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Income taxes - Narrative (Details) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2018
Operating loss carryforwards        
Taxable income before consideration of NOL $ 61,600      
State income tax provision 4,224 $ 3,844 $ 24,984  
Deferred tax valuation allowance 672,172 525,570    
Valuation allowance, deferred tax asset, increase (decrease) 146,600 146,000    
Deferred tax liability on indefinite-lived intangibles acquired 102,834 137,110    
Orphan Drug Credit carryover 145,800      
Net operating loss carryforwards utilized $ 49,300 $ 0 $ 364,100  
Federal income tax provision at statutory rate 21.00% 21.00% 21.00%  
Uncertain tax position $ 0      
Increase in current taxable income resulting from the elimination of current deduction of qualifying R&D costs under Section 174. 450,100      
Undistributed earnings from non-US subsidiaries 65,100      
Undistributed earnings from non-US subsidiaries, tax 0      
Unrecognized tax benefits 27,217 $ 27,217    
Agilis        
Operating loss carryforwards        
Deferred tax liability on indefinite-lived intangibles acquired       $ 122,000
Federal        
Operating loss carryforwards        
Net operating loss carryforwards 333,100      
Operating loss carryforwards limited by IRC Section 382 231,500      
Research and development credit carryforwards 29,000      
Operating loss carryforwards, not subject to expiration 169,200      
Operating loss carryforwards, subject to expiration 62,300      
Net operating loss carryforwards limited by IRC Section 382 utilized 11,400   $ 97,700  
Operating loss carryforwards for immediate use 333,100      
Operating loss carryforwards in next twelve months 5,700      
Federal | First five years from ownership change        
Operating loss carryforwards        
Annual net operating loss carryforward available as limited by IRC Section 382 16,700      
Federal | After five years        
Operating loss carryforwards        
Annual net operating loss carryforward available as limited by IRC Section 382 5,700      
State        
Operating loss carryforwards        
Net operating loss carryforwards $ 164,900