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Intangible assets and goodwill - Definite-lived Intangibles (Details) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Definite-lived intangible assets      
Milestone Payable $ 2,500    
Accrued royalties 74,111 $ 40,546  
Definite-lived intangibles      
Amortization (222,635) (116,554) $ (54,751)
Finite-Lived Intangible Assets, Net $ 143,731    
Weighted Average      
Definite-lived intangible assets      
Remaining amortization period 6 years 4 months 24 days    
Emflaza asset acquisition      
Definite-lived intangible assets      
Milestone obligation payments recorded $ 107,200    
Marathon | Emflaza asset acquisition | Accounts payable and accrued expenses      
Definite-lived intangible assets      
Milestone Payable 52,700    
Akcea | Waylivra      
Definite-lived intangible assets      
Royalty payments 500    
Akcea | Waylivra | Accounts payable and accrued expenses      
Definite-lived intangible assets      
Accrued royalties 400    
Akcea | Tegsedi      
Definite-lived intangible assets      
Royalty payments 5,800    
Akcea | Tegsedi | Accounts payable and accrued expenses      
Definite-lived intangible assets      
Accrued royalties 1,600    
Definite-lived intangible assets      
Definite-lived intangibles      
Beginning balance - Definite-lived assets, Gross 526,228    
Additions 113,536    
Reclass from Indefinite Lived to Definite Lived 743    
Impairment 640,507    
Ending balance - Definite-lived assets, Gross   526,228  
Beginning balance - Accumulated amortization (273,903)    
Amortization (222,635)    
Foreign Currency Translation - Accumulated amortization (238)    
Ending balance - Accumulated amortization (496,776) (273,903)  
Finite-Lived Intangible Assets, Net 143,731    
Definite-lived intangible assets | Emflaza      
Definite-lived intangibles      
Beginning balance - Definite-lived assets, Gross 420,253    
Additions 107,164    
Impairment 527,417    
Ending balance - Definite-lived assets, Gross   420,253  
Beginning balance - Accumulated amortization (266,023)    
Amortization (212,595)    
Ending balance - Accumulated amortization (478,618) (266,023)  
Definite-lived intangible assets | Waylivra      
Definite-lived intangibles      
Beginning balance - Definite-lived assets, Gross 9,316    
Additions 533    
Reclass from Indefinite Lived to Definite Lived 369    
Impairment 10,218    
Ending balance - Definite-lived assets, Gross   9,316  
Beginning balance - Accumulated amortization (2,751)    
Amortization (1,080)    
Foreign Currency Translation - Accumulated amortization (134)    
Ending balance - Accumulated amortization (3,965) (2,751)  
Definite-lived intangible assets | Tegsedi      
Definite-lived intangibles      
Beginning balance - Definite-lived assets, Gross 7,109    
Additions 5,839    
Reclass from Indefinite Lived to Definite Lived 374    
Impairment 13,322    
Ending balance - Definite-lived assets, Gross   7,109  
Beginning balance - Accumulated amortization (1,709)    
Amortization (1,498)    
Foreign Currency Translation - Accumulated amortization (104)    
Ending balance - Accumulated amortization (3,311) (1,709)  
Definite-lived intangible assets | Upstaza      
Definite-lived intangibles      
Beginning balance - Definite-lived assets, Gross 89,550    
Impairment 89,550    
Ending balance - Definite-lived assets, Gross   89,550  
Beginning balance - Accumulated amortization (3,420)    
Amortization (7,462)    
Ending balance - Accumulated amortization $ (10,882) $ (3,420)