My particular use case is to annotate emails, spreadsheet, etc., and merge them as exhibits into a legal brief.
After annotation, the other programs can export the original or it export the annotation layers but it could not give you a PDF with both the original and the annotations merged into one layer. This was a deal breaker.
With Okular you can print the PDF with the annotations as a new PDF to make sure your annotations are always visible. With the other programs the annotations are on separate layers which can get hidden on purpose or by mistake.
I found no other free program that could flatten the layers.
Okular deserves to be better known.