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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 | $ 213,454 | $ 1,577,459
Balance (in shares) at Dec. 31, 2019 | 140,340 |  |  |  |  |  |
Increase (Decrease) in Stockholders' Equity [Roll Forward] |  |  |  |  |  |  |
Net loss | $ 0 | 0 | 0 | (444,263) | (444,263) | 0 | (444,263)
Change in unrealized gains (losses), net of tax | 0 | 0 | 3,729 | 0 | 3,729 | 0 | 3,729
Foreign currency translation | 0 | 0 | 617 | 0 | 617 | 0 | 617
Issuance of common stock in connection with employee stock plans | $ 1 | 52,033 | 0 | 0 | 52,034 | 0 | 52,034
Issuance of common stock in connection with employee stock plans (in shares) | 1,721 |  |  |  |  |  |
Purchase of noncontrolling interest of Akcea Therapeutics, Inc., including cash payments for cancellation of Akcea Therapeutics, Inc. equity awards | $ 0 | (324,022) | 301 | 0 | (323,721) | (220,965) | (544,686)
Repurchases and retirements of common stock | $ (1) | 0 | 0 | (90,548) | (90,549) | 0 | (90,549)
Repurchases and retirements of common stock (in shares) | (1,478) |  |  |  |  |  |
Stock-based compensation expense | $ 0 | 230,117 | 0 | 0 | 230,117 | 0 | 230,117
Payments of tax withholdings related to vesting of employee stock awards and exercise of employee stock options | $ 0 | (13,410) | 0 | 0 | (13,410) | 0 | (13,410)
Payments of tax withholdings related to vesting of employee stock awards and exercise of employee stock options (in shares) | (217) |  |  |  |  |  |
Deferred tax liability adjustment due to purchase of noncontrolling interest of Akcea Therapeutics, Inc. | $ 0 | 7,714 | 0 | 0 | 7,714 | 0 | 7,714
Noncontrolling interest in Akcea Therapeutics, Inc. | 0 | (42,563) | (428) | 0 | (42,991) | 7,511 | (35,480)
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 | (28,597) | (28,597) | 0 | (28,597)
Change in unrealized gains (losses), net of tax | 0 | 0 | (11,486) | 0 | (11,486) | 0 | (11,486)
Foreign currency translation | 0 | 0 | (111) | 0 | (111) | 0 | (111)
Issuance of common stock in connection with employee stock plans | $ 1 | 11,563 | 0 | 0 | 11,564 | 0 | 11,564
Issuance of common stock in connection with employee stock plans (in shares) | 1,132 |  |  |  |  |  |
Issuance of warrants | $ 0 | 89,752 | 0 | 0 | 89,752 | 0 | 89,752
Purchase of note hedges | 0 | (136,620) | 0 | 0 | (136,620) | 0 | (136,620)
Stock-based compensation expense | 0 | 120,678 | 0 | 0 | 120,678 | 0 | 120,678
Payments of tax withholdings related to vesting of employee stock awards and exercise of employee stock options | $ 0 | (16,725) | 0 | 0 | (16,725) | 0 | (16,725)
Payments of tax withholdings related to vesting of employee stock awards and exercise of employee stock options (in shares) | (288) |  |  |  |  |  |
Balance at Dec. 31, 2021 | $ 141 | 1,964,167 | (32,668) | (1,159,903) | 771,737 | 0 | 771,737
Balance (in shares) at Dec. 31, 2021 | 141,210 |  |  |  |  |  |
Increase (Decrease) in Stockholders' Equity [Roll Forward] |  |  |  |  |  |  |
Net loss | $ 0 | 0 | 0 | (269,722) | (269,722) | 0 | (269,722)
Change in unrealized gains (losses), net of tax | 0 | 0 | (24,395) | 0 | (24,395) | 0 | (24,395)
Foreign currency translation | 0 | 0 | (417) | 0 | (417) | 0 | (417)
Issuance of common stock in connection with employee stock plans | $ 1 | 6,372 | 0 | 0 | 6,373 | 0 | 6,373
Issuance of common stock in connection with employee stock plans (in shares) | 1,194 |  |  |  |  |  |
Stock-based compensation expense | $ 0 | 100,264 | 0 | 0 | 100,264 | 0 | 100,264
Payments of tax withholdings related to vesting of employee stock awards and exercise of employee stock options | $ 0 | (10,953) | 0 | 0 | (10,953) | 0 | (10,953)
Payments of tax withholdings related to vesting of employee stock awards and exercise of employee stock options (in shares) | (346) |  |  |  |  |  |
Balance at Dec. 31, 2022 | $ 142 | $ 2,059,850 | $ (57,480) | $ (1,429,625) | $ 572,887 | $ 0 | $ 572,887
Balance (in shares) at Dec. 31, 2022 | 142,058 |  |  |  |  |  |

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