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Intangible assets and goodwill - Definite-lived Intangibles (Details) - USD ($)
$ in Thousands
 3 Months Ended
Mar. 31, 2024
Mar. 31, 2023
Dec. 31, 2023
Definite-lived intangible assets      
Milestone Payable $ 2,500 $ 32,500  
Accrued royalties 28,952   $ 74,111
Definite-lived intangibles      
Amortization (51,530) (39,415)  
Finite-Lived Intangible Assets, Net $ 94,274    
Weighted Average      
Definite-lived intangible assets      
Remaining amortization period 9 years 4 months 24 days    
Akcea | Waylivra      
Definite-lived intangible assets      
Royalty payments $ 1,700    
Akcea | Waylivra | Accounts payable and accrued expenses      
Definite-lived intangible assets      
Accrued royalties 1,600    
Akcea | Tegsedi      
Definite-lived intangible assets      
Royalty payments 800    
Akcea | Tegsedi | Accounts payable and accrued expenses      
Definite-lived intangible assets      
Accrued royalties 800    
Definite-lived intangible assets      
Definite-lived intangibles      
Beginning balance - Definite-lived assets, Gross 640,507    
Additions 2,450    
Foreign Currency Translation (566)    
Ending balance - Definite-lived assets, Gross 642,391    
Beginning balance - Accumulated amortization (496,776)    
Amortization (51,530) $ (39,400)  
Foreign Currency Translation - Accumulated amortization 189    
Ending balance - Accumulated amortization (548,117)    
Finite-Lived Intangible Assets, Net 94,274    
Definite-lived intangible assets | Emflaza      
Definite-lived intangibles      
Beginning balance - Definite-lived assets, Gross 527,417    
Ending balance - Definite-lived assets, Gross 527,417    
Beginning balance - Accumulated amortization (478,618)    
Amortization (48,799)    
Ending balance - Accumulated amortization (527,417)    
Definite-lived intangible assets | Waylivra      
Definite-lived intangibles      
Beginning balance - Definite-lived assets, Gross 10,218    
Additions 1,658    
Foreign Currency Translation (246)    
Ending balance - Definite-lived assets, Gross 11,630    
Beginning balance - Accumulated amortization (3,965)    
Amortization (366)    
Foreign Currency Translation - Accumulated amortization 106    
Ending balance - Accumulated amortization (4,225)    
Definite-lived intangible assets | Tegsedi      
Definite-lived intangibles      
Beginning balance - Definite-lived assets, Gross 13,322    
Additions 792    
Foreign Currency Translation (320)    
Ending balance - Definite-lived assets, Gross 13,794    
Beginning balance - Accumulated amortization (3,311)    
Amortization (499)    
Foreign Currency Translation - Accumulated amortization 83    
Ending balance - Accumulated amortization (3,727)    
Definite-lived intangible assets | Upstaza      
Definite-lived intangibles      
Beginning balance - Definite-lived assets, Gross 89,550    
Ending balance - Definite-lived assets, Gross 89,550    
Beginning balance - Accumulated amortization (10,882)    
Amortization (1,866)    
Ending balance - Accumulated amortization $ (12,748)