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Commitments and contingencies - Narrative (Details) - USD ($)
$ in Thousands
 3 Months Ended 9 Months Ended 12 Months Ended
Apr. 29, 2020
Jun. 30, 2016
Sep. 30, 2023
Dec. 31, 2022
Sep. 30, 2022
May 29, 2020
Other Commitments            
Milestone payable     $ 2,500   $ 50,000  
Accrued royalties     52,087 $ 40,546    
Wellcome Trust            
Other Commitments            
Development milestone payment obligations       2,500    
Milestone obligation payments made   $ 800        
Censa            
Other Commitments            
Asset acquisition, development and regulatory milestones           $ 109,000
Censa | Maximum            
Other Commitments            
Asset acquisition, milestone, amount           217,500
Asset acquisition, net sales milestone           $ 160,000
Former Censa Securityholders            
Other Commitments            
Development milestone obligation payments made     30,000      
Development milestone obligation cash payments made     $ 400      
Shares issued for milestone payment     657,462      
SMA License Agreement | SMA Foundation            
Other Commitments            
Royalty expense     $ 40,300      
Royalty payments     35,300      
Accrued royalties     5,000      
SMA License Agreement | SMA Foundation | 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      
Potential developmental and regulatory milestones     31,100      
Potential sales milestones     50,000      
Milestone obligation payments made       $ 50,000    
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      
Potential sales milestones     $ 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            
Milestone obligation payments made     50,000      
Net product revenue | Wellcome Trust | Maximum            
Other Commitments            
Development milestone payments which the entity is obligated to pay     $ 14,500