Objectives: We aimed to compare the incidence of adverse events (AEs) and persistency of biologics in RA patients with or without ILD. Methods: A total of 981 RA patients with chest radiograph or chest computed tomography (CT) data at enrollment were extracted from BIOlogics Pharmacoepidemiologic StudY (BIOPSY) cohort, a nationwide multicenter prospective cohort for biologic users of RA patients in Korea. We classified them into two groups: 1) RA-ILD group as patients with ILD, and 2) RA-non ILD group as patients without ILD. We compared the incidence of AEs during use of biologics between two groups, and then tested the differences of drug discontinuation rates due to AEs, infection, and respiratory infection between RA-ILD and RA-non ILD groups using Kaplan-Meier survival analysis and log-rank test. In addition, Cox proportional hazard model were used to identify the impact of ILD on AEs in RA patients with biologics. Results: The 42 patients (4.3%) revealed to have RA-ILD by chest radiograph or chest CT. Patients in RA-ILD group were older (p＜0.01), and male patients were more in RA-ILD group (p＜0.01). During mean follow-up of 20 months with 1,611 person years (PY), the incidence of AEs was higher in RA-ILD group (IRR 1.55, CI 1.11-2.17). In addition, the incidence of infection and respiratory infection were higher in RA-ILD group (IRR 2.38, CI 1.32-4.30 for infection, IRR 3.00, CI 1.50-5.99 for respiratory infection, respectively). The biologics discontinuation rate due to AEs was comparable in two groups (p＝0.13), whereas the biologics discontinuation rate due to infection (p＝0.03) and respiratory infection (p＜0.01) were significantly higher in RA-ILD group. After adjusting for variables, age (HR 1.27, CI 1.15-1.41) and having ILD (HR 10.77, CI 2.26-51.41) were risk factors for mortality in RA patients with biologics. Conclusions: The incidence of adverse events, especially respiratory infections were higher in RA-ILD patients with biologics compared with RA-non ILD patients. In addition, the biologics discontinuation rate due to infection, especially respiratory infection was significantly higher in RA-ILD patients. Concerning the mortality, ILD increased the mortality in RA patients with biologics.