 % CI 98-100 %). At 24 weeks, the response rate increased to 79 % in HBeAg-negative patients. CONCLUSION: This meta-analysis suggested that on-treatment HBsAg quantification is effective in guiding the therapy of PEG-IFN in CHB infections, especially in HBeAg-negative patients