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Commitments and contingencies - Narrative (Details) - USD ($)
$ in Thousands
 1 Months Ended 3 Months Ended 12 Months Ended
Apr. 29, 2020
Aug. 31, 2021
Dec. 31, 2019
May 31, 2019
Mar. 31, 2022
Dec. 31, 2019
Dec. 31, 2021
May 29, 2020
Jun. 30, 2016
Other Commitments                  
Accrued royalties         $ 30,670   $ 35,679    
Akcea                  
Other Commitments                  
Upfront licensing fee         12,000        
Milestone payments   $ 4,000              
Akcea | Maximum                  
Other Commitments                  
Milestone payments   $ 4,000              
Censa                  
Other Commitments                  
Asset acquisition, development and regulatory milestones               $ 109,000  
Asset acquisition, initial milestone               30,000  
Censa | Maximum                  
Other Commitments                  
Asset acquisition, milestone, amount               217,500  
Asset acquisition, net sales milestone               $ 160,000  
Agilis Merger Agreement | Akcea                  
Other Commitments                  
Milestone payments     $ 4,000 $ 6,000 4,000 $ 6,000      
SMA License Agreement                  
Other Commitments                  
Accrued royalties         14,000        
SMA License Agreement | Maximum                  
Other Commitments                  
Potential royalty payments due on net product sales         52,500        
Agilis                  
Other Commitments                  
Development milestone payments which the entity is obligated to pay $ 40,000       40,000        
Development milestone obligation payments made         $ 2,400        
Agilis | Minimum                  
Other Commitments                  
Product sales (as a percent)         2.00%        
Agilis | Maximum                  
Other Commitments                  
Development milestone payments which the entity is obligated to pay         $ 60,000        
Priority review voucher amount         535,000        
Net sales amount         $ 150,000        
Product sales (as a percent)         6.00%        
Development milestone payment obligations, net of cancellation and forfeiture         $ 20,000        
Contingent liability, milestone, potential achievements, priority review voucher amount, net of cancellation and forfeiture         361,000        
Agilis | Rights Exchange Agreement                  
Other Commitments                  
Contingent liability cancellation and forfeiture of potential milestone payments 174,000                
Development milestone payment obligations, cancellation and forfeiture 37,600                
Contingent liability, cancellation and forfeiture $ 211,600                
BioElectron | Maximum                  
Other Commitments                  
Development milestone payments which the entity is obligated to pay         200,000        
Marathon | Agilis Merger Agreement                  
Other Commitments                  
Development milestone payments which the entity is obligated to pay         50,000        
Net product revenue | Wellcome trust                  
Other Commitments                  
Development milestone payments which the entity is obligated to pay                 $ 800
Net product revenue | Wellcome trust | Maximum                  
Other Commitments                  
Development milestone payments which the entity is obligated to pay         $ 22,400