Horizon Therapeutics plc
2023
$27.8B
Why
Amgen acquired Horizon Therapeutics plc in October 2023 for approximately $27.8 billion in the largest acquisition in Amgen's history. The deal's strategic purpose was threefold: diversifying into rare diseases with high-pricing, durable commercial profiles; acquiring Tepezza's leadership position in thyroid eye disease, a condition affecting an estimated 200,000 patients in the U.S. With a treatment market estimated to ultimately exceed $3 billion; and adding Krystexxa's dominance in refractory gout a condition affecting approximately 100,000 patients annually who do not respond to standard urate-lowering therapy.
Impact
The Horizon medicines reshaped the revenue mix, adding roughly US$3.5 billion of annualised revenue in 2024 and about US$4.6 billion in fiscal 2025 across Tepezza, Krystexxa, Uplizna and the ultra-rare products. The cost was the balance sheet: debt outstanding was US$60.1 billion at the end of 2024 and US$54.6 billion at December 31, 2025 after US$6.0 billion of retirements, with US$2.8 billion of net interest expense in fiscal 2025. The FTC consent decree also imposed ongoing compliance obligations.
Outcome
Two years after closing, the Horizon assets are growing. Uplizna rose 73% in fiscal 2025 to US$655 million after approvals in IgG4-related disease and generalized myasthenia gravis, Krystexxa rose 13% to US$1.34 billion, and Tepezza rose 3% to US$1.90 billion. The ultra-rare group declined 5% as Ravicti met generic competition. Investor attention has shifted from the acquisition premium to the pace of deleveraging.