What specifically are you referring to (regarding tooling)? Do you mean running it on Azure as a managed service that auto scales, programming tools/frameworks like LINQ, or client side GUI tools?
From an automation perspective not having a decent CLI for MSSQL to facilitate scripting makes it a pain from day one.
We use Database projects in Visual Studio, so all our schema, stored procedures, and other scripts are in version control. We can compile them (additional validation) into dacpac packages, and script updates and deployment to local instances and Azure with sqlpackage and sqlcmd.
That said, the code is in C# as well (and not .NET core, from what I saw), so they're pretty tied to Windows anyway, which is awkward since this is a macOS app.
What compels someone to write a net new application (from scratch with no legacy DB) that uses MSSQL?
In my book it's in front of only DB2 and Oracle on the "Will not use unless you're already using it, migration is impossible, and you're going to have to seriously pay me to deal with this" list.