Simple example - Chebyshev polynomials. How many Csound users even understand that these will alias if they cross Nyquist?
So Csound does a lot badly. It's not quite unusable in a commercial setting, but the sound quality is a long way behind even basic VSTs - which means the steep learning curve and 1960s-style programming system don't justify the benefits.
Supercollider has similar issues. The control language is more interesting, but the synthesis and processing code are similarly unrefined.
I mean, I can put stuff into WordPress with SQL directly, but it's much nicer to do it with an interface.
Similarly, I can program a snare sound using a noise generation, an envelope, and a filter, but it's sometimes nice to grap a box and it a button even if I'm constrained by whatever filter and parameters are already in the box... because the interface will dictate a lot of how I use the tool, and that is a feature not a bug :D
Compare a CSound IDE to something like the Ableton Operator interface or even PureData as someone else mentioned. Very different (and both great for different approaches and people!). A lot of folks want flexibility in the sound by exploring an interface/instrument without having to come up with that interface/instrument themselves.
But there are some exceptions, e.g. Autechre are well known for using the similarly flexible MaxMSP. As Sean Booth said in an interview with Resident Advisor[0] when asked about new equipment:
"I just use MaxMSP now, because in Max I can generally build the thing I need, and if I don't know how to do that it'll generally be worthwhile learning. Intellectual capital or whatever. So rather than spend me money on equipment, I spend me money—as time—in learning how to build stuff."
Because there are a ton of alternatives to CSound.
I use Max/MSP. But you could also use PureData, SuperCollider, Chuck, JUCE, etc.