There are items like Scope and Jab which are designed for low universe runs (since they only work in 1/2 universes, they're relatively better when you have fewer universes.)
Item removal is... sort of here? "Recycle" lets you transform your broken daggers into shuffle items, and one of the characters in the full game can buy an item that lets you remove certain kinds of items from your deck. I might add more ways of removing items, though.