Takeda Pharmaceutical has finally secured the backing of Shire’s Board of Directors for a £46 B (US$62.3 B) cash and stock takeover of the rare disease specialist, although concerns have been raised over both the size and rationale of the deal. While arguably not a natural strategic fit, the Shire takeover will increase Takeda’s footprint in the lucrative US market, where Shire has a strong presence, while strengthening its offerings in neuroscience and gastroenterology and adding a market-leading rare disease franchise and a robust late-stage pipeline. Takeda will be left with a hefty debt pile, however, and the task of integrating two rather different companies.