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You'll have to defeat Delirium the old-fashioned way - it should be much easier to not die if you have a way to gain invulnerability multiple times (for example, Starter Pack + Book of Shadows + 2x Algiz).
But yeah, it's basically useless for Delirium if you're not Lazarus.
It technically works on Delirium too, but its death animation is too slow (and it's the only boss like this).
If you need a reminder on the downside of Plan C, its first effect is to insta-kill everything in the room except the player. Then, 3 seconds later, it kills you.
That's why using it on Delirium isn't advised: because of the time it takes for it to die, you'll actually die before the boss.
Mega Satan's skull should be quicker, so it should work (as well as Hush second form and Ultra Greed, Greedier works too if you use it on its last phase).
Using it on the Boss Rush is a nonsense indeed, you'll only kill one wave with that item (then die). Unless you keep it for the last wave of course.