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CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($) shares in Thousands, $ in Thousands | Common Stock [Member] | Additional Paid In Capital [Member] | Accumulated Other Comprehensive Loss [Member] | Accumulated Deficit [Member] | Total Ionis Stockholders' Equity [Member] | Noncontrolling Interest in Akcea Therapeutics, Inc. [Member] | Total
--- | --- | --- | --- | --- | --- | --- | ---
Balance at Dec. 31, 2019 | $ 140 | $ 1,985,650 | $ (25,290) | $ (596,495) | $ 1,364,005 | $ 213,453 | $ 1,577,458
Balance (in shares) at Dec. 31, 2019 | 140,340 |  |  |  |  |  |
Increase (Decrease) in Stockholders' Equity [Roll Forward] |  |  |  |  |  |  |
Net loss | $ 0 | 0 | 0 | (39,628) | (39,628) | 0 | (39,628)
Change in unrealized losses, net of tax | 0 | 0 | (1,954) | 0 | (1,954) | 0 | (1,954)
Foreign currency translation | 0 | 0 | 9 | 0 | 9 | 0 | 9
Issuance of common stock in connection with employee stock plans | $ 0 | 7,652 | 0 | 0 | 7,652 | 0 | 7,652
Issuance of common stock in connection with employee stock plans (in shares) | 606 |  |  |  |  |  |
Repurchases and retirements of common stock | $ (1) | 0 | 0 | (90,549) | (90,550) | 0 | (90,550)
Repurchases and retirements of common stock (in shares) | (1,478) |  |  |  |  |  |
Stock-based compensation expense | $ 0 | 40,790 | 0 | 0 | 40,790 | 0 | 40,790
Payments of tax withholdings related to vesting of employee stock awards and exercise of employee stock options | $ 0 | (11,603) | 0 | 0 | (11,603) | 0 | (11,603)
Payments of tax withholdings related to vesting of employee stock awards and exercise of employee stock options (in shares) | (186) |  |  |  |  |  |
Noncontrolling interest in Akcea Therapeutics, Inc. | $ 0 | (6,973) | 0 | 0 | (6,973) | (3,281) | (10,254)
Balance at Mar. 31, 2020 | $ 139 | 2,015,516 | (27,235) | (726,672) | 1,261,748 | 210,172 | 1,471,920
Balance (in shares) at Mar. 31, 2020 | 139,282 |  |  |  |  |  |
Balance at Dec. 31, 2020 | $ 140 | 1,895,519 | (21,071) | (1,131,306) | 743,282 | 0 | 743,282
Balance (in shares) at Dec. 31, 2020 | 140,366 |  |  |  |  |  |
Increase (Decrease) in Stockholders' Equity [Roll Forward] |  |  |  |  |  |  |
Net loss | $ 0 | 0 | 0 | (89,869) | (89,869) | 0 | (89,869)
Change in unrealized losses, net of tax | 0 | 0 | (3,006) | 0 | (3,006) | 0 | (3,006)
Foreign currency translation | 0 | 0 | (126) | 0 | (126) | 0 | (126)
Issuance of common stock in connection with employee stock plans | $ 1 | 7,758 | 0 | 0 | 7,759 | 0 | 7,759
Issuance of common stock in connection with employee stock plans (in shares) | 809 |  |  |  |  |  |
Stock-based compensation expense | $ 0 | 37,861 | 0 | 0 | 37,861 | 0 | 37,861
Payments of tax withholdings related to vesting of employee stock awards and exercise of employee stock options | $ 0 | (15,337) | 0 | 0 | (15,337) | 0 | (15,337)
Payments of tax withholdings related to vesting of employee stock awards and exercise of employee stock options (in shares) | (251) |  |  |  |  |  |
Balance at Mar. 31, 2021 | $ 141 | $ 1,925,801 | $ (24,203) | $ (1,221,175) | $ 680,564 | $ 0 | $ 680,564
Balance (in shares) at Mar. 31, 2021 | 140,924 |  |  |  |  |  |

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