This game is an absolute blast to play with friends. It's kind of hard to give it a rating, but it is very easy for me to say that I cannot recommend this game enough to anyone who enjoys the drafting, puzzle solving, and theory crafting parts of The Binding of Isaac video game!
I play this any chance I get with my friends. A round can slow down a lot sometimes just due to bad draws, and some characters are wildly more powerful than others; which is why I would recommend using some house rules to keep the game going at a pace you like and to prevent situations where the strongest and weakest characters are in the same game.