All of the updates and content expansions and so on and so forth have really made Isaac unmanageable in that regard. Throw in the fact that there are quite a few item drops that are objectively detrimental in basically every situation so that a not insignificant fraction of the item pool is just trash drops that nobody in their right mind would ever pick up, and it gets ridiculous quickly. Once you have enough unlocked that you’re regularly getting runs down into the lower sub-basements of hell, unless you’re an absolute guru the meta is literally just to meta. Know a couple of the game-breaking combinations off the top of your head and cross your fingers that you’ll run across all of the components.

This is in stark contrast to e.g. Dead Cells, which is why I’ve got such an immense respect for the latter. If you’re willing to adjust your play style slightly, every single drop in Dead Cells is a viable weapon that can be deadly in the right hands. You could be wielding a legendary golden abyssal trident, sure, but you can also just as well beat the shit out of all the boss monsters with a pair of frying pans tied together with some rope. It must have taken an immense amount of work to get all of that even vaguely balanced and ensure that there were no duds, wheras Isaac’s strategy seems to be more just throwing shit at the wall (probably literally…) to see what sticks, with a salting of deliberately adding things to troll the player for the lulz.